Control Of Blood Pressure Levels Research Articles

Auditing the Cost of Treating Hypertension in a Tertiary Health Facility in Yobe State, North-Eastern Nigeria

BACKGROUND: Studies quantifying the financial burden of hypertension are lacking, despite the high prevalence of this disease among Nigerian adults, together with its huge associated costs. AIM: The aim of this study was to estimate the cost of hypertension treatment and blood pressure control among patients attending a tertiary health centre in Yobe, Nigeria METHODS: The study utilised a cross-sectional study design, using interviewer-administered questionnaire to collect information from the respondents. Data on the cost of medications and laboratory investigations were collected from the hospital’s billing unit, while other costs were based on self-reporting by the patients. Overall cost of blood pressure control as well as cost-effectiveness for the different drug combinations were calculated. RESULTS: Most of the respondents were unemployed (62.2%), and out of those who were employed, 43.9% earned below the Nigerian minimum wage of ₦18,000. About a third (36.62%) of the respondents had their blood pressures controlled. The overall average cost of treating hypertension per patient per month was ₦3,374.00; and was ₦3,474.00 for those who were employed, for whom it corresponded to 12% of their monthly income. The average cost of achieving one blood pressure was ₦9,082.14. Mono-therapy with thiazide diuretics was the most cost-effective treatment option. CONCLUSION: The cost of treating hypertension in this study was on the high side, with a sub-optimal level of blood pressure control. Considering the high rate of unemployment, as well as the low income among those who were employed, there is the need for government to subsidise hypertension treatment.

Hypertension and Mild Cognitive Impairment: State-of-the-Art Review.

Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). However, there is still limited direct evidence to support the approach, and particularly for the treatment of the very old and those with existing MCI. This review presents an overview of the current evidence for the relationship between MCI and hypertension, and of the potential pathophysiological mechanisms related to cognitive decline and incidence dementia in relation to aging. Although observational data are near consistent in showing an association between mid-life hypertension and MCI and/or dementia, the evidence in relation to hypertension in younger adults and the very old (age >80 years) is much more limited. Most of the commonly available antihypertensive agents appear to provide beneficial effects in reducing the risk dementia, but there is limited evidence to support such treatment in those with existing MCI. Further studies are needed to determine the optimal levels of BP control across different age groups, especially in adults with MCI, and which class(es) of antihypertensive agents and duration of treatment best preserve cognitive function in those at risk of, or with established, MCI.

Myocardial Remodeling Markers in Hypertensive and Overweight or Obese Patients

Pro-inflammatory and anti-inflammatory cytokines can be used as markers of the severity of the arterial hypertension (AH) and the risk of its complications. The objective: to analyze the significance of interleukin-10 (IL-10) and interleukin-1β (IL-1β) as markers of myocardial remodeling in patients with arterial hypertension (AH) and overweight or obesity. Materials and methods. 103 patients with AH (60 women and 43 men) took part in the study. The average age of the participants was 53.21±8.5 years, the average duration of AH – 8.2±6.3 years. The patients were divided into two groups according to the level of IL-10. The first group included 80 (78%) patients with AH and body mass index (BMI) ≥25 kg/m2 who had a normal level of IL-10 (up to 32 pg/ml), the second group included 23 (22%) individuals with increased anti-inflammatory cytokine. Also, the patients were divided into two groups according to cytokine levels. The first group included 74 (72%) patients with AH and overweight or obesity (the level of IL-1β was up to 11 pg/ml), the second group included 29 (28%) patients with an elevated level of IL-1β. All subjects underwent an anthropometric measurement, clinical and laboratory examination, and determination of the level of anti-inflammatory cytokine IL-10 and pro-inflammatory cytokine IL-1β by enzyme immunoassay method. Results. The results of pro-inflammatory and anti-inflammatory cytokine concentrations (IL-1β and IL-10, respectively) were different. It was found that the level of IL-10 does not depend on the age of patients and the duration of AH, but there is a direct relationship between the level of the anti-inflammatory cytokine and BMI (35.8±5.7 kg/m2 vs. 32.4±5.7 kg/m2; p<0.05) with fasting glycemia level (r=0.3; p<0.05). It is also indicated that patients AH and increased BMI have on average a significantly longer QT interval (0.40±0.07 s vs. 0.36±0.04 s; p<0.05). It was determined that 13% of patients with elevated anti-inflammatory cytokine levels had QT prolongation. In 39% of cases, an increase in the mass index of the myocardium of the left ventricle was found (twice more among women). A direct correlation between the level of homocysteine and pro-inflammatory (r=0.31; p<0.05) and anti-inflammatory cytokines (r=0.47; p<0.05) was determined. At the same time, patients with elevated levels of IL-1β had a direct correlation with left ventricular myocardial mass index (r=0.42; p<0.05) and average daily mean arterial pressure (r=0.85; p<0.005). Conclusions. The anti-inflammatory cytokine IL-10 has greater prognostic significance than the pro-inflammatory cytokine IL-1β. An increased level of IL-10 in patients with AH and BMI ≥25 kg/m2 may indicate an adaptive reaction of the organism’s immune response. A high level of IL-10 in this cohort of patients is associated with worse control of blood pressure levels and can be considered as a predictor of the development of cardiac arrhythmias.

