Strategies For Management Of Hypertension Research Articles

Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities.

Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus. To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.

Impact of educational intervention on hypertension management by primary care physician: A randomized control trial

ObjectiveThe current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. MethodsThis randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. ResultsA total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. ConclusionAfter the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. InnovationThe study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

A Randomized Controlled Trial to Assess the Effectiveness of Warm Foot Soak Therapy on Reduction of Blood Pressure among Hypertensive Patients

Introduction : Hypertension is known as the “silent killer” because of its uncertain symptom. Therefore, early detection efforts are needed such as regular blood pressure check and effective management. Both Pharmacological and Non-pharmacological management strategies for hypertension. This study aimed to determine the effectiveness of one of the non-pharmacological management : “warm water foot soak therapy” in reduction of blood pressure among hypertensive patients. Method : Experimental study design - Randomized Controlled Trial was conducted among 60 hypertensive patients using convenient sampling technique. Participants were randomly and equally allocated into Experimental and Control group with the help of computer generated randomization list. Sequentially Numbered Opaque Sealed Envelope (SNOSE) were used for allocation concealment. Experimental group received “Warm foot soak therapy” of both feet for 10-15 cm above ankle in warm water of temperature 37-40 degree Celsius for 15 minutes, once a day for 3 consecutive days. Before and after intervention blood pressure assessment were taken in both groups. Data were analyzed using SPSS ver. 27 Result : Homogenity of socio-demographic, clinical and pre-intervention blood pressure among both groups were statistically established using chi-square test (p> 0.05). Paired t test concluded that, warm foot soak therapy were having statistically significant effect on blood pressure ( p < 0.05) and there was a significant reduction in blood pressure among hypertensive patients (p=0.01). The study also discovered that there is no significant association between selected sociodemographic & clinical variables with pre-interventional change in blood pressure except for the dietary pattern (Veg) in both groups & presence of comorbidity (DM) in experimental group among hypertensive patients at level of significance 0.05. Conclusion : The study demonstrated that warm foot soak therapy have an effect on reduction of blood pressure among hypertensive patients.

Current insights and future perspectives of flavonoids: A promising antihypertensive approach.

Hypertension, or high blood pressure (BP), is a complex disease influenced by various risk factors. It is characterized by persistent elevation of BP levels, typically exceeding 140/90 mmHg. Endothelial dysfunction and reduced nitric oxide (NO) bioavailability play crucial roles in hypertension development. L-NG-nitro arginine methyl ester (L-NAME), an analog of L-arginine, inhibits endothelial NO synthase (eNOS) enzymes, leading to decreased NO production and increased BP. Animal models exposed to L-NAME manifest hypertension, making it a useful design for studying the hypertension condition. Natural products have gained interest as alternative approaches for managing hypertension. Flavonoids, abundant in fruits, vegetables, and other plant sources, have potential cardiovascular benefits, including antihypertensive effects. Flavonoids have been extensively studied in cell cultures, animal models, and, to lesser extent, in human trials to evaluate their effectiveness against L-NAME-induced hypertension. This comprehensive review summarizes the antihypertensive activity of specific flavonoids, including quercetin, luteolin, rutin, troxerutin, apigenin, and chrysin, in L-NAME-induced hypertension models. Flavonoids possess antioxidant properties that mitigate oxidative stress, a major contributor to endothelial dysfunction and hypertension. They enhance endothelial function by promoting NO bioavailability, vasodilation, and the preservation of vascular homeostasis. Flavonoids also modulate vasoactive factors involved in BP regulation, such as angiotensin-converting enzyme (ACE) and endothelin-1. Moreover, they exhibit anti-inflammatory effects, attenuating inflammation-mediated hypertension. This review provides compelling evidence for the antihypertensive potential of flavonoids against L-NAME-induced hypertension. Their multifaceted mechanisms of action suggest their ability to target multiple pathways involved in hypertension development. Nonetheless, the reviewed studies contribute to the evidence supporting the useful of flavonoids for hypertension prevention and treatment. In conclusion, flavonoids represent a promising class of natural compounds for combating hypertension. This comprehensive review serves as a valuable resource summarizing the current knowledge on the antihypertensive effects of specific flavonoids, facilitating further investigation and guiding the development of novel therapeutic strategies for hypertension management.

Association between sleep quality and blood pressure control among hypertensive patients at a rural tertiary hospital in Southern Nigeria: a cross-sectional study

ObjectivesRestorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between...

Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: ASimulation Study.

Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults. The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200. As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.

Sex differences in cardiovascular risk factors and quality of life among individuals with hypertension in Korea from 2013 to 2018: A cross-sectional cohort study.

As its prevalence increases and its association with cardiovascular disease and mortality is established, there is a need to improve prevention and management strategies for hypertension. Therefore, we aimed to compare differences in cardiovascular health status between men and women with hypertension defined by systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, and/or treatment with antihypertensive drugs. The association between cardiovascular health status and health-related quality of life was also evaluated. Additionally, a secondary analysis was performed on the cross-sectional data from 7306 adults with hypertension, ≥40 years of age between 2013 and 2018. Of this sample, 51.2% of patients were women from the Korean National Health and Nutrition Examination Survey. The seven Cardiovascular Health Metrics were used to quantify cardiovascular health status and the 5-dimensional European Quality of Life Questionnaire (EQ-5D) was used to evaluate health-related quality of life. A higher proportion of men than that of women was observed in the poor cardiovascular health score group [total score 0-7], with a higher proportion of women in the intermediate group [total score 8-10] and ideal group [total 11-14] (p<0.0001). The proportion of women in the EQ-5D index was higher than that of men in the poor and intermediate groups (p<0.0001), with no difference in the proportion of men and women in the ideal group (p = 0.1452). Furthermore, specific cardiovascular risk factors were different between men and women: women had lower physical activity level and higher prevalence of high cholesterol (≥200 mg/dl), and men had higher body mass indices and worse diet management. These findings indicate that prevention and management strategies for hypertension and cardiovascular health might need to differ for men and women to improve outcomes.

An Exploration of Dietary Strategies for Hypertension Management: A Narrative Review.

This review aims to clarify the influence of various nutritional approaches in the management of hypertension.An extensive search of databases, namely, PubMed, Cochrane Library, Scopus, and Web of Science, was performed, covering the period from January 2012 to October 2023. We used keywords, such as "hypertension,""nutrition,""nutritional management,""nutrient intake,""dietary strategies,""DASH diet,""Mediterranean diet,"and related terms.Hypertension, a grave global health concern, affects more than one billion people worldwide. Lifestyle modifications, including nutritional strategies, are important in non-pharmacological interventions. Dietary patterns, such as the DASH (DietaryApproaches to Stop Hypertension) and Mediterranean diets, which emphasize fruit and vegetable consumption, have demonstrated efficacy in reducing blood pressure. Certain nutrients, such as potassium, calcium, and magnesium, have significant effects on blood pressure. The mechanisms underlying these dietary strategies include vasodilation, improvement in endothelial function, regulation of sodium balance, and mitigation of oxidative stress. However, successful implementation of these strategies can be hindered by various factors, such as adherence challenges, socioeconomic disparities, and cultural preferences. In conclusion, robust evidence supports the effectiveness of nutritional strategies in the management of hypertension. DASH and Mediterranean diets, along with an increased intake of specific nutrients, contribute to blood pressure reduction. Hence, comprehensive lifestyle modifications, with a focus on nutritional changes, are recommended as primary or complementary treatments for hypertension. Addressing the identified barriers could enhance the efficacy and use of these dietary approaches in clinical practice.

Comparing cardiovascular outcomes and costs of perindopril-, enalapril- or losartan-based antihypertensive regimens in South Africa: real-world medical claims database analysis

