Physician Inertia Research Articles

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: a pilot cluster RCT of the MIAMI intervention

BackgroundHypertension, or high blood pressure, is a key modifiable risk factor for heart disease and stroke. International guidelines have highlighted ‘poor adherence to treatment’ and ‘physician inertia’ as major barriers to effective blood pressure management. The Maximising Adherence, Minimising Inertia (MIAMI) intervention, a theory-based complex intervention, supports General Practitioners (GPs) and people with hypertension in maximising medication use to manage blood pressure. This pilot cluster randomised control trial (RCT) aimed to collect and analyse feasibility data to refine the MIAMI intervention and assess the feasibility of a definitive RCT.MethodA pilot cluster RCT with a MIAMI intervention arm and usual care control arm was conducted. Quantitative data collection consisting of clinical measures and a self-report questionnaire took place at baseline and twelve week follow up. Semi-structured interviews with GP and patient participants were conducted. Fidelity (as measured by a protocol checklist and through qualitative interviews) and health economics costings were assessed.ResultsSix GP practices (intervention arm n = 3, control arm n = 3) and 52 patients (intervention arm n = 25, control arm n = 27) took part. All six GP practices and 92% of patients were retained. Fidelity, as measured by a checklist and through qualitative interviews, was good but three deviations from protocol were identified. Outcomes and measures used were acceptable. The implementation cost of the MIAMI intervention was estimated at €490 per participant. The qualitative data demonstrated that the intervention was considered acceptable and feasible by both GP and patient participants, except for the urine test component, which GPs found difficult to incorporate into practice due to logistical challenges.ConclusionsThe MIAMI intervention was considered largely acceptable and feasible. Some changes to both intervention components and trial processes are required but with these in place a definitive RCT could be considered worthwhile.Trial registrationISRCTN registry, ISRCTN85009436, registered 17/1/23.

Physician-reported barriers and facilitators to thyroid hormone deprescribing in older adults.

Thyroid hormone is one of the most commonly prescribed medications in the United States. Misuse of and overtreatment with thyroid hormone is common in older adults and can lead to cardiovascular and skeletal adverse events. Even though deprescribing can reduce inappropriate care, no studies have yet explored specific barriers and facilitators to guide thyroid hormone deprescribing in older adults (defined as discontinuation of thyroid hormone when initiated without an appropriate indication or dose reduction in those overtreated). We conducted semi-structured interviews with 19 endocrinologists, geriatricians, and primary care physicians who prescribe thyroid hormone. Interviews were completed between July 2020 and December 2021 via two-way video conferencing. We used both an inductive and deductive content analysis guided by the Theoretical Domains Framework to evaluate transcribed and coded participant responses. Thematic analysis characterized themes related to barriers and facilitators to thyroid hormone deprescribing practices in older adults. The most commonly reported barriers to thyroid hormone deprescribing were related to patient-level factors, followed by physician- and system-level factors. Patient factors included patients' perceived need for thyroid hormone use and patient anxiety/concerns about potential side effects related to thyroid hormone dose reduction, patient lack of knowledge, and misinformation regarding deprescribing. Physician- and system-level barriers included clinic visit time constraints, physician inertia, physician lack of knowledge about deprescribing, perceived lack of sufficient patient follow-up, and electronic health record limitations. The most prominent physician-reported facilitators to thyroid hormone deprescribing were effective physician-to-patient communication, and positive physician-patient relationship, including patients' trust in their treating physician. Barriers and facilitators to thyroid hormone deprescribing in older adults were reported at multiple levels including patient-, physician-, and system-level factors. Interventions to improve thyroid hormone deprescribing in older adults should aim to improve patient education and expectations, increase multidisciplinary physician awareness, and overcome physician inertia.

P209 A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE PHYSICIANS BY MEANS OF VASCULAR AGE (RIESCO/TOGETHER)

Background and Objective: Estimating arterial stiffness in Community Farmacies (CPh) has been shown to improve hypertension (HTN) management in Portugal, Austria and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases HTN control, establishing paths of lasting cooperation between Primary Care (PC) doctors and CPh. Methods: TOGETHER is a cluster-randomized, prospective study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with high values. CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The therapeutic options of EVA will be explained to patients/PC. HTN will be treated by PC according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months and HTN control will be compared between the arms. The degree of patient-doctor interaction will be determined through validated surveys. Results Five fundamental unmet needs will be addressed by TOGETHER: 1) lack of HTN screening programs; 2) Implementation of the simpler and more informative EVA concept (“Your arteries are 10 years older than you”); 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) Implementation of health educational programs, combined with the concept of EVA; 5) Higher collaboration and development of a team-based approach to HTN care between CPh and PC. Conclusions: The complementary organizational settings and strengths of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.