Long-Term Follow-Up of Patients With Elevated Aldosterone-to-Renin Ratio but Negative Confirmatory Test: The Progression of Primary Aldosteronism Phenotypes.

About 10% of patients with arterial hypertension have a positive screening test for primary aldosteronism (PA) and 50% to 70% of them have a negative confirmatory test: the appropriate follow-up of these patients is currently unknown. We investigated the incidence of PA in patients with previous negative confirmatory testing, after at least a 2-year follow-up. One hundred eighty-four patients with a previously elevated aldosterone-to-renin ratio followed by a negative confirmatory test were recruited in 2 hypertension centers (Torino and Munich). We repeated the screening test for PA and, if positive, the confirmatory test (seated saline infusion test or captopril challenge test). Primary end point of the study was the incidence of newly diagnosed overt PA, as defined by a positive confirmatory test. After a mean follow-up of 5 years, 20% of patients developed overt PA. When subtype diagnosis was offered systematically, one-third of patients displayed unilateral PA. Patients who developed PA showed worsening of blood pressure control and a higher rate of cardiac organ damage, despite similar implementation of antihypertensive therapy, compared with patients without PA. A mild progression of autonomous aldosterone secretion was evident even in patients without confirmed PA but with relatively stable control of blood pressure levels over time. About one-fifth of patients with a negative confirmatory test develop overt PA over time. A clinical follow-up of patients with a negative confirmatory test is advisable, along with the repetition of PA investigation, primarily in patients with worsening of blood pressure control.

The association between blood pressure control and long-term cardiovascular outcomes in Hypertension coexistent with obstructive sleep apnea

PurposeThe goal of blood pressure (BP) control will be lower when hypertensive patients have comorbidities that can affect the risk of cardiovascular diseases. But, the goal of BP control for hypertensive patients coexistent with obstructive sleep apnea (OSA) is not discussed, which is a special population at high risk of cardiovascular diseases.Patients and methodsUsing data from a retrospective study(Urumqi Research on Sleep Apnea and Hypertension (UROSAH) study, we enrolled 3267 participants who were diagnosed with hypertension and performed polysomnography during 2011–2013 to explore the association between BP control and long-term major adverse cardiovascular and cerebrovascular event (MACCE). Outcomes of interest was the levels of BP control, MACCE, cardiac event and cerebrovascular event. Then we calculated the cumulative incidence of MACCE and performed Cox proportional hazards with stepwise models.Results379 of 3267 patients experienced MACCE during a median follow-up of 7.0 years. After full risk adjustment, BP control of 120-139/80-89mmHg was associated with the lowest risk of cerebrovascular event (HR: 0.53, 95%CI:0.35–0.82) rather than MACCE and cardiac event in the total cohort. The association did not change much in patients with OSA. When the SBP and DBP were discussed separately, the SBP control of 120-139mmHg or < 120mmHg was associated with the decreased incidence of MACCE and cerebrovascular event. When DBP control < 80 mm Hg, the risk of cerebrovascular event showed 54% decrease [(HR:0.46, 95%CI: 0.25–0.88)] in patients with hypertension and OSA.ConclusionIn this retrospective study, antihypertensive-drug-induced office and home BP control at 120-139/80-89mmHg showed possible beneficial effect on incident MACCE. However, current results need to be verified in future studies.

Differential Modulation of Markers of Oxidative Stress and DNA Damage in Arterial Hypertension.

Patients with arterial hypertension have an increased risk of developing tumors, particularly renal cell carcinoma. Arterial hypertension is linked to DNA damage via the generation of oxidative stress, in which an upregulated renin-angiotensin-aldosterone system plays a crucial role. The current study investigated surrogates of oxidative stress and DNA damage in a group of hypertensive patients (HypAll, n = 64) and subgroups of well (HypWell, n = 36) and poorly (HypPoor, n = 28) controlled hypertensive patients compared to healthy controls (n = 8). In addition, a longitudinal analysis was performed with some of the hypertensive patients. Markers for oxidative stress in plasma (SHp, D-ROM, and 3-nitrotyrosine) and urine (8-oxodG, 15-F2t-isoprostane, and malondialdehyde) and markers for DNA damage in lymphocytes (γ-H2AX and micronuclei) were measured. In HypAll, all markers of oxidative stress except malondialdehyde were increased compared to the controls. After adjustment for age, this association was maintained for the protein stress markers SHp and 3-nitrotyrosine. With regard to the markers for DNA damage, there was no difference between HypAll and the controls. Further, no significant differences became apparent in the levels of both oxidative stress and DNA damage between HypWell and HypPoor. Finally, a positive correlation between the development of blood pressure and oxidative stress was observed in the longitudinal study based on the changes in D-ROM and systolic blood pressure. In conclusion, we found increased oxidative stress in extensively treated hypertensive patients correlating with the level of blood-pressure control but no association with DNA damage.

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

BackgroundHypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India.MethodsThis was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant.ResultsWe included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82).ConclusionsHypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.

Analisis Faktor Yang Memengaruhi Kejadian Hipertensi Pada Lansia Di Poli Penyakit Dalam RSUD Dr.R.M.Djoelham Binjai

According to the American Heart Association or AHA, hypertension is a silent killer, with symptoms that can vary from individual to individual and are almost the same as symptoms of other diseases. Hypertension is a risk factor for various cardiovascular diseases and stroke. According to the AHA, hypertension is a disease that occurs due to an increase in systolic blood pressure&gt; 140 mmHg or diastolic blood pressure&gt; 90 mmHg.&#x0D; This type of research uses a descriptive analytic survey with a cross sectional design. The population in this study were all elderly (≥60 years) hypertensive patients at the Internal Medicine Polyclinic totaling 156 people, while the sample numbered 156 people by means of total sampling. Data analysis was performed using univariate, bivariate and multivariate analysis.&#x0D; Based on the results of the chi-square test it is known that the incidence of hypertension affects smoking, obesity, low-fiber diet, excessive salt consumption and lack of physical activity p = 0.000, meaning that there is an effect of smoking, obesity, low-fiber diet, excessive salt consumption and lack of physical activity on hypertension incident. From the results of multivariate analysis it is known that the most influential variable in this study is obesity with an OR value of 62,850.&#x0D; The conclusion in this study is that obesity is the dominant factor influencing the incidence of hypertension in the Internal Medicine Polyclinic at Dr.R.M.Djoelham Binjai Hospital. In order to reduce the prevalence of hypertension, it is hoped that the Patients of the Internal Medicine Polyclinic at Dr, R.M.Djoelham Binjai Hospital will apply hypertension management with a healthy lifestyle so that diabetics can have controlled blood pressure levels.

Blood Pressure Control in a Diverse Population of Hypertensive Patients With Heart Failure

Hypertensive patients with heart failure (HF), with reduced or preserved ejection fraction, belong to a vulnerable subset with high mortality risks. In HF patients, the current clinical guideline recommends attaining a systolic blood pressure (BP) <130mm Hg. However, levels of BP control and their correlates in this subgroup are not well understood. Our study aimed at establishing levels of BP control and its associated factors in a geographically, racially diverse population of hypertensive patients with HF. Our study involved 10,802 patients within a large health system in the Charlotte metropolitan area in 2019. We documented a high prevalence of systolic BP ≥130mm Hg, 48.1% (95% confidence interval 47.4% to 48.8%), and of BP ≥130/80mm Hg, 57.6% (57.0% to 58.3%). From a multivariate logistic regression model, systolic BP ≥130mm Hg was associated with race-ethnicity (p <0.0001), gender (p=0.0001), insurance (p <0.0001), attribution with a primary care physician (p=0.0001). Non-Hispanic Blacks (vs non-Hispanic Whites odds ratio [OR] 1.38, 1.28 to 1.48), women (OR 1.12, 1.06 to 1.19), and uninsured patients (vs privately insured OR 1.43, 1.20 to 1.72) had a higher risk of systolic BP ≥130mm Hg; patients with primary care physician attribution had a lower risk of systolic BP ≥130mm Hg (OR 0.87, 0.81 to 0.94). Similar results were found with the outcome BP ≥130/80mm Hg. Overall, further efforts are needed to optimize treatment in hypertensive patients with HF and improve health equity across patient communities.

Impact of Nonsurgical Periodontal Treatment on Blood Pressure: A Prospective Cohort Study.

Arterial hypertension and periodontitis are two of the most common diseases worldwide and recent evidence supports a causal relationship between them. Despite all antihypertensive strategies, an important number of patients are undiagnosed and a large number of the diagnosed fail to achieve optimal blood pressure (BP) measurements. Some studies point out that periodontal treatment could have positive effects on BP levels. The aim of this study is to determine if nonsurgical periodontal treatment can help BP level control in prehypertensive patients with periodontitis. Thirty-five patients were included in the study and received nonsurgical periodontal treatment according to necessity. Clinical data, periodontal data, and BP measurements were taken at baseline, periodontal re-evaluation visit (4-6 weeks after treatment), and 6-month follow-up. Periodontal treatment caused a statistically significant reduction (p < 0.05) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at re-evaluation visit of 4.7 (p = 0.016) and 3.4 mm Hg (p = 0.015), respectively. The effect was maintained at 6-month follow-up visit with a reduction in SBP and DBP of 5.2 (p = 0.007) and 3.7 (p = 0.003) mm Hg, respectively. Despite the limitations of this study, it suggests that nonsurgical periodontal treatment can be effective in lowering BP levels in patients with prehypertension and periodontitis. Moreover, it highlights the importance of dentists in prevention, detection, and control of this important cardiovascular risk factor.

Blood Pressure Control among Adults with Hypertension at a Tertiary Hospital in Ethiopia.

Uncontrolled hypertension is a leading modifiable risk factor for cardiovascular disease morbidity and mortality. Despite the availability of several effective blood pressure lowering drugs, hypertension control rates remain poor globally. This study aimed to define the level of blood pressure control and to determine the factors associated with poor hypertension control. A hospital-based cross-sectional study was conducted from January to March 2019 at Tikur Anbessa Specialized Hospital among randomly selected 369 patients with hypertension. Data were collected using a pre-tested structured questionnaire. Multivariate binary logistic regression was used to identify determinants of blood pressure control. The mean (SD) age of the study participants was 55.5 (13.2) years; 188 (50.9%) were males and 28 (7.6%) were active smokers. More than half of the patients (56.0%) were overweight or obese. The most commonly identified comorbidities were diabetes mellitus (48.0%), dyslipidemia (50.9%), and chronic kidney disease (56.1%). The mean (SD) systolic blood pressure was 140.6 (22) mmHg, and diastolic blood pressure was 85.8 (14) mmHg. About two-thirds of the patients (60.2%) had uncontrolled blood pressure. The factors associated with poor blood pressure control with an AOR (95% CI) were increasing age: 1.05 (1.00-1.11), increasing household income: 1.25 (1.04-1.49), being physically inactive: 7.64 (1.14-51.13), chronic kidney disease: 5.36 (1.14-5.16), and use of home blood pressure monitoring: 0.31 (0.102-0.94). The rate of blood pressure control in patients with hypertension was suboptimal. Age, household income, level of physical activity, chronic kidney disease, and use of home blood pressure monitoring were independent predictors of blood pressure control. It is important to optimize the treatment of hypertension in this high-risk group by implementing effective strategies.

Evaluation of Hypertension Patient Management During Family Medicine Trainee Education

Objective: Hypertension (HT) is a systemic disease manifested by high blood pressure and is a major health problem, common in the community and the cause of serious complications. Control of blood pressure levels is an essential step in reducing omit complications. The aim of the study is to evaluate the impact of face-to-face HT training on the HT knowledge and awareness of the family medicine resident doctors and to understand their needs.&#x0D; Materials and Methods: Our study was planned in a descriptive-cross-sectional research design. Just before and after the face-to-face training, participants were given a questionnaire developed by researchers based on two documents: the Turkish Hypertension Consensus Reports published in 2019, and the Hypertension Diagnosis and Treatment Guidelines published by the Turkish Endocrinology and Metabolism Society in 2022.&#x0D; Results: In our study, we observed the effect of face-to-face education on 15 sub-categories of HT as an intervention research model. In the post-training evaluation, 12 of the 15 sub-categories involved theoretical questions, and three were case-based evaluation questions. The goal was to answer 50% or more of the questions correctly, and it was observed that, after the training, in five of the fifteen sub-categories, this target was generally achieved.&#x0D; Conclusion: Face-to-face training is effective in increasing knowledge and awareness, and evaluation capacity, which are two important elements of HT administration in primary care. A detailed examination of 15 sub-categories related to HT revealed the categories that were better in terms of effect size. Our study also detailed the effects on sub-categories related to HT management (such as resistance to first-stage HT management), which reveal interesting and somewhat unexpected results.

A Clinical Study of Low Molecular Weight Heparin Sodium Injection Combined with Magnesium Sulfate Injection and Labetalol Tablets in the Treatment of Severe Pregnancy-Induced Hypertension

Objective: To investigate the clinical effect of low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension. Methods: A total of 48 patients with severe pregnancy-induced hypertension admitted from February 2021 to February 2023 were selected, and the patients were divided into two groups by simple sampling, with 24 cases in each group. Patients in the control group received labetalol orally and intravenous infusion of magnesium sulfate, whereas those in the observation group received subcutaneous injection of low molecular weight heparin sodium on the basis of the control group. The two groups of patients underwent 5 days of treatment, and the blood pressure control, vascular endothelial function, renal function, and blood coagulation were compared between the two groups. Results: Before treatment, there were no significant differences in blood pressure readings, endothelin-1 (ET-1) and nitric oxide (NO) levels, serum creatinine (SCr) and blood urea nitrogen (BUN) levels, and the four coagulation indices between the two groups (all P &gt; 0.05). After treatment, the blood pressure readings in the observation group were lower than those in the control group (P &lt; 0.05); ET-1 in the observation group was lower than that in the control group, and the NO level in the observation group was higher than that in the control group (P &lt; 0.05); compared with the control group, the observation group had lower SCr and BUN (P &lt; 0.05), longer prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT), and lower fibrinogen (Fib) level (P &lt; 0.05). Conclusion: Low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension can help control blood pressure levels, promote the recovery of vascular endothelial function and renal function, and effectively correct coagulation function.

CHARACTERISTICS OF THE HIGH BLOOD PRESSURE IN A TYPE 2 DIABETIC POPULATION IN THE AREA OF BLIDA (ALGERIA)

Objective: The association diabetes-high blood pressure (BP) is frequent. It increases the cardiovascular risk and accelerates the onset of degenerative complications of diabetes. The aim of the present study was to test the effect of the hypertension-diabetes association on the degenerative complications of diabetes and to determine the proportion and the factors associated with uncontrolled hypertension. Design and method: This was a cross-sectional study conducted among 2129 type 2 diabetic hypertensive patients aged 40 years or over, followed in the internal medicine department of hospital of Blida (Algeria), between February 2020 to November 2022. Results: The average age was 46 ± 6.6 years, with a female predominance (73.5%). Hypertension was present in 60.4% of normal weight patients, in 55.1% of overweight patients and 62.8% of obese patients with a significant difference (p = 0.03). Macroangiopathy was observed in 57% of patients with mainly ischemic heart disease (44%). It was significantly more frequent in patients with LDL-c greater than 1.3 g/l and hypoHDLemia less than 0.35 g/l. The proportion of uncontrolled hypertension (BP &gt; 140/90) was 55% including 13% of cases of severe hypertension (BP &gt; 180/110). Resistant hypertension was found in 21% of cases. This poor blood pressure control was correlated with insulin treatment (p = 0.05), insufficient physical activity (p = 0.03), treatment duration greater than 10 years (p = 0.01) and a number of tablets greater than 2 (p = 0.031). We did not find a significant difference between the level of BP control and the seniority of diabetes, the body mass index, the presence of degenerative complications, the intellectual and socioeconomic level. The analytical study showed no positive association between the onset of hypertension and the following factors: the HbA1c level and the duration of diabetes progression. We found a strong correlation between the degenerative complications of diabetes and the presence of hypertension: retinopathy (p = 0.05), neuropathy (p = 0.02), nephropathy (p = 0.001), coronary artery disease (p = 0.001), cerebrovascular accidents (p = 0.01). Conclusions: Our study highlights the positive effect of hypertension on the degenerative complications of diabetes. Optimal control of blood pressure figures is imperative to limit the development of these complications and improve life expectancy.

THE IMPACT OF OBESITY ON THE CONTROL OF TREATED HYPERTENSIVE PATIENTS

Objective: Obesity is as a risk factor for hypertension, but there are few studies evaluating its impact on the response to antihypertensive drug and on the control of hypertensive patients. The aim of our study was to determine the effect of obesity on the control of treated hypertension. Design and method: We analyzed recordings of ambulatory blood pressure measurement (ABPM) in 84 treated hypertensive patients aged &gt; 18 years, in the cardiology department of Mohamed Taher Maamouri University hospital in Nabeul. Patients were stratified into two groups: obese (Body Mass Index (BMI) &gt;30 kg/m2) and non-obese. Hypertension control is defined by 24-hour ambulatory blood pressure (BP) = &lt; 130/80 mmHg, daytime = &lt; 135/85 mmHg and nighttime = &lt; 120/70 mmHg. The comparisons of percentages were carried out by the Chi-square test. Results: Our Population was composed of 33 obese and 51 non-obese patients. The mean age of our population was 59.37±13.1 years. BMI in obese was significantly higher than in non-obese (34.47±5.4 versus 25.36±2.5; p&lt;0.001). The prevalence of uncontrolled patients was significantly higher in obese patients detected in 24-hour ABPM (75.8% versus 51%; p = 0.039), in daytime ABPM (69.7% versus 41.2%; p = 0.014) and in night-time ABPM (90.9% versus 68.6%; p = 0.018) than in normal weight patients. Conclusions: Prevalence of uncontrolled hypertension was higher with higher BMI values. The level of blood pressure control in our sample remains relatively insufficient. To achieve a better control of hypertension, we must insist on therapeutic compliance and on the correction of risk factors, particularly obesity, which is significantly associated with an increase in BP.

ELEVATED PLATELET REACTIVITY IN PATIENTS WITH UNCONTROLLED HYPERTENSION: THE EFFECT OF CHA2DS2-VASC SCORE

Objective: Hypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis. Purpose: The aim of this study was to evaluate multiple platelet activation pathways in hypertensive patients with different level of blood pressure control and cardiovascular risk factors. Design and method: Thirty nine uncontrolled (office SBP &gt; 140 mmHg and ambulatory daytime SBP &gt;135 mmHg, 27 males, aged 58 ± 9 years) and 32 well controlled (office SBP &lt; 140 mmHg and ambulatory daytime SBP &lt; 135 mmHg, 21 males, aged 58 ± 8 years) essential hypertensive patients were included in the study. Twenty four healthy individuals (12 males, aged 53 ± 10 years) were served as control group. Blood samples were obtained before and 48 hours after the procedure and platelet aggregation was tested in platelet rich plasma after activation with arachidonic acid (AA), adenosine diphosphate ADP), collagen (Col), epinephrine (Epi) and ristocetin (Risto), by using AggRAM Platelet Aggregation Analyzer. Results: Hypertensive patients showed elevated platelet reactivity in all platelet activation pathways compared to normotensive group (AA: 88.8 ± 6.8% versus 79.5 ± 7.3%, ADP: 86.8±9.1% versus 71.5±7.7%, Col: 86.5 ± 5.7% versus 73.9 ± 6.7%, Epi: 92.6±5.4% versus 80.5 ± 5.7%, Risto: 93.8 ± 6.8% versus 79.9 ± 6.3%, p &lt;0.05 for all). Col, Epi and Risto platelet activation pathway showed a statistically significant increase in patients with uncontrolled hypertension compared to the group with well controlled hypertension (AA: 88.8 ± 6.1% versus 89.1 ± 4.1%, ADP: 89.8 ± 4.1% versus 87.5±4.7%, Col: 87.5±4.7% versus 81.9 ± 6.7%, Epi: 93.6 ± 4.4% versus 80.1 ± 5.7%, Risto: 94.8 ± 3.8% versus 80.9 ± 4.3%,). Notably, strong correlations were found between the Col platelet pathway activation and Risto platelet pathway activation and CHA2DS2-VASc score (r = 0.57, p &lt;0.001 and r = 0.61, p &lt;0.001, respectively) in hypertensive patients. Conclusions: Patients with uncontrolled hypertension showed elevated platelet reactivity. Patients with high CHA2DS2-VASc even without atrial fibrillation carry also a higher risk of thrombosis as indicated by the increased platelet aggregation under certain pathways of activation.

Prevalence of pharmacological control of arterial hypertension by ambulatory blood pressure measurement (ABPM) findings

Introduction: Arterial hypertension (AHT) is one of the most prevalent chronic non-transmittable diseases and the main cause of cardiovascular death worldwide (World Health Organization, 2021). Adequate control of blood pressure levels is the best therapeutic measure to manage and prevent hypertension-related complications. In the Dominican Republic, there is insufficient and unreliable data related to pharmacological control through ambulatory blood pressure measurement (ABPM). Methods: Cross-sectional and retrospective study, in which the results of 380 patients, who underwent an ABPM, were analyzed to determine if their blood pressure levels were within therapeutic control. The study was conducted between March 2022 and May 2022. The diagnostic criteria to determine blood pressure control were used from the guidelines of the Specialized Diagnostic Center (CEDISA), and included being older than 18 and having a study duration longer than 18 hours. Likewise, we excluded pregnant patients, patients diagnosed with heart failure, or patients taking triple antihypertensive therapy. For the data summary, we used mean and standard deviation. For statistical testing, we performed a Shapiro-Wilk normality test, and a two-tailed Student's t-test was used to assess the mean difference for which a value of p&lt;0.05 was chosen to demonstrate significance. We performed a Bonferroni correction to adjust the significance value using the mean blood pressure in the repeated measures for the t-test, which reduced the significance from 0.05 to 0.016. Results: The point prevalence of adequate pharmacological control was 44.2% (95% CI 39.21% to 49.19%). The mean systolic blood pressure of controlled patients was 117.8 (±7.5), while that of un-controlled patients was 140.8 (±14.5). Between controlled and uncontrolled patients, the drugs most frequently used for managing hypertension were angiotensin II, receptor antagonists. There is a statistically significant difference between the mean 24-hour and daytime systolic blood pressure between males and females (p. 0.0016 and p. 0.0007, respectively) and 24-hour, daytime, and nighttime systolic blood pressure between controlled and uncontrolled patients (p. 0.000, p. 0.000, p 0.000, respectively) Discussion: The prevalence of adequate pharmacological control in patients suffering from arterial hypertension encompasses 168 patients of the 380 studied, so it is evident that the remaining 212 patients, even when diagnosed, have not managed to obtain controlled blood pressure levels. The study was limited by not being able to investigate the treatment specifications and other risk factors. Regardless of these issues, the study obtained the desired sample size; therefore, it can establish the study’s reported AHT control prevalence as a direct measure of hypertensive patients in the Dominican Republic not being adequately controlled.

The Cost of Uncontrolled Blood Pressure in Australian General Practice: A Modelling Study Using Electronic Health Records (MedicineInsight).

Hypertension is the most common condition seen in Australian general practice. Despite hypertension being amenable to lifestyle modifications and pharmacological treatment, only around half of these patients have controlled blood pressure levels (< 140/90 mmHg), placing them at an increased risk of cardiovascular disease. We aimed to estimate the health and acute hospitalisation costs of uncontrolled hypertension among patients attending general practice. We used population data and electronic health records from 634,000 patients aged 45-74 years who regularly attended an Australian general practice between 2016 and 2018 (MedicineInsight database). An existing worksheet-based costing model was adapted to calculate the potential cost savings for acute hospitalisation of primary cardiovascular disease events by reducing the risk of a cardiovascular event over the next 5 years through improved systolic blood pressure control. The model estimated the number of expected cardiovascular disease events and associated acute hospital costs under current levels of systolic blood pressure and compared this estimate with the expected number of cardiovascular disease events and costs under different levels of systolic blood pressure control. The model estimated that across all Australians aged 45-74 years who visit their general practitioner (n = 8.67 million), 261,858 cardiovascular disease events can be expected over the next 5 years at current systolic blood pressure levels (mean 137.8 mmHg, standard deviation = 12.3 mmHg), with a cost of AUD$1813 million (in 2019-20). By reducing the systolic blood pressure of all patients with a systolic blood pressure greater than 139 mmHg to 139 mmHg, 25,845 cardiovascular disease events could be avoided with an associated reduction in acute hospital costs of AUD$179 million. If systolic blood pressure is lowered further to 129 mmHg for all those with systolic blood pressure greater than 129 mmHg, 56,169 cardiovascular disease events could be avoided with potential cost savings of AUD$389 million. Sensitivity analyses indicate that potential cost savings range from AUD$46 million to AUD$1406 million and AUD$117 million to AUD$2009 million for the two scenarios, respectively. Cost savings by practice range from AUD$16,479 for small practices to AUD$82,493 for large practices. The aggregate cost effects of poor blood pressure control in primary care are high, but cost implications at the individual practice level are modest. The potential cost savings improve the potential to design cost-effective interventions, but such interventions may be best targeted at a population level rather than at individual practices.

PS-C19-11: ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE THERAPY AND BLOOD PRESSURE TARGETS ACHIEVING AMONG HYPERTENSIVE PATIENTS IN THE REPUBLIC OF KAZAKHSTAN

Introduction: Arterial hypertension is one of most prevalent cardiovascular diseases and leading factor of mortality and morbidity due to higher cardiovascular risk. To prevent cardiovascular events: myocardial infarction, stroke, heart failure it is crucial to manage hypertensive patients carefully and to achieve blood pressure targets. The one of leading causes of not achieving control of blood pressure levels is low adherence to therapy. Objective: The objective of this investigation is to assess the level of adherence to antihypertensive therapy and blood pressure targets achieving. Methods: A prospective cross-sectional study was conducted from August 2021 to November 2021 in four regions of Kazakhstan, included 1805 adults of both sexes (1073 women (59.40%) and 732 men (40.60%)) of mean age 39 years. Special survey, including assessment of current antihypertensive therapy, blood pressure and heart rate measurement were performed. Statistical test was performed by the StatTech 2.6.1 (Russia, 2020), IBM SPSS statistics version 28.0, Epi Info, version 7. Results: The prevalence of arterial hypertension in the population was 37.06%. Of the 658 participants with hypertension, 333 (40.51%) were aware of their diagnosis and 227 (68.17%) of them were taking antihypertensive medications. 33.5% were on monotherapy; 36.1%, 17.6%, and 3% were taking 2, 3, and 4 classes of antihypertensive drugs, respectively. 113 (49.78%) had a blood pressure lower or equal to 140/90 mm Hg, and only 33 (14.54%) lower or equal to 130/80 mm Hg. Among participants on monotherapy, 42% had blood pressure levels higher or equal to 140/90 mm Hg. Of all patients on therapy, only 152 (45.6%) were taking drugs regularly. A strong relationship was found between adherence to therapy and age (OR 1.049, 95% CI 1.031, 1.066, p &lt; 0.001): adherence to therapy was higher in older patients. It should also be noted that of the total number of participants on antihypertensive therapy, 95 (41.9%) were taking acetylsalicylic acid, of which only 16 (16.8%) had a history of myocardial infarction or stroke. Conclusion: To conclude, the level of adherence to therapy was 45.6%, more than half of the patients were not adherent to current antihypertensive therapy. When using the lower BP target of &lt; 130/80 mm Hg as the definition of control, which more accurately reflects current guidelines the proportion controlled was 14.54%. It could be related to several different causes: low levels of adherence, little knowledge of healthcare specialists about target blood pressure levels and little knowledge of population about importance of control blood pressure. In conclusion, the study confirms the importance and relevance of arterial hypertension as socially significant disease.

Status of Hypertension Control in Urban Slums of Central India: A community Health Worker-Based Two-Year Follow-Up.

Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.