Number Of Antihypertensive Drugs Research Articles

Postpartum furosemide for accelerating recovery in patients with preeclampsia: A Randomized Placebo-Controlled Trial: Furosemide for postpartum hypertension.

Preeclampsia is a major hypertensive disorder of pregnancy, which may lead to severe complications, particularly in the first two weeks of the postpartum period. During the postpartum period, blood pressure levels remain high, often increasing to levels higher than those experienced during pregnancy. Furosemide, a fast-acting diuretic, reduces the intravascular volume overload and may represent an alternative to accelerate the normalization of blood pressure levels. To evaluate the effectiveness of furosemide compared to placebo for blood pressure control in the postpartum period in women with severe preeclampsia. In a triple-masked placebo-controlled randomized clinical trial, women in the postpartum period with de novo preeclampsia with severe features or eclampsia diagnosed during pregnancy and adequate diuresis, who had received magnesium sulfate, were randomized to receive furosemide (40 mg/day orally for five days) or placebo. The primary outcomes were mean blood pressure levels. Secondary outcomes were: frequency of severe hypertensive episodes, a continued need for antihypertensives, number of antihypertensives used to control blood pressure, length of hospital stay, adverse effects and maternal complications. A sample size of 120 patients was estimated, 60 in each arm of the study, based on the estimated difference between the mean systolic pressure of 142±12mmHg for the furosemide group and 153±19mmHg for the placebo group. Between June 20 and November 30, 2014, 271 women were screened and 120 were randomized to furosemide or placebo, with 118 being included in the final analysis (58 in the furosemide group and 60 in the placebo group). Most characteristics were similar in both groups. Mean daily systolic and diastolic pressure was lower in the furosemide group (P<0.001) and there were fewer episodes of severe hypertension on the second (P=0.04) and fifth (P=0.04) days. In addition, shorter time was required until blood pressure was controlled (P=0.01) in the furosemide group. Compared to placebo, 40 mg/day of oral furosemide in patients with preeclampsia in the postpartum period reduced mean daily systolic blood pressure in 1st and 5th days and mean daily diastolic blood pressure in 1st, 2nd and 5th days and the time required until blood pressure is controlled.

Antihypertensive therapy in patients with arterial hypertension and concomitant diseases in real clinical practice (according to the National Registry of Arterial Hypertension, 2019-2022)

Arterial hypertension (AH) remains the leading risk factor associated with cardiovascular diseases (CVDs), cerebrovascular disease and chronic kidney disease. About 70% of patients with AH who are on monotherapy cannot achieve blood pressure (BP) targets, and therefore all quidelines for the management of AH have recently recommended prescribing combination therapy (PCT). In real clinical practice (RCP), there remains significant uncertainty in the effectiveness and rationality of therapy, despite the wide availability of antihypertensive drugs (AHD) and the presence of recommendations for a stepwise approach to prescribing combinations of specific groups of AHD in different clinical situations. Analyze the real ongoing antihypertensive therapy, including the PCT; international nonproprietary names of drugs and their dosages in RCP; compliance of therapy with clinical recommendations; changing trends in the PCT. An analysis was carried out of the data from the register of AH, the compliance of treatment in different clinical groups of patients and the achievement of BP and low-density lipoprotein cholesterol targets in the sample of 2019-2022 (n=5012). The prescription of AHD and achievement of targets values were assessed in accordance with current clinical guidelines for the management of AH and hypercholesterolemia. Data from 2010 (n=7782) and 2020 (n=3061) were analyzed to assess the dynamics of prescription of monotherapy and PCT. The greatest increase in the number of AHD was observed in patients with hypertension in combination with coronary heart disease, heart failure, and atrial fibrillation. In a small group of patients with hypertension without other CVDs, the recommended combinations of AHD were not prescribed; preference was given to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-adrenoblocker (β-AB). PCT mainly differed from the recommended combinations by the wider use of drugs from the β-AB group. The PCT of recommended drugs was highest in patients with hypertension and coronary artery disease - more than 90%, hypertension and heart failure in 56.2%, hypertension and atrial fibrillation - 33.3%, hypertension and chronic kidney desease - 19.6%. Achievement of BP and low-density lipoprotein cholesterol targets was insufficient in all analyzed groups. Among the international nonproprietary names of drugs, the most frequently prescribed are the following: bisoprolol, metoprolol, lisinopril, perindopril, losartan, spironolactone, amlodipine, torasemide, indapamide, hypochlorothiazide, moxonidine. The prescribed daily dosages were closer to the initial recommended ones. By 2020, the prescription of PCT with β-AB and a more uniform prescription of various combinations will come to the fore, while PCT in 2010 is characterized by the presence of one or two leaders combinations. The described features of prescribing AHD partially reproduce clinical recommendations for the management of AH. Differences in therapy provided in RCP may be associated with an attempt to intensify the treatment of hypertension in patients with other concomitant CVDs. At the same time, analysis of combinations and dosages of prescribed drugs suggests the presence of wide opportunities for further escalation of therapy. The presented data can provide insight into current patterns of antihypertensive therapy prescription in patients in RCP and lay the foundation for optimizing therapy in different categories hypertensive patients.

THU594 Outcome Data From Fabulas: A Feasibility Study Of Radiofrequency Endoscopic Ablation, With Ultrasound Guidance, As A Non-surgical, Adrenal Sparing Treatment For Aldosterone Producing Adenomas

Abstract Disclosure: G. Argentesi: None. X. Wu: None. A. Ney: None. E. Goodchild: None. K. Laycock: None. Y. Lee: None. R. Senanayake: None. J. MacFarlane: None. E. Ng: None. J. Kearney: None. A. Palma: None. I. Munteanu: None. J. Salsbury: None. E.D. Benu: None. P. Ebano: None. P. Wilson: None. E.M. Godfrey: None. G. Goodchild: None. J. Bestwick: None. M. Gurnell: None. H. Cheow: None. S.P. Pereira: None. W. Drake: None. M.J. Brown: None. Introduction: Primary aldosteronism (PA) is potentially curable if due to a unilateral aldosterone producing adenoma (APA), but complete clinical success after adrenalectomy is the exception. Selective radiofrequency ablation (RFA) of the APA, if safe, would lower the bar for intervention, but there are concerns about catecholamine crises, peri-adrenal catastrophes, and ablation of non-functional adenomas. Endoscopic ultrasound (EUS)-guided RFA of left-side APAs is an attractive alternative in which proximity to the stomach enables multiple, short, precise burns as the catheter is steered around the APA. Aims and Methods: We conducted a 3-centre feasibility study to determine the safety of EUS-RFA as an adrenal sparing treatment, and assess likely efficacy. The APA was visualised as increased uptake of 11C-metomidate (MTO) in a post-dexamethasone PET CT (1). Initial recruitment was limited to patients in whom surgery was contra-indicated (co-morbidities, ambiguous estimation of unilateral PA). α-and ß blockade were introduced 2 weeks prior to RFA, performed under general anaesthesia or deep sedation. Metanephrines were measured before and during RFA. Following diagnostic fine-needle aspiration (FNA), a 5-10 mm19G StarmedTM ablation probe was introduced into the APA. The primary outcome was safety, pre-specified as absence of perforation, haemorrhage, or infarction of major organs on a CT scan performed within 24-48 hours of RFA. Secondary outcomes, at 6 months post-RFA, were PASO criteria for biochemical/clinical success, changes in aldosterone/renin ratio (ARR), BP and drug doses, and in the MTO uptake on repeat scan. Results: 28 patients (21 male), age 57.9 ± 10.23, were studied. 7 patients had 2 ablations. None of the pre-specified serious adverse events occurred. Metanephrines rose in only one patient, given ephedrine and metaraminol. 2 further patients had RFA-related events which delayed discharge but rapidly resolved. 14 patients achieved complete biochemical success and 3 partial. 4 patients achieved complete clinical success and 4 partial. ARR fell from median 3975 (IQR 2090-7475) to 880 (369-2670), p&amp;lt;0.001. BP was unchanged, but on less treatment: number of antihypertensives and defined daily dose fell from 2.9 (95% CI 2.4-3.3) to 2 (1.5-2) and from 4.9 (3.6 -6.2) to 2.7 (1.7-3.6) respectively. In 6 patients, MTO uptake into the APA was reduced to &amp;lt;50% of adjacent adrenal (indicating complete ablation) whilst the latter was unchanged or minimally reduced in all patients (i.e. preserved function). APA diameter was reduced in 21/28 patients. In 13/28 FNA samples analysed to date, all were positive for CYP11B2 (8/13 strongly and 5/13 weakly positive). Conclusion: EUS-guided trans-gastric RFA is a safe alternative to adrenalectomy for the treatment of left-sided APAs. RFA is now being compared with surgery in a RCT of 110 patients with PA. 1. Wu et al. Nat Med 29:190-202, 2023. Presentation: Thursday, June 15, 2023

Drug Therapy Problem: Prevalence and Associated Risk Factors Among Hypertensive Patient