TRUE REFRACTORY HYPERTENSION IN 2023- LESSONS LEARNED FROM A NATIONAL REGISTRY OF 1.82 MILLION ADULTS

Objective: Refractory hypertension (refHTN) is defined as blood pressure that remains uncontrolled on maximal therapy, which is defined as the use of 5 or more antihypertensive agents of different drug classes. We aimed to define the prevalence of apparent and true refHTN in a real life national registry of an Health Maintenance Organization (HMO). Design and method: In this real-life observational study we utilized the Maccabi Healthcare Services (MHS) database during 2023. Data includes pharmacy prescriptions and purchases. Apparent refHTN was defined as patients included in the Maccabi “Hypertension Registry” during 2023 and taking 5 different antihypertensive medications of different classes, of which four were from pre-specified groups (diuretics, CCB, RAAS inhibitors and MRAs). True refHTN (unlike apparent refHTN) was defined as being fully adherent to the antihypertensive medication regimen with at least 6 prescriptions and purchases (refills) during 2023 as well as blood pressure which was not optimally controlled during the year (less than 80% of blood pressure measurements equal or below the well-defined target of 130/80mmHg). Results: Out of 1,821,685 adult members of Maccabi HMO during 2023, 361,721 patients were defined as hypertensive patients (20%) and included in the registry. 0.5% (1750) of the hypertensive population were at some stage during 2023 on at least 5 anti-hypertensive medications (i.e., apparent refHTN). Of those only 264 patients (15%) were adherent to their medications during the whole year. Mean age was 71.3 years. Of the well adherent group, 205 patients (77%) were not optimally controlled and thus regarded as true refHTN. Therefore in total, true refHTN was evident in 0.056% of hypertensive population in Maccabi HMO. Conclusions: In an “optimal world” which lacks physician inertia, four medication regimen is prescribed (Diuretics, CCB, RAAS inhibitors and MRAs) and there is willingness to prescribe a fifth and a sixth medication, if needed (alpha blockers, beta blockers, central alpha-2 agonists or direct vasodilators). In the unlikely case of full adherence to all medications, true refHTN is extremely rare (0.056% of hypertensive patients). This suggests that most hypertensive patients can be well controlled using the current anti hypertensive armamentarium.

VASCULAR AGE AS A KEY FOR A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE AND CARDIOVASCULAR RISK BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE CENTERS (TOGETHER)

Objective: Hypertension (HTN) is the main cause of premature death worldide. Previous studies in Portugal, Austria and Spain have shown that estimating arterial stiffness in Community Farmacies (CPh) improves its management. The main objective is to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases the rate of HTN control. Secondary objective is to establish paths of lasting cooperation between Primary Care (PC) doctors and CPh. Design and method: TOGETHER is a randomized study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered blood pressure measurement and ambulatory blood pressure monitoring (ABPM) for those cases with high values. 140 CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The concept and therapeutic options of EVA will be explained to patients and PC. HTN will be treated by PC according to usual clinical practice. After 6 months a second evaluation with ABPM will be performed and HTN control will be compared between the two arms. The degree of patient-doctor interaction and economic implications will be determined through validated surveys. Results: TOGETHER will address five fundamental unmet needs: 1) lack of HTN screening programs; 2) the concept of cardiovascular risk is difficult to understand. The EVA concept (“Your arteries are 10 years older than you”) is simple and more informative; 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) TOGETHER will implement health educational programs, combined with the concept of EVA; 5) there is an objective need to improve collaboration and develop a team-based approach to HTN care between CPh and PC. Conclusions: The complementary strengths and organizational settings of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.

Adherence to Current Dyslipidemia Guideline in Patients Utilizing Statins According to Risk Groups and Gender Differences: The AIZANOI Study.

The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population. The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021. A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of high-risk patients have been using a high-intensity statin regimen, only 24.5% of very-high-risk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%). The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients.

Experts' Perspectives on the Current Practices and Gaps in the Management of Dyslipidemia: A Report from The United Arab Emirates

<P>Background: The prevalence of dyslipidemia in the United Arab Emirates (UAE) can be as high as 72.5%. Patients with dyslipidemia usually present with other metabolic risk factors, increasing their risk of acute cardiovascular diseases (CVD). Despite these alarming findings, local data regarding management practices in the UAE are lacking. The current report gathered the perspectives of experts from the UAE regarding the burden and current practices in managing dyslipidemia, as well as the current unmet needs and treatment gaps. <P> Methods: The present perspective is based on a consensus meeting that gathered the insights of six consultant cardiologists. All experts were affiliated with academic institutions representing the UAE's different geographical areas. <P> Findings and Conclusion: Data regarding the prevalence of dyslipidemia in the UAE and its associated ethnic differences are lacking. It is suggested that there needs to be more adherence to international recommendations for screening lipid profiles in primary care centers, which may lead to underestimating the burden of dyslipidemia. As CVD presents at a younger age in the UAE, screening for lipid profile at 35 is recommended, regardless of CVD risk. The panel emphasized that most dyslipidemia patients in the UAE are categorized as high or very high-risk groups for CVD; however, current risk assessment tools have not been validated in the UAE population and may not be tailored to the Middle Eastern and Asian populations. International guidelines have recommended the high-intensity statins-ezetimibe combination for high and very high-risk patients; the experts stated that the high-intensity statins-ezetimibe combination could be initiated in high-risk groups in the UAE. Several barriers to effectively controlling dyslipidemia in the UAE have been identified, including non-adherence, limited awareness about screening and management recommendations, and physician inertia toward achieving the recommended therapeutic goals.</P>

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: Protocol for a pilot cluster RCT of the MIAMI intervention.

Background: Hypertension is one of the most important risk factors for stroke and heart disease. Recent international guidelines have stated that 'poor adherence to treatment - in addition to physician inertia - is the most important cause of poor blood pressure control'. The MaxImising Adherence, Minimising Inertia (MIAMI) intervention, which has been developed using a systematic, theoretical, user-centred approach, aims to support general practitioners (GPs) and people with hypertension to maximise medication use, through the facilitation of adequate information exchange within consultations about long-term antihypertensive medication use and adherence skill development. The aim of the MIAMI pilot cluster randomised controlled trial (RCT) is to gather and analyse feasibility data to allow us to (1) refine the intervention, and (2) determine the feasibility of a definