Hypertension Outcomes Research Articles

Improving Hypertension Outcomes: Assessing Caregivers’ Knowledge, Attitude and Practices in Rural Malawi

Introduction: Hypertension is a major global health issue, significantly contributing to the burden of cardiovascular diseases, particularly in low- and middle-income countries (LMICs) like Malawi. Caregivers play a crucial role in managing hypertension in these settings, yet their knowledge, attitudes, and practices (KAP) are not well-documented. Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) of caregivers for hypertensive patients in rural Malawi, as well as to identify any disparities in these areas. Methods: A descriptive cross-sectional study was conducted from November 2023 to February 2024 at Lisungwi Community Hospital and Neno District Hospital in Neno, Malawi. A total of 422 caregivers were conveniently sampled, with 248 from Lisungwi and 174 from Neno. Data were collected using a validated pre-tested questionnaire, assessing KAP on hypertension. Descriptive, one-way ANOVA and linear regression statistical analyses were performed using SPSS version 22.0. Results: In both Lisungwi and Neno hospitals, the majority of participants were female, accounting for 63.7% and 62.6%, respectively. The mean age of participants was 44.7 years (± 10.3) in Lisungwi and 45.3 years (± 9.3) in Neno, with average care durations of 4.1 years (± 3.3) and 4.2 years (± 3.2). Notably, 94.4% of caregivers at Lisungwi and 94.3% at Neno exhibited poor knowledge of hypertension; however, all caregivers maintained a positive attitude toward its prevention and management. Significant differences in practice scores were observed (p < 0.001), with caregivers in Lisungwi performing better. Additionally, factors such as education, age, and occupation influenced Knowledge, Attitude, and Practices (KAP) scores, while gender impacted practices alone. Conclusions: The findings of poor knowledge highlight the urgent need for enhanced educational interventions, gender-specific support, community engagement, and a context-specific approach to improve the knowledge and practices of caregivers, which are critical for effective hypertension prevention and management in rural setting.

Controlling Nutritional Status Score Predicts 1-Year Outcomes in Chronic Thromboembolic Pulmonary Hypertension.

The prognosis for patients with chronic thromboembolic pulmonary hypertension (CTEPH) using their nutritional status has not been established. We investigated the relationship between the prognosis of patients with CTEPH and the Controlling Nutritional Status (CONUT) score, which is a nutritional assessment tool. A total of 157 patients with CTEPH was enrolled in the study. The primary outcome was defined as the composite outcome of all-cause mortality and non-elective hospitalization due to heart failure. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff CONUT score for predicting the 1-year rate of the primary outcome. Patients were divided into 2 groups according to the significant cutoff value and compared. Undernutrition was observed in 51.6% of patients. ROC analysis revealed a significant cutoff CONUT score of 3.5 (area under the curve=0.789). The incidence rate of the primary composite outcome was higher in the high CONUT group (score ≥4) than in the low CONUT group (score ≤3; 20% vs. 2.2%; P<0.001). Cox analysis revealed the CONUT score per point increase was an independent risk factor for the primary composite outcomes (hazard ratio 2.301; 95% confidence interval 1.081-4.895; P=0.031). The CONUT score can predict the 1-year rate of all-cause death and non-elective hospitalization in patients with CTEPH.

Abstract MP20: Leveraging Electronic Health Records to Assess Neighborhood Advantages and Risk of Cardiovascular Outcomes Among Hypertensive Patients

Introduction: Hypertension disproportionately impacts socially disadvantaged groups in the U.S. with increasing prevalence and suboptimal control rates. Our study aims to examine the association between neighborhood-level social vulnerability and hypertension outcomes using electronic health record (EHR) data from a large regional health system. Methods: We conducted a retrospective analysis of EHR data from the Sentara Health System, covering the period from January 1st, 2010, to December 31st, 2022. We assigned a Social Vulnerability Index (SVI) based on the residential census tract of each patient and established a longitudinal cohort of patients who consistently utilized healthcare services. To be included in the study, patients were required to have a minimum of five years of observational time and to have healthcare visits in at least 50% of the observed years. The study focused on patients diagnosed with hypertension—either through a hypertension diagnosis, a blood pressure measurement exceeding 140/90, or antihypertensive medication prescriptions. We utilized multivariate Cox Proportional Hazards models to analyze the associations of SVI with cardiovascular outcomes and blood pressure control (&lt;140/90 mmHg). Results: The longitudinal cohort consisted of 55,060 patients, with an average age of 54 years (Interquartile range: 42-65), 30.0% of whom were Black adults and 60.0% were females. Compared to patients residing in the most advantaged neighborhoods (quartile 1 of SVI), those in more disadvantaged neighborhoods (quartiles 2, 3, and 4) had hazard ratios for composite cardiovascular endpoint (myocardial infarction, heart failure, and stroke) of 1.22 (95% CI, 1.19-1.25), 1.40 (95% CI, 1.37-1.44), and 1.64 (95% CI, 1.60-1.68), respectively, after adjustment for age and sex. Additionally, blood pressure control was significantly lower in higher SVI quartiles, with control rates in quartiles 1 through 4 at 78.4%, 76.5%, 75.2%, and 72.8%, respectively (P&lt;0.001). Among the SVI themes, socioeconomic status (theme 1) and housing type and transportation (theme 4) were associated with the highest hazard ratios for cardiovascular outcomes. Conclusions: Neighborhood-level social vulnerability is significantly associated with worse hypertension control and adverse cardiovascular outcomes. Health systems can employ tailored interventions targeting high-risk neighborhoods to reduce disparities and enhance health outcomes for vulnerable populations.

Right ventricular dyssynchrony predicts outcome in pulmonary arterial hypertension when assessed in multiple CMR views

BackgroundRight ventricular (RV) dyssynchrony or post systolic contraction (PSC) cause inefficient pumping and have not been investigated as prognostic markers in pulmonary arterial hypertension (PAH). ObjectivesTo investigate if RV dyssynchrony and PSC are prognostic markers of transplantation-free survival in PAH and if multiple RV views improve the prognostication. MethodsPatients with PAH undergoing cardiac magnetic resonance (CMR) between 2003-2021 were included. For strain analysis, endocardial end-diastolic RV contours were delineated in RV 3-chamber (RV3ch), 4-chamber (4ch) and midventricular short axis slice (SAX). RV dyssynchrony was defined as standard deviation of time to peak strain in the walls from one (4ch), two (4ch and SAX) or three views (4ch, SAX and RV3ch). PSC was defined as peak strain occurring after pulmonary valve closure. Outcome was defined as death or lung transplantation. ResultsOne hundred-one patients (58±19 years, 66% women) were included. Median follow-up was 37 [51] months. There were 60 events (55 deaths and 5 lung transplantations). Outcome was associated with RV dyssynchrony from three views and with RV strain in 4ch. An increase of RV dyssynchrony - from 3 views - by 1% was associated with a 10% increased risk of lung transplantation or death. There was no association between outcome and RV dyssynchrony in one or two views nor with PSC. ConclusionRight ventricular dyssynchrony from three views were associated with outcome in PAH, whereas assessing dyssynchrony from one or two views and PSC were not. This implies that assessment of multiple instead of single RV views potentially could be used for prognostication in PAH.

Hypertension induced by peri-pubertal protein restriction depends on renin-angiotensin system dysfunction in adult male rats

Background and aimsHypertension depends on renin-angiotensin system dysfunction; however, little is known about its implications in the outcomes of neurogenic hypertension induced by peri-pubertal insults. This study aimed to evaluate whether hypertension induced by a peri-pubertal low-protein diet is related to renin-angiotensin system dysfunction in adult male Wistar rats. Methods and resultsThirty-day-old male Wistar rats were fed a low-protein diet (4% casein) for 30 days and subsequently fed a 20.5% normal protein diet for a 60-day dietary recovery (LP group). Control animals (NP group) were fed a 20.5% protein diet throughout their lives. Cardiovascular and renin–angiotensin system functions were evaluated on postnatal day 120 (6-24 animals per group). Statistical analyses were performed using the Student’s t-test. Animals with LP show increased arterial blood pressure. The angiotensin 2 dose-response curve of LP animals showed an increase in the pressor response at a lower dose (50 ng/kg) and a reduction in the pressor response at a higher dose (400 ng/kg) compared with NP animals. Angiotensin 2 type 1 receptor mRNA levels were increased in the hearts of LP animals; however, angiotensin 2 type 2 receptor and MAS receptor mRNA levels were reduced. In the aorta, AT1 and AT2 mRNA levels were increased in LP animals, whereas MAS receptor mRNA levels were decreased in comparison to NP animals. ConclusionThe renin-angiotensin system is disrupted in hypertension induced by protein restriction exposure during peri-pubertal life.

Prognostic value of the triglyceride-glucose index for adverse cardiovascular outcomes in young adult hypertension

BackgroundThe triglyceride-glucose (TyG) index is a reliable marker of insulin resistance that is involved in the progression of hypertension. This study aimed to evaluate the association of the TyG index with the risk for major cardiovascular events (MACE) in young adult hypertension.MethodsA total of 2,651 hypertensive patients aged 18–40 years were consecutively enrolled in this study. The TyG index was calculated as Ln [triglycerides × fasting plasma glucose/2]. The cutoff value for an elevated TyG index was determined to be 8.43 by receiver-operating characteristic curve analysis. The primary endpoint was MACE, which was a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, and end-stage renal dysfunction. The secondary endpoints were individual MACE components.ResultsDuring the median follow-up time of 2.6 years, an elevated TyG index was associated with markedly increased risk of MACE (adjusted hazard ratio [HR] 3.440, P < 0.001) in young hypertensive adults. In subgroup analysis, the elevated TyG index predicted an even higher risk of MACE in women than men (adjusted HR 6.329 in women vs. adjusted HR 2.762 in men, P for interaction, 0.001); and in patients with grade 2 (adjusted HR 3.385) or grade 3 (adjusted HR 4.168) of hypertension than those with grade 1 (P for interaction, 0.024). Moreover, adding the elevated TyG index into a recalibrated Systematic COronary Risk Evaluation 2 model improved its ability to predict MACE.ConclusionsAn elevated TyG index is associated with a higher risk of MACE in young adult hypertension, particularly in women and those with advanced hypertension. Regular evaluation of the TyG index facilitates the identification of high-risk patients.Graphical abstract

Pulmonary hypertension and lung transplantation waitlist outcomes for hypersensitivity pneumonitis

RationaleHypersensitivity pneumonitis is an interstitial lung disease that can progress to pulmonary hypertension which increases mortality. The European Society of Cardiology recently reduced the diagnostic criteria for pre-capillary pulmonary hypertension from mean pulmonary artery pressure ≥25mmHg to ≥20mmHg and pulmonary vascular resistance from ≥3Wu to ≥2Wu. ObjectiveWe investigated the effect of the new criteria on hypersensitivity pneumonitis lung transplantation waitlist outcomes. MethodsWe conducted a retrospective cohort study of the Scientific Registry of Transplant Recipients.1175 hypersensitivity pneumonitis patients listed for lung transplantation were divided into three groups based on the presence of pre-capillary pulmonary hypertension; those with pre-capillary pulmonary hypertension based on old criteria, new criteria, and those without pre-capillary pulmonary hypertension based on either criterion. The individual components of pre-capillary pulmonary hypertension were also assessed with three mean pulmonary artery pressure groups (≤20mmHg, >20mmHg to <25mmHg, ≥25 mmHg) and three pulmonary vascular resistance groups (≤2Wu, >2Wu to <3Wu, ≥3Wu). Survival analysis was performed. Measurements and Main ResultsKaplan-Meier analysis showed a difference in waitlist survival probability among the mean pulmonary artery pressure groups and among the pulmonary vascular resistance groups driven by the most severe groups. Multivariate Cox regression showed no difference between the various pre-capillary pulmonary hypertension groups. Pulmonary vascular resistance ≥3Wu was associated with increased waitlist mortality. ConclusionsThe new thresholds of mean pulmonary artery pressure and pulmonary vascular resistance do not appear to prognosticate waitlist outcomes when combined. PVR ≥3Wu is associated with worse waitlist outcomes and may be useful in prognostication.