Drug therapy problem is an event involving drug therapy that actually or potentially interferes with the desired health outcomes. This study aimed to identify drug therapy problems encountered by hypertensive patients receiving care in BUK Clinic, Nigeria. It was a retrospective analysis of the medical records of adult hypertensive patients. A total of 206 patient folders were used for the study. The data were collected from the patient’s medical records using the Pharmaceutical Care Network Europe (PCNE) Classification tool Version 9.1 (PCNE, 2020). Data were analyzed using the IBM Statistical Product and Service Solutions (SPSS). The total number of drug therapy problem found was 314 of which majority was effect of drug treatment not optimal [P1.2] 155(49.4%) followed by adverse drug event [P1.3] 155(49.0%) and no effect of drug therapy despite correct use [P1.1] 5(1.6%) was the least type of drug therapy problem encountered. The major cause of drug therapy problem was inappropriate drug according to guidelines/formulary and inappropriate combination of drugs (C1.1 &amp; C1.3) which account for 80(26.4%) of drug related problem. Prevalence of drug therapy problem was high (85.9%). Number of Antihypertensives on (P=0.022) and age(P=0.025) were significantly associated with increased drug therapy problem. Increased drug therapy problem can lead to increase in complications, increased hospital stays, emergency hospitalization and increased medical cost.

Hypertension evaluated in the public and private Brazilian health system hypertension in public and private service.

Hypertension (HT) remains the leading cause of death worldwide. In Brazil it is estimated that 35% of the adult population has HT and that about 20% of these have blood pressure values within the targets recommended for the reduction of cardiovascular risk. There are some data that point to different control rates in patients treated by cardiologists in public and private referral center and this is an important point to be investigated and discussed. To compare sociodemographic characteristics, body mass index (BMI), antihypertensive (AH) drugs, blood pressure (BP) and control rate in public (PURC) and private (PRRC) referral centers. A cross-sectional multicenter study that analyzed data from hypertensive patients assisted by the PURC (one in Midwest Region and other in Northeast region) and PRRC (same distribution). Variables analyzed: sex, age, BMI, classes, number of AH used and mean values of systolic and diastolic BP by office measurement and home blood pressure measurement (HBPM). Uncontrolled hypertension (HT) phenotypes and BP control rates were assessed. Descriptive statistics and χ2 tests or unpaired t-tests were performed. A significance level of p < 0.05 was considered. A predominantly female (58.9%) sample of 2.956 patients and a higher prevalence of obesity in PURC (p < 0.001) and overweight in PRRC (p < 0.001). The mean AH used was 2.9 ± 1.5 for PURC and 1.4 ± 0.7 for PRRC (p < 0.001). Mean systolic and diastolic BP values were higher in PURC as were rates of uncontrolled HT of 67.8% and 47.6% (p < 0.001) by office measurement and 60.4% and 35.3% (p < 0.001) by HBPM in PURC and PRRC, respectively. Patients with HT had a higher prevalence of obesity in the PURC and used almost twice as many AH drugs. BP control rates are worse in the PURC, on average 15.3 mmHg and 12.1 mmHg higher than in the PRRC by office measurement.

COMPARISON OF FIRST RESULTS OF RADIOFREQUENCY RENAL DENERVATIONS WITH FIRST AND SECOND GENERATION TECHNIQUES

Objective: A form of renal denervation, when using radiofrequency technique, thermal energy destroys the nerve-fibres around the renal artery. The Symplicity FlexTM was the first such catheter, an improved new generation version of it is the Symplicity SpyralTM catheter. In the Albert Szent-Györgyi Health Center of the University of Szeged, renal denervations were performed with both devices in hypertensive patients whose blood pressure could not be reduced to the goal range with multiple antihypertensive combinations. Design and method: With the first generation catheter, only the main branch was ablated at 4-5 points per side, and with the Symplicity SpyralTM catheter, even the segmental small branches together with the main branches were ablated at a total of at least 16-18 points per side. Results: With the old method after RDN, SBP decreased by 40 mmHg and DBP by 20 mmHg. The reduction was greatest 1 month after the intervention, 45 and 35 mm Hg. But did not reach the goal values. With new method after RDN, SBP decreased by 38 mmHg and DBP by 27 mmHg. The reduction was greatest 1 month after the intervention, 49 and 37 mm Hg. With the new the SBP was already in the target range after the intervention and remained there for 6 months. In addition, the number of antihypertensives could be significantly reduced. With the old method the goal BP value could not be achieved. Vascular complications did not occur in either case of interventions. Conclusions: Our first result with the Symplicity SpyralTM catheter according to the new concepts supports the view that more accurate ablation and preferably distal ablation can lead to more effective blood pressure reduction.

Contrast medium free selective adrenal vein sampling in the management of primary aldosteronism

BackgroundTo analyze contrast free adrenal vein sampling (AVS) for differentiating unilateral from bilateral disease in patients diagnosed with hypertension due to primary aldosteronism (PA). MethodsConsecutive patients with PA and subsequent contrast medium free AVS between April 2015 and March 2020 were retrospectively included. Cross-sectional imaging (CSI), AVS and clinical data were analyzed regarding diagnostic performance. In addition, patients with lateralisation receiving adrenalectomy were compared to a control group treated with mineralocorticoid antagonists. ResultsIn total 186 patients with AVS were included. The success rate for bilateral catheterization was 88% (median effective dose 2.8 mSv). CSI had an accuracy of 60% (CI: 0.52–0.67) in the detection of lateralization compared to AVS. Patients with bilateral adrenal hyperplasia and those with aldosterone-producing adenoma did not differ in systolic blood pressure (sBP) (p = 0.63) or number of antihypertensive drugs (NAD) (p = 0.11). After adrenalectomy, 28 patients were cured (51%; sBP ≤130 mmHg, NAD = 0), 18 were improved (33%; decrease of sBP ≥20 mmHg and NAD), and 8 were unchanged (15%). Serum renin increased significantly after treatment (p < 0.01). ConclusionContrast medium free AVS is a reliable procedure in the diagnostic management of patients with PA with high technical success rate. The accordance between CSI and results from AVS was only moderate indicating the central role of AVS in the diagnostic work-up of patients with PA. Patients with predominant disease diagnosed with AVS had a high cure rate and/or significant improvement after adrenalectomy.

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Society for Education and the Advancement of Research in Connected Health SEARCH 2022 – The National Telehealth Research Symposium Abstracts Virtual Meeting November 16–18, 2022

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience.

BACKGROUNDThe burden of chronic kidney disease (CKD) is rising rapidly globally. Fluid overload (FO), an independent predictor of mortality in CKD, should be accurately assessed to guide estimation of the volume of fluid to be removed during haemodialysis (HD). Clinical score (CS) and bio-impedance analysis (BIA) have been utilized in assessment of FO and BIA has demonstrated reproducibility and accuracy in determination of fluid status in patients on HD. There is need to determine the performance of locally-developed CSs in fluid status assessment when evaluated against BIA.AIMTo assess the hydration status of patients on maintenance HD using BIA and a CS, as well as to evaluate the performance of that CS against BIA in fluid status assessment.METHODSThis was a single-centre, hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD at Kenyatta National Hospital. The patients were aged 18 years and above and had been on maintenance HD for at least 3 mo. Those with pacemakers, metallic implants, or bilateral limbs amputations were excluded. Data on the patients’ clinical history, physical examination, and chest radiograph findings were collected. BIA was performed on each of the study participants using the Quantum® II bio-impedance analyser manufactured by RJL Systems together with the BC 4® software. In evaluating the performance of the CS, BIA was considered as the gold standard test. A 2-by-2 table of the participants’ fluid status at each of the CS values obtained compared to their paired BIA results was constructed (either ++, +-, -- or -+ for FO using the CS and BIA, respectively). The results from this 2-by-2 table were used to compute the sensitivity and specificity of the CS at the various reference points and subsequently plot a receiver operating characteristic (ROC) curve that was used to determine the best cut-off point. Those above and below the best CS cut-off point as determined by the ROC were classified as being positive and negative for FO, respectively. The proportions of participants diagnosed with FO by the CS and BIA, respectively, were computed and summarized in a 2-by-2 contingency table for comparison. McNemar’s chi-squared test was used to assess any statistically significant difference in proportions of patients diagnosed as having FO by CS and BIA. Logistic regression analysis was conducted to assess whether the variables for the duration of dialysis, the number of missed dialysis sessions, advisement by health care professional on fluid or salt intake, actual fluid intake, the number of anti-hypertensives used, or body mass index were associated with a patient’s odds of having FO as diagnosed by BIA.RESULTSFrom 100 patients on maintenance HD screened for eligibility, 80 were recruited into this study. Seventy-one (88.75%) patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02 ± 1.79 L as opposed to the forty-seven (58.25%) patients who had FO when evaluated using the CS. The difference was significant, with a P value of < 0.0001 (95% confidence interval: 0.1758-0.4242). Using CS, values above 4 were indicative of FO while values less than or equal to 4 denoted the best cut-off for no FO. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.CONCLUSIONFO is very prevalent in patients on chronic HD at the Kenyatta National Hospital. CS detects FO less frequently when compared with BIA. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.

ANALYSIS BETWEEN THE NUMBER OF ANTIHYPERTENSIVE WITH MEDICATION ADHERENCE IN END STAGE RENAL DISEASE

&#x0D; End-Stage Renal Disease (ESRD) is a condition of severe renal damage associated with a higher incidence of hypertension that requires antihypertensive therapy to prevent the worsening disease. Therefore, patients who received more than two types of antihypertensives have affected medication adherence. This study aimed to analyze relationship between the number of antihypertensives and medication adherence in ESRD patients. The study was a cross-sectional design involving 77 participants selected by a purposive sampling technique at Outpatient Private Hospital Buleleng Bali in July-September 2020. Data were collected based on patient’s medical records and the Probabilistic Medication Adherence Scale (ProMAS) questionnaire. The inclusion criteria were ESRD patients aged ≥18 years, with hypertension history, taking the same antihypertensive for three months before the study, sign informed consent, and completed medical record data. Those who were a weak general condition and cognitive impairment were excluded from the study. Data were analyzed using a Kruskal-Wallis test. The results showed that overall, of patients were &lt;65 years old (80.52%), male (70.13%), duration of ESRD &lt;5 years (89.61%), primarily high school (57.14%), and without complications (57.1%). Most patients used a combination of two antihypertensives (35.07%), and 61.04% has a high medication adherence. There was no significant relationship between the number of antihypertensives and medication adherence (p=0.847). Nevertheless, it was still shown that the higher number of antihypertensives in ESRD patients was directly proportional to the lower medication adherence.&#x0D; &#x0D;

STUDY ON COST VARIATION OF ORAL ANTIHYPERTENSIVE MEDICATIONS AVAILABLE IN RETAIL STORES ACROSS CHITWAN

Background: Antihypertensive medications reduce blood pressure and decrease cardiovascular dis­ease morbidity and mortality. A number of antihypertensives with same formulation but different prices are available in the market. In the present study we aim to study such price variations of antihypertensive drugs currently available in the Nepalese market. Methods: We obtained the marked price of different antihypertensives manufactured in Nepal and India from various medicine stores within Chitwan from February to June 2021. Cost ratio (CR) and percentage cost variation (%CV) was calculated using Microsoft Office Excel-2019. Results: We observed a high percentage of cost variation in Amlodipine 5mg (CR: 3.33 %CV: 233.33) among Nepali and Losartan 50mg (CR: 32.31 %CV: 3131.47) among Indian antihypertensives. Conclusions: A wide percentage cost variation was observed among antihypertensive medications cur­rently available in the Nepalese market. Regulatory bodies could address the issue to ensure affordability of essential antihypertensive medications.

A Japan nationwide web-based survey of estimation on patients for renal denervation based on blood pressure level and the number of antihypertensives (J-NEEDs survey).

Catheter‐based renal denervation (RDN) is currently being developed as a new complementary treatment option for hypertension. RDN has not yet received approval in Japan and so the number of possible candidates for RDN in Japan also remains unknown. A total of 10 756 hypertensive patients who regularly visit medical institutions and reported their latest home blood pressure (BP) values were identified from registrants at an online research company. They filled out a survey regarding their prescribed antihypertensives and latest BP values in March 2020 in Japan. The mean age of the patients was 61.3 years old (83.5% male). According to JSH 2019, the prevalence of resistant hypertension (RHT) was estimated to be 1.4% (0.52% having an office BP of 140/90 mm Hg or more while taking three antihypertensives, including diuretics; 0.84% taking four or more antihypertensives regardless of BP level). Assuming the indication for RDN was RHT with morning home systolic BP (HSBP) ≥ 135 mm Hg and office systolic BP (OSBP) ≥ 140 mm Hg, the number of candidates for RDN was estimated to be approximately 340 000 and 372 000, respectively. When hypertensive patients prescribed three or more, two, one, and no antihypertensives were included, the estimated number based on uncontrolled HSBP and OSBP cumulatively increased 2.6, 14.2, 40.6, and 58.0‐fold; 1.8, 8.6, 25.3, and 36.4‐fold, respectively. These findings revealed that a substantial number of hypertensive patients are unable to adequately control their BP level with existing treatments, and new complemental therapies, such as RDN, would alleviate the burden of hypertension in this population.

MO843PREVALENCE AND MANAGEMENT OF HYPERTENSION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension (HTN) is common in hemodialysis (HD) patients &amp; diagnosed by pre-dialysis BP &amp;gt;140/90 mmHg. Causes include high salt intake, volume overload, &amp; loss of residual kidney function. Therapy includes achieving correct dry weight with each session, restricting interdialytic sodium &amp; fluid intake &amp; medications. We review its prevalence, factors associated with it &amp; its management in our patients. Method Demographics, HD prescription &amp; medications data collected for patients from 5 dialysis centers. Results A total of 1585 files reviewed. Males were 51.8% &amp; mean age was 59. Mean age significantly higher for females (61 vs 57). ESKD cause was DM in 51% &amp; HTN in 35%. However, of files reviewed, adequate data on comorbidities in 1390 patients (table 1), 69% had DM, 92% had HTN, 47% had CVD &amp; 31% had BMI &amp;gt; 25 (which was significantly more frequent in females). HTN was more likely in older patients, diabetics &amp; females with odds of HTN in females nearly twice the odds of HTN in males &amp; odds of HTN with DM is 2.27 times odds of HTN without DM &amp; one-year increase in age would increase odds of HTN by nearly 4%. Mean pre-HD BP for those with HTN was 143/76 mmHg &amp; for those without HTN was 136/75 mmHg. HD frequency was thrice weekly in 94% &amp; HD duration was &amp;gt; 3.5 hours in only 77% of patients. HDF used in 81.5%. Mean interdialytic weight gain (IDWG) was 2.8 kg, with no difference according to gender or presence of DM or HTN (Table 2). Higher IDWG associated with age &amp;lt; 65, Calcium bath of 1.75 &amp; Sodium bath &amp;gt; 138 with 0.638 kg higher IDWG with calcium of 1.75 compared to calcium of 1.25. Higher IDWG was associated with higher BP. Mean volume of fluid removed per session was 2.74, which was less than mean IDWG, with no difference according to gender or DM, however, it was higher in the higher dialysate sodium group, &amp; lower in the shorter session group (with trend towards statistical significance). CCB used to treat HTN in 62% followed by βB in 52%. Number of patients with HTN on 1 drug 21%, 2 drugs 27%, 3 drugs 23%, ≥ 4 drugs 20% &amp; 9% missing data. Number of antihypertensives did not correlate with IDWG. Conclusion Interdialytic weight gain in our HD patients is excessive &amp; contributing to HTN. Patients must restrict salt &amp; fluid intake &amp; dialysis centers must regularly &amp; frequently assess dry weight, ensure thrice weekly schedule &amp; 4 hours per session are met, so excess fluid is completely removed. Also, high sodium &amp; high calcium baths need to be avoided.

POS-260 ASSOCIATION OF BLOOD PRESSURE VARIABILITY AND NON-DIPPING WITH THE PROGRESSION OF CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR OUTCOMES- A SINGLE-CENTRE PROSPECTIVE OBSERVATIONAL STUDY

Hypertension is seen in almost seventy percent of patients with chronic kidney disease (CKD). The association of blood pressure variability and non-dipping with the progression of chronic kidney disease (CKD) and cardiovascular events is unclear. We aimed to study if blood pressure variability and non-dipping were associated with the progression of chronic kidney disease and cardiovascular events. This was a single-centre, prospective observational study, conducted at a tertiary care centre in South India over eighteen months. Patients with CKD with estimated glomerular filtration rate (eGFR) between 59 and 15 ml/minute per1.73 m2, and aged between 18 and 70years were included in the study. Standardized clinic blood pressure (BP) and 24-hour ambulatory BP were recorded in all enrolled patients. All study participants had follow-up visits every three months for one year. Office BP and serum creatinine were recorded during the visit and the history of occurrence of cardiovascular events were noted. The association of ambulatory blood pressure monitoring (ABPM) parameters with cardiovascular and renal outcomes was analyzed. The cardiovascular outcome was defined as a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death. The renal outcome was defined as a composite of end-stage renal disease (eGFR<15ml/minute/1.73m2) or the initiation of renal replacement therapy. The correlation of BP variability and non-dipping with decline in glomerular filtration rate was also analyzed. Of the seventy-six study participants, 49(64.5%) were male and the mean age was 54±12 years. When the index of dipping was analyzed we found that 15(19.7%) were dippers, 40 (52.6%) were non-dippers and 21(27.6%) were reverse dippers. The percentage decline in eGFR over one year was significantly more in non-dippers (35.49 ± 19.29 ml/minute/1.73m2) compared to dippers (23.24 ± 12.19ml/minute/1.73m2) (p = 0.022). The baseline characteristics of dippers and non-dippers given in Table 1. At one year, out of the seventy-six study participants, 29(38.2%) had the defined cardiovascular outcome. Cardiovascular outcome was significantly associated with number of anti-hypertensives used (p=0.035), dipping status(p=0.029), 24-hour systolic BP(p=0.038), night systolic BP(p=0.014), index of BP dipping(p=0.014), and BP variability(p=0.036). On multivariate analysis, non-dipping was independently associated with cardiovascular events. The composite renal outcome was seen in 22(28.9%) patients. The renal outcome was found to be significantly associated with diabetes(p=0.053), 24-hour systolic BP(p=0.000), day systolic BP(p=0.001), night systolic BP(p=0.000), index of BP dipping(p=0.000), and BP variability(p=0.071). On multivariate analysis, non-dipping (p=0.030) was independently associated with significant decline in eGFR. The index of nocturnal dipping (r=-0.522, p<0.001) and blood pressure variability (r=0.324, p=0.004) showed a significant correlation with the decline in glomerular filtration rate over one year. In chronic kidney disease ABPM parameters like non-dipping and short-term blood pressure variability were associated with poor renal and cardiovascular outcomes. Although ABPM is time-consuming our study demonstrated that information from ABPM can potentially impact future CV and renal outcomes in patients with CKD.