Abstract Background Effective strategies for hypertension management are essential to reduce associated morbidity and mortality in sub-Saharan Africa, where blood pressure control rates are alarmingly low. Renin-angiotensin-aldosterone system (RAAS) inhibitors are recommended as first-line treatment; however, differences in class or molecule-specific effects have not been conclusively demonstrated. Purpose This real-world study analysed medical insurance claims data to assess clinical and cost outcomes of antihypertensive therapy based on the three most commonly prescribed RAAS inhibitors in South Africa: perindopril, losartan and enalapril. Methods Patients on standard doses of perindopril, enalapril or losartan (alone or in combination with other agents) for ≥12 months prior to January 2015 were identified from a large, South African private health insurance database. Anonymised patient-level claims over the next 5 years (January 2015 to December 2019) were analysed in patients with ≥80% adherence. The primary outcome was the risk-adjusted rate of the composite of myocardial infarction (MI), ischaemic heart disease (IHD), heart failure (HF) or stroke. The key secondary clinical outcome was the risk-adjusted all-cause mortality rate; risk-adjusted costs per life per month (PLPM) in South African Rands (ZAR) were also assessed. Results In total, 63,489 patients who received perindopril (n=32,857), losartan (n=16,693) or enalapril (n=13,939) were included. Within the 5-year study period, the risk-adjusted rate of ≥1 claim for MI, IHD, HF or stroke (primary outcome) was significantly lower with perindopril than losartan (205 vs 221 per 1000 patients; P&amp;lt;0.0001) or enalapril (205 vs 223 per 1000 patients; P&amp;lt;0.0001). The risk-adjusted all-cause mortality rate was also significantly lower with perindopril than enalapril (100 vs 139 deaths per 1000 patients; P=0.007), but similar to that with losartan (100 vs 94 deaths per 1000 patients; P=0.650). Perindopril was also associated with significantly lower overall risk-adjusted costs than the other agents, with mean (95% confidence interval) costs PLPM of ZAR 1342 (87–8973) for perindopril, ZAR 1466 (104–9365) for losartan (P=0.0044) and ZAR 1540 (77–10,546) for enalapril (P=0.0003). Conclusion In this real-world analysis of South African individuals with hypertension, perindopril-based regimens were associated with a lower rate of cardiovascular events (MI, IHD, HF and stroke) over 5 years than enalapril- or losartan-based regimens. Perindopril also provided considerably greater cost-saving benefits, both statistically and socioeconomically, compared with the other RAAS inhibitor agents. Although these observations need to be confirmed in a broader South African population, including those treated in the public health sector, they may have significant implications for the choice of antihypertensive therapy.Time to outcome event over 5 yearsRisk-adjusted cost in South African Rand

Qualitative Study on Knowledge of Non-Pharmacological Interventions as Management Strategies for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State

Recent World Health Organization records show that hypertension is more common in Africa than in other parts of the world, and remains a major common risk factor for cardiovascular diseases, stroke, renal diseases, and death. However, little is known about hypertension management strategies among people in rural areas. Therefore, this phenomenological study aimed to investigate knowledge of hypertension management strategies among middle-aged adults in rural areas of Anambra state. Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). The data were analysed thematically. Results showed that the participants were all aware of hypertension but lacked in-depth knowledge of disease management strategies. Most of the participants did not believe that engaging in regular physical exercise/activity, and other factors like reduction in salt and alcohol intake could help in controlling high blood pressure. Social workers who are also social service providers are needed to raise awareness among middle-aged people in rural areas about hypertension management strategies. This can be done through the provision of social services like education, health services, and transport services, as this will go a long way in helping rural dwellers gain more knowledge of hypertension management strategies. With the provision of health services, the rural population will not only know management strategies for hypertension but will also be able to check their blood pressure regularly, while transport services will make it possible for the rural population who do not have health centres in their community and means of transporting themselves to the neighbouring community for treatment to do so. Future research should focus on the importance of welfare/home visits as an avenue for awareness creation on hypertension management strategies, as this will be an avenue for the provision of better social services for people in rural areas and an improvement in social service research.

Effect Of Mindfulness Based Cognitive Therapy (MBCT) on Anxiety and Blood Pressure for Hypertension: A scoping review

Hypertension, a prevalent and chronic medical condition, is often associated with elevated anxiety levels, contributing to its progression and complications. Mindfulness-Based Cognitive Therapy (MBCT) has emerged as a potential intervention to address both anxiety and hypertension. This scoping review aims to explore the existing literature on the effect of MBCT on anxiety and blood pressure in individuals with hypertension. Methods: A comprehensive search was conducted across electronic database, including Garuda, PubMed, Web of Science (WOS), and Science, for relevant articles published between 2013 to 2023. The searching process utilized PCC approach (Population: adult with hypertension; concept (C): mindfulness based cognitive therapy (MBCT), anxiety, high blood pressure, hypertension, cardiovascular disease; context (C): clinical and community settings). Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was employed as guideline to the screening process of articles in this study. A total of eight articles were evaluated their quality using The Joanna Briggs Institute Checklist. Some characteristics of mindfulness were identified: MBCT general, MBCT for perinatal depression (MBCT-PD), MBCT for anxiety (MBCT-A), and telephone delivered MBCT (MBCT-T). In general, the timeframe for conducting MBCT is eight weeks, with each session lasting 2 to 2.5 hours. MBCT demonstrates promise as an adjunctive intervention for managing anxiety and blood pressure in individuals with hypertension. While preliminary evidence suggests its potential benefits, further research is needed to establish its efficacy and refine its application in clinical practice. Integrating MBCT into comprehensive hypertension management strategies may offer a multifaceted approach to improving the well-being of individuals with hypertension.

GeogRaphic and socioecoNomic Distribution of real-world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India.

One-fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti-hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the "true BP control rate" should be performed using both clinic BP measurement and out-of-office BP measurement as the latter shows better prognosis for patients' hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan-India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.

Association of TyG index with prehypertension or hypertension: a retrospective study in Japanese normoglycemia subjects.

The objective of our study was to investigate the potential association between the triglyceride and glucose (TyG) index and the occurrence of prehypertension or hypertension in a cohort of normoglycemic Japanese subjects. The NAGALA physical examination program was conducted in 1994 at Murakami Memorial Hospital in Gifu City, Japan. For our retrospective study, we selected 15,450 participants who had taken part in this program. Our aim was to explore the potential link between the TyG index, a surrogate marker for insulin resistance, and the presence of prehypertension (pre-HTN) or hypertension (HTN). Our analysis included adjustments for clinical demographic attributes and serum biomarkers. Logistic regression was employed to assess the relationship between the TyG index and the likelihood of pre-HTN or HTN. A total of 15,450 study subjects were included in our analysis. Notably, the prevalence of both pre-HTN and HTN displayed an ascending trend with increasing quartiles of the TyG index. In our comprehensive multivariable logistic regression analysis, when evaluating TyG as a continuous variable, the adjusted odds ratio (OR) for pre-HTN was OR 1.31 [95% CI 1.11-1.56], while for HTN, it was OR 1.76 [95% CI 1.24-2.5] within the fully adjusted model (model 3). When TyG was stratified into quartiles within model 3, the adjusted ORs for pre-HTN were OR 1.16 [95% CI 1.02-1.31], OR 1.22 [95% CI 1.06-1.41], and OR 1.31 [95% CI 1.08-1.59], respectively, using quartile 1 as the reference. The adjusted ORs for HTN in quartiles 2, 3, and 4 were OR 1.22 [95% CI 0.89-1.66], OR 1.4 [95% CI 1.02-1.91], and OR 1.48 [95% CI 1.02-2.15], respectively, within the same model and analysis, with quartile 1 as the reference. Subgroup analysis indicated that the TyG index exhibited a significant positive correlation with the risk of hypertension or prehypertension, except in the subgroup aged ≥65 years. Our study highlights a robust correlation between the TyG index and the likelihood of pre-HTN or HTN in normoglycemic Japanese subjects. This underscores the potential clinical relevance of the TyG index in refining early hypertension management strategies. Nonetheless, the validation of these findings necessitates larger studies with extended follow-up periods.

Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device.

Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.

Abstract P348: Utilizing A Whatsapp Community To Enhance Hypertension Control And Address Misconceptions Among Patients With High Blood Pressure