P146 EFFECT OF HOME BLOOD PRESSURE TELE-MONITORING PATHWAY WITH PHARMACIST CASE MANAGEMENT TO SUPPORT PATIENTS DISCHARGED FROM EMERGENCY DEPARTMENT WITH ASYMPTOMATIC HYPERTENSION: A STUDY PROTOCOL FOR MULTICENTRE RANDOMIZED CONTROLLED TRIAL (TEC4HOME-BP)

Background and Objectives: Severely elevated blood pressure (BP) in the emergency department (ED) has recently been associated with undiagnosed hypertension and adverse cardiovascular outcomes, regardless of the initial reason (e.g.: pain or anxiety) for the ED visit. Clinical uncertainty exists on how best to manage severe asymptomatic BP post-discharge from the ED. In this study protocol, we propose home BP telemonitoring with pharmacist case management intervention on participants discharged from the ED with severe asymptotic hypertension. The overall purpose of this trial is to evaluate whether home BP telemonitoring and pharmacist case management can improve BP management in participants discharged from the ED with severe asymptotic hypertension and whether participants find this intervention to be acceptable. Methods: The study is a multi-centre, randomized controlled trial of 408 participants discharged from the ED with severe hypertension (defined as average of 3 readings systolic blood pressure [SBP] ≥ 160 mm Hg and/or diastolic blood pressure [DBP] ≥ 100 mm Hg over 3 readings). Participants will be randomized to either usual care or home BP telemonitoring and pharmacist case management for 12-months. The primary outcome is proportion achieving disease specific SBP control using 24 h ambulatory BP monitoring (ABPM) at 12-months. Secondary outcomes are change in SBP and DBP based on 24 h ABPM and home BP averages at 6- and 12-months. Patient acceptability and satisfaction will be assessed using EuroQoL 5-level EQ5 version and patient Satisfaction Questionnaire Short Form. Exploratory outcomes include adverse events, prescription of anti-hypertensive medications, fidelity of interventions and health care utilization. Conclusions: Results from this study will advise the integration of home blood pressure telemonitoring and pharmacist case management pathway as key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with asymptomatic severe hypertension in the ED. Trial registration: ClinicalTrials.gov: NCT 06303206

1443P Association between fruquintinib-induced hypertension and clinical outcomes from FRUTIGA, a phase III study of fruquintinib plus paclitaxel in previously treated advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma

1443P Association between fruquintinib-induced hypertension and clinical outcomes from FRUTIGA, a phase III study of fruquintinib plus paclitaxel in previously treated advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma

High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi-month dispensing in Malawi: results from a cross-sectional survey and retrospective chart review.

People living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication. We conducted a cross-sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year. We surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0-1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0-1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year. Uncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.

Addressing Hypertension Disparities via Systems Dynamics: Insights From Community Health Connections.

Background and objective Hypertension remains a major public health challenge in the United States, disproportionately affecting various demographic groups. Significant disparities persist in hypertension prevalence and control due to interactions between socioeconomic factors, healthcare access, and systemic inequities. In this study, we aimed todetermine the impact of socioeconomic and healthcare factors on hypertension control among patients at Community Health Connections (CHC), a Federally Qualified Health Center serving 36 communities in North Central Massachusetts, and identify effective interventions using systems dynamics modeling to promote health equity. Materials and methods This was a retrospective observational study using data from 2023 CHC patients, and the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Systems dynamics modeling was employed to visualize interactions among factors influencing hypertension outcomes. The study included 4,870 CHC patients. Participants were selected based on clinical records and comprised 3,690 White participants (76%), 464 Black/African American participants (10%), 108 Asian participants (2%), and 608 classified as Other/Non-reported (12%). The cohort included 2,490 males (51%) and 2,380 females (49%). Socioeconomic factors (e.g., race, age, insurance status) and healthcare access were the study variables. The primary outcome was hypertension control, defined as a blood pressure reading of <140/90 mmHg. The study measured control rates across different demographic groups and assessed the impact of socioeconomic and healthcare factors on these rates. Results Among the 4,870 CHC patients, 3,007 (62%) achieved hypertension control. The overall hypertension control rate varied significantly by race: White: 68.6%, Black/African American: 61.6%, Asian: 63.2%, and Other/Non-reported: 65.6%. Insured patients had a control rate of 67.7%, compared to 37.5% for uninsured patients (p<0.001). Systems dynamics models illustrated how socioeconomic disparities and healthcare access issues amplify health inequities. Key interventions identified include, but are not limited to, multidisciplinary care teams, community health worker programs, and telehealth services. Conclusions Addressing hypertension disparities among CHC patients requires a systemic approach integrating socioeconomic, healthcare, and policy-related interventions. Systems dynamics modeling provides a framework for designing and implementing targeted interventions, enhancing health equity, and improving hypertension control outcomes in underserved populations. Further research is needed to test the effectiveness of these interventions before their broad implementation.