COMPARING THE DISCRIMINATIVE ABILITY OF DIFFERENT ELECTROGRAPHIC CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PREDICTING CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS

Abstract Objective: Several ECG criteria are used clinically to define Left Ventricular Hypertrophy (LVH), but there is no consensus on which of these criteria is better at predicting cardiovascular (CV) events in hypertensive patients. In this post-hoc analysis, our objective was to compare the discriminative ability and strength of association of different LVH criteria to predict the risk of CV-morbidity and mortality. Design and method: We used the database of the Anglo-Scandinavian Cardiovascular Outcome Trial Our primary outcome was composite of fatal and non-fatal CV event including: coronary heart disease, stroke and coronary re-vascularisation. We developed several cox regression models, separately for each LVH criterion (Modified Sokolov, Cornell, Framingham, Strain Pattern, Cornell-Strain, Cornell-Product), after adjusting for a-priori confounders (age, sex, smoking status, diabetes, pulse pressure, chronic kidney disease stage 3) and other confounders found using stepwise selection (number of anti-hypertensives, previous vascular disease, metabolic syndrome, atrial fibrillation). We compared discriminative ability using c-statistic, goodness of fit of the model using Bayesian information criterion (BIC), hazard ratios (HR) and z-statistics for strength of association of each one of these LVH criteria in respective models. Results: 9.7% to 17.2% of 17959 hypertensive patients had LVH at baseline as defined by one or more LVH criterion (see Fig. 1). During a median follow up of 5.6 Years (IQR 5.2–6.1) there were 2736 CV events. Figure 1 shows that, whilst c-statistics and accuracy of most criteria are similar, strain pattern and the Cornell strain are better in improving the prediction models and with a higher strength of association with the CV-outcomes (HR 1.52 95% CI: 1.35 - 1.71, Z-statistic 6.88 and HR 1.37 95% CI: 1.226 - 1.519, Z-statistic 5.70, respectively). Both criteria had excellent BIC too. Conclusions: In hypertensive patients, compared to other ECG criteria of LVH, strain pattern and Cornell-strain index are stronger and better predictor of the risk of CV morbidity and mortality.

POS-339 IMPACT OF HOME TELEMONITORING AND MANAGEMENT SUPPORT ON BLOOD PRESSURE CONTROL IN NON-DIALYSIS CKD: A SYSTEMATIC REVIEW AND META-ANALYSIS

Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of using home blood pressure telemonitoring (HBPT) for BP control and outcomes, but the effects of this intervention remain unclear in patients with CKD. We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and Dissertations and Theses for studies in non-dialysis CKD using HBPT for BP control as well as evaluation of other outcomes. We analyzed systolic blood pressure (SBP), diastolic blood pressure (DBP), estimated glomerular filtration rate (eGFR), and change in number of anti-hypertensives using a random effects model. We selected seven studies from 1,669 articles that were initially identified. Four studies were included in meta analysis for BP (Figure 1). Overall, pooled estimates in the mean difference (MD) for SBP and DBP was -8.8 mmHg; 95% CI: -16.2, -1.4; P=0.02 and -2.4 mmHg; 95% CI: -3.8, -1.0; P<0.001, respectively. For studies comparing intervention with usual care (UC), pooled estimates in MD for SBP was -7.9 mmHg; P=0.02) with no significant reduction for DBP (-2.6 mmHg; P=0.18). For studies without a UC arm, both SBP and DBP were not significantly reduced (p>0.05) (Figure 2). Two studies with a UC arm and baseline eGFR values that were not significantly different evaluated changes of eGFR after 6 months of follow-up in 79 participants. The pooled results showed a significant difference (MD: 5.35 mL/min/1.73m2; 95% CI: 2.49 to 8.21; I2= 0.0%; P<0.001) (Figure 3). However, sensitivity analysis using the follow-up measurements showed a non-significant difference (MD: 5.66 mL/min/1.73m2; 95% CI: − 1.51 to 12.83; I2= 0.0%; P=0.12) (Figure 2). Only one study reported the changes in number of hypertensive medications after 6 months of follow-up (MD: 2.63; 95% CI: − 6.52 to 1.26; I2= 0.0%). Figure 1: PRIMSA flow chart of study selection and inclusion Figure 2: Forest plot and meta-analysis for the effect of HBPT on SBP, DBP, and eGFR using 6-month follow-up mean values (sensitivity analysis). Figure 3: Forest plot and meta-analysis for the effect of HBPT on SBP, DBP, and eGFR after 6 months of follow-up. Our study shows that HBPT is associated with significant reduction of SBP and a significant improvement of kidney function, likely modulated by HBPT effects on BP. However, larger studies with improved designs and prolonged intervention periods are still needed to assess the effects of HBPT on patients’ outcomes including BP, kidney function and non-fatal and fatal CV events in patients with CKD.