A prospective intervention study was conducted, involving patients diagnosed with hypertension and exhibiting misconceptions regarding the condition. The study explored the impact of a WhatsApp community in promoting knowledge exchange, peer support, and adherence to hypertension management strategies. A total of 3000 patients were enrolled in the study, all of whom had been diagnosed with high blood pressure and displayed misconceptions surrounding hypertension. The WhatsApp community provided a platform for these patients to interact, share experiences, and receive guidance from healthcare professionals. The community facilitated the exchange of accurate information regarding hypertension, its causes, risk factors, and effective management strategies. Among the population, 30% were below 40 years of age and predominantly male (70%). About 18% were not on active treatment and a further 12% had switched themselves onto alternative medicines for fear of prescription medicines. Through active participation in the WhatsApp community, patients gained a deeper understanding of hypertension (formative assessment through quizzes), dispelled misconceptions (direct question and answer sessions), and received valuable support from peers facing similar challenges. This real-time communication fostered a sense of empowerment and accountability among the patients. These findings highlight the potential of utilizing technology-based platforms, such as WhatsApp communities, as effective tools for improving hypertension control and addressing misconceptions among patients. Implementing similar interventions in healthcare settings can lead to enhanced patient education, improved adherence, and ultimately better health outcomes for individuals with hypertension.

Renin‐angiotensin-aldosterone system inhibitors and mortality risk in elderly patients with atrial fibrillation. Insights from the nationwide START registry

BackgroundArterial hypertension is the most common cardiovascular comorbidity in atrial fibrillation (AF). Few studies investigated management strategies of hypertension in AF. Materials and methodsWe included 5769 AF patients on oral anticoagulants from the nationwide ongoing Italian START registry. We investigated the prescription of antihypertensive drugs and mortality risk. Subgroup analyses according to sex and major cardiovascular comorbidities were performed. ResultsMean age was 80.8 years, 46.1% were women; 80.3% of patients were hypertensive. Furosemide (30.1%) was the most frequent diuretic followed by hydrochlorothiazide (15.4%) and potassium canrenoate (7.9%). 61.1% received β-blockers: 34.2% bisoprolol, 6.2% atenolol. Additionally, 36.9% were on angiotensin converting enzyme inhibitors (ACE-I): ramipril (20.9%), enalapril (5.3%) and perindopril (2.8%); 31.7% were on angiotensin receptors blockers (ARBs): valsartan (7.6%) and irbesartan (6.4%). Amlodipine and lercanidipine were prescribed in 14.0% and 2.3%, respectively. ACE-I (p < 0.001), α-blockers (p = 0.020) and Dihydropyridines calcium channel blockers (p = 0.004) were more common in men, while ARBs (p = 0.008), thiazide diuretics (p < 0.001) and β-blockers (p < 0.001) in women.During 22.61 ± 17.1 months, 512 patients died. Multivariable Cox regression analysis showed that ACE-I (Hazard ratio [HR] 0.758, 95% Confidence Interval [95%CI] 0.612–0.940, p = 0.012) and ARBs (HR 0.623, 95%CI 0.487–0.796, p < 0.001) inversely associated with mortality. ACE-I/ARBs inversely associated with mortality in both sexes and in patients with diabetes. This associastion was evident for ACE-I in patients with previous cardiovascular disease, and for ARBs in HF. ConclusionA lower mortality risk was found in AF patients on ACE-I/ARBs. Different prescription patterns of antihypertensive drugs between men and women do exist.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine.

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Abstract P2148: Beyond Traditional Pharmacology: A Critical Appraisal Of Enhanced External Counterpulsation (EECP) As A Promising Alternative Treatment For Hypertension

Introduction: Hypertension is a significant global public health concern and a leading cause of cardiovascular disease. Despite the availability of numerous pharmacological therapies, many hypertensive patients experience inadequate blood pressure control, medication side effects, or resistance. Thus, non-pharmacological interventions such as Enhanced External Counter pulsation (EECP) have garnered interest as a promising alternative treatment for hypertension.This systematic review aims to evaluate the existing clinical evidence on the efficacy, safety, and underlying mechanisms of EECP as a non-invasive therapy for hypertension. Eligible studies included randomized controlled trials, non-randomized controlled trials, and observational studies. Material and Methods: A comprehensive search of the MEDLINE database was done from March 2002 to March 2023 to identify studies evaluating the use of “EECP in hypertensive patients”. Initially, 31 articles were screened for eligibility, and subsequently, 9 articles met the inclusion criteria, &amp; were thereby included in the review. The inclusion criteria being relevance to the research question, thereby excluding the rest. Results: The review finds that EECP therapy can have beneficial effects on blood pressure control, endothelial function, arterial stiffness, and inflammation in patients with hypertension. The underlying mechanisms of EECP involve enhancing arterial blood flow, improving endothelial function, and reducing peripheral vascular resistance. Although the evidence base for EECP is limited, the available studies suggest that this therapy is safe and well-tolerated, with few adverse effects reported. Conclusions: EECP represents a promising alternative treatment option for hypertension beyond traditional pharmacotherapy. However, further high-quality studies are needed to confirm its efficacy and to identify optimal treatment protocols for different patient populations. Nevertheless, the current evidence suggests that EECP is a valuable addition to the armamentarium of hypertension management strategies.