Impact of preoperative body mass index on long-term survival, quality of life, and functional outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Results from the UK National Cohort

BackgroundPrevious studies have demonstrated the safety of pulmonary endarterectomy (PEA) in all body mass index (BMI) strata. However, long-term survival and patient-reported quality of life outcome measures by BMI strata remain unknown. We sought to examine the impact of preoperative BMI on long-term survival, quality of life, and functional outcomes for patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH). MethodsRetrospective review of 2004 patients from the UK National Cohort between 2007 and 2021 undergoing PEA for CTEPH (mPAP>20 mmHg and PVR>160 dynes). Patients were stratified into BMI<20, 20-29, 30-39, 40-49, and 50+. All-cause mortality was the primary outcome measure. Secondary outcome measures were 3-6 month postoperative hemodynamics, 6-minute walk distance (6MWD), New York Heart Association (NYHA) class, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scores. Kruskal-Wallis, ANOVA, and Kaplan Meier Estimate were used for comparisons. ResultsPostoperative hemodynamics and 6MWD at 3-6 months were similar across BMI strata. However, patients with BMI 50+ reported the highest incidence of post-operative NYHA III/IV limitation (53.3%, p<0.001) and the highest residual symptom burden by CAMPHOR (p<0.001). Overall 5-year survival was lowest in patients with BMI 50+ (70.2%) and BMI<20 (73.4%), whilst highest in BMI 30-39 (88.2%, p=0.008). 10-year Kaplan-Meier Estimates predicted lowest survival in BMI 50+ and BMI<20. ConclusionPEA remains safe and effective for all patients regardless of BMI. Despite similar hemodynamic outcomes, patients with BMI 50+ are at greatest risk of long-term all-cause mortality and patients with BMI 50+ experience residual symptomatic limitation.

Venous sinus stenting versus ventriculoperitoneal shunting: comparing clinical outcomes for idiopathic intracranial hypertension

BackgroundVenous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns...

Public health and system approach in eliminating disparities in hypertensive disorders and cardiovascular outcomes in non-Hispanic Black women across the pregnancy life course

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Risk factors and clinical outcomes of pulmonary hypertension associated with bronchopulmonary dysplasia in extremely premature infants: A systematic review and meta-analysis.

This systematic review and meta-analysis evaluated the risk factors for bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH) in extremely premature infants (gestational age < 32 weeks) and its impact on outcomes. A computerized search of eight databases was performed, from the time of library construction to February 2024. The quality of the included studies was assessed with the Newcastle‒Ottawa scale. Statistical analyses were performed using RevMan 5.4.1 and Stata 16.0 software. Meta-analysis of 2137 extremely premature infants revealed that oligohydramnios (OR = 2.21, 95% CI 1.06-4.61), low gestational age (SMD = -0.36, 95% CI -0.47 to -0.24), low birth weight (SMD = -0.54, 95% CI -0.74 to -0.35), small for gestational age (OR = 1.61, 95% CI 1.06-2.44), neonatal respiratory distress syndrome (OR = 2.05, 95% CI 1.45-2.91), gradeIII bronchopulmonary dysplasia (OR = 4.67, 95% CI 1.34-16.30), and sepsis (OR = 2.25, 95% CI 1.69-4.66) were risk factors for BPD-PH, whereas antenatal steroids (OR = 0.66, 95% CI 0.49-0.88) were protective factors. BPD-PH led to the extension of oxygen therapy (SMD = 0.67, 95% CI 0.42-0.92) and hospital stay (SMD = 0.77, 95% CI 0.14-1.40), and elevated the risk of discharged on oxygen (OR = 2.77, 95% CI 1.35-5.70) and death (OR = 4.38, 95% CI 2.21-8.69). BPD-PH is a multifactorial disease. In this study, a total ofseven risk factors, and one protective factor for BPD-PH were identified in extremely premature infants. By managing and mitigating these factors, it is possible to decrease the occurrence of BPD-PH. Furthermore, BPD-PH may increase the risk of a poor prognosis in extremely premature infants.