POS-656 CORRELATION OF BIO-IMPEDANCE ANALYSIS REPORTS WITH IN-HOME BLOOD PRESSURE MEASUREMENTS IN AUTOMATED PERITONEAL DIALYSIS PATIENTS

A key objective of peritoneal dialysis (PD) is to achieve euvolemia. Patients undergoing automated PD (APD) are frequently fluid overloaded, while anuric APD patients with low fluid removal can have uncontrolled hypertension, left ventricular hypertrophy and worse survival. In this report, we aim to explore the correlation of fluid status in APD patients with in-home blood pressure (HBP) measurements and number of antihypertensives used.

Personalized text message and checklist support for initiation of antihypertensive medication: the cluster randomized, controlled check and support trial

Objective: To assess whether the use of a checklist combined with text message support improves systolic blood pressure (SBP) control.Design and setting: A cluster randomized controlled trial in Finnish primary care.Interventions: Personalized text message support and a checklist for initiation of antihypertensive medication.Patients: 111 newly diagnosed hypertensive patients aged 30–75 years.Main outcome measures: The proportion of patients achieving 1) the office SBP target <140 mmHg or 2) the home SBP target <135 mmHg at 12 months.Results: 28% (n = 16) and 31% (n = 17) of patients in the intervention and control groups met the office SBP target, respectively (p = 0.51). The corresponding proportions were 36% (n = 18) and 42% (n = 21) for the home SBP target (p = 0.21). Office SBP decreased 23 mmHg (95% CI: 29–17) in the intervention group and 21 mmHg (95% CI: 27–15) in the control group (p = 0.61). Medication changes, number of antihypertensives at 12 months and health care utilization were similar in both study groups. Patients considered checklist and text message support useful and important.Conclusion: Only a small proportion of patients in the intervention and control groups reached their treatment target despite multiple health care contacts and medication changes. The study interventions did not improve SBP control. However, this study demonstrates new information about hypertension control, antihypertensive medication and health service utilization during the first treatment year.

Evaluation of antihypertensive therapies in immunotherapy-associated systemic reactions

Anaphylaxis is commonly encountered in the allergy clinic, especially in practices with a large number of patients receiving immunotherapy. Risk factors that may increase the frequency or severity of anaphylaxis are still being investigated. To our knowledge, a study has not been conducted that evaluated the association between antihypertensive therapy and the severity of anaphylaxis or whether the number of antihypertensives is associated with the severity of anaphylaxis. This study sought to investigate these associations and bridge the gap in the available medical literature on this topic.

Clinic and patient variation in intermediate clinical outcomes for type 2 diabetes: a multilevel analysis

BackgroundVariation at different levels of diabetes care has not yet been quantified for low- and middle-income countries. Understanding this variation and its magnitude is important to guide policy makers in designing effective interventions. This study aims to quantify the variation in the control of glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) for type 2 diabetes (T2D) patients at the clinic and patient level and determine patient and clinic factors associated with control of these outcomes in T2D.MethodsThis is a cross-sectional study within the baseline data from the impact evaluation of the Enhanced Primary Health Care (EnPHC) intervention on 40 public clinics in Malaysia. Patients aged 30 and above, diagnosed with T2D, had a clinic visit for T2D between 01 Nov 2016 and 30 April 2017 and had at least one HbA1c, SBP and LDL-C measurement within 1 year from the date of visit were included for analysis. Multilevel linear regression adjusting for patient and clinic characteristics was used to quantify variation at the clinic and patient levels for each outcome.ResultsVariation in intermediate clinical outcomes in T2D lies predominantly (93% and above) at the patient level. The strongest predictors for poor disease control in T2D were the proxy measures for disease severity including duration of diabetes, presence of microvascular complications, being on insulin therapy and number of antihypertensives. Among the three outcomes, HbA1c and LDL-C results provide greatest opportunity for improvement.ConclusionClinic variation in HbA1c, SBP and LDL-C accounts for a small percentage from total variation. Findings from this study suggest that standardised interventions need to be applied across all clinics, with a focus on customizing therapy based on individual patient characteristics.