Blood pressure outcomes at 12 months in primary care patients prescribed remote physiological monitoring for hypertension: a prospective cohort study

Remote patient monitoring (RPM) for hypertension enables automatic transmission of blood pressure (BP) and pulse into the electronic health record (EHR), but its effectiveness in primary care is unknown. This pragmatic matched cohort study using EHR data compared BP outcomes between individuals prescribed RPM and temporally-matched controls from six primary care practices. We retrospectively created a cohort of 288 Medicare-enrolled patients prescribed BP RPM (cases) and 1152 propensity score-matched controls (1:4). Matching was based on age, sex, systolic blood pressure (SBP), marital status, and other characteristics. Outcomes at 3, 6, 9 and 12 months were: controlling high BP (most recent BP < 140/90 mm Hg), antihypertensive medication intensification, and most recent SBP assessed using: all measurements, and office measurements only. At baseline, RPM-prescribed patients and controls had similar ages and systolic BP. BP control diverged at 3 months (RPM: 72.2%, control: 51%, p < 0.001). This difference persisted but decreased over follow-up. After 12 months, the RPM-prescribed cohort had greater BP control (RPM: 71.5%, control: 58.1%, p < 0.001) and lower SBP (132.3 versus 136.5 mm Hg, p = 0.003) using all measurements, but they did not differ using only office measurements (12 month BP control: 60.8% versus 58.1%, p = 0.44; SBP: 135.9 versus 136.5 mm Hg, p = 0.91). At 12 months, the most recent BP measurements were more current for RPM-prescribed patients (median [IQR] 8 [0–109] versus 134 [56–239] days). Net increases in antihypertensive medications by 12 months were similar. Implementation of RPM in primary care could inform hypertension management strategies and increase hypertension control. Registration: ClinicalTrials.gov identifier: NCT05562921.

Blood pressure reduction in difficult-to-control patients and the effect of a nurse-led program in Bulgaria

Hypertension is a major contributor to cardiovascular morbidity and mortality. Although there has been significant improvement in blood pressure (BP) control during the last decades, it is still far from optimal. Several strategies for hypertension management have been proposed, and among all – nurse-led programs seem encouraging. AimTo evaluate the effect of a complex nurse program aiming to reduce BP in patients with uncontrolled hypertension. Patients and MethodsIn a cardiologist's office, a trained nurse included patients with uncontrolled hypertension and newly referred patients with high BP in a program for hypertension management. It consisted of patient education, assessment of quality of life, lifestyle advice, medication improvement and adherence stimulation. All patients were followed for 6 months and their BP, lifestyle indicators, and quality of life measurements were recorded. Statistical analyses included two- and one sample t-tests, chi-square test, correlation and multivariate linear regression. ResultsOverall, 47 patients, presenting with uncontrolled hypertension and with BP>140/90 mm Hg were included in this research. Their BP was reduced within 6 months by mean 30 /11 mm Hg and after 6 months, from 162/88 to 133/77 mm Hg. The drop of BP values was present at the first month with mean BP 140/82 mm Hg. Control of hypertension improved from 2% to 55% at the 1st month mark and to 79% at the 6th month, p<0.0001. The decrease in SBP was positively correlated to decrease in waist circumference, p = 0.47, p = 0.009. In multivariate linear regression analysis, the difference in BP was significantly related to self-assessment health scoring and marginally significant with renal impairment. ConclusionsThe development of a complex nurse-led program, tailored to patients with uncontrolled hypertension, leads to significant positive effect on BP decrease and improves hypertension control in primary care. This may be cost effective and improve BP control in low- to middle-income countries.