Exploring the Challenges of Recruiting Older People for a Randomised Trial Assessing the Feasibility of Treating White Coat Hypertension in the UK General Practices: A Mixed-methods study.

There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients > 75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow-up study, we sought to explore the reasons for not recruiting. Furthermore, using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS), UK, were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics. Nineteen (19) individuals responded to the online questionnaires (15 primary care staff, 4 CRN staff). Moreover, using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes are established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient- facing study documents, limited research resources in primary care, and identification of eligible patients using existing coding. Our experience showed that recruiting older people from primary care to a WCH study was not feasible. A national scoping survey amongst primary care physicians in the UK, as well as robust patient and public involvement (PPI) targeting older people with WCH, might improve recruitment in future studies addressing the management of WCH in older people.

Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial

BackgroundThe World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated.ObjectiveTo compare hypertension outcomes in clinics implementing HEARTS...

Remote Patient Monitoring Is Associated with Improved Outcomes in Hypertension: A Large, Retrospective, Cohort Analysis.

Hypertension (HTN) is a chronic condition that requires careful monitoring and management. Blood pressure readings in the clinic and self-reported blood pressure readings are often too intermittent to allow for careful management. Remote patient monitoring is a solution that may have positive impacts on HTN management. Individuals at cardiac and primary care clinics were prescribed a remote patient-monitoring (RPM) program. Patients were sent blood pressure monitors that were enabled to transmit data over cellular networks. We reviewed trends in HTN management retrospectively in patients who had previously been on conventional therapy for a year and participated in RPM for a minimum of 90 days. There were 6595 patients enrolled, and the mean duration on RPM was 289 days. A total of 4370 participants (66.3%) had uncontrolled HTN, and 2476 (37.5%) had stage 2 HTN. After at least 90 days on the RPM program, the number of patients with uncontrolled HTN reduced to 2648 (40.2%, p < 0.01), and the number of patients with stage 2 HTN reduced to 1261 (19.1%, p < 0.01). Systolic blood pressure improved by 7.3 mmHg for all patients and 16.7 mmHg for stage 2 HTN. There was improvement in mean arterial pressure (MAP) in all patients with uncontrolled HTN by 8.5 mmHg (p < 0.0001). RPM is associated with improved HTN control and provides further evidence supporting telehealth programs which can aid in chronic disease management.

Management and Outcomes of Delayed Cerebral Ischemia Associated with Vasospasm Post Nontraumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study in the National Neurosurgical Center in Ireland

Abstract Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit. Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined. Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone. Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.

Anesthesia Management in Antenatal Care for Women With Chronic Kidney Disease: A Comprehensive Review.

Chronic kidney disease (CKD) presents significant challenges in the management of pregnant women due to its impact on renal function and cardiovascular stability. This review examines the crucial role of anesthesia management in antenatal care for women with CKD, focusing on the complexities introduced by renal dysfunction and the implications for maternal and fetal health outcomes. The review discusses the physiological changes in CKD during pregnancy, highlighting the increased risks of hypertension, proteinuria, and adverse fetal outcomes. Anesthesia considerations, including the choice of anesthesia techniques (general anesthesia, regional anesthesia), perioperative monitoring, and management of fluid and electrolyte balance, are analyzed in the context of CKD-specific challenges. Clinical outcomes and current evidence regarding anesthesia efficacy and safety in CKD patients are reviewed, emphasizing the need for tailored anesthesia protocols to ensure optimal maternal comfort and fetal safety. The review concludes by identifying research gaps and proposing future directions to enhance anesthesia practices and improve outcomes for pregnant women with CKD undergoing surgical interventions or labor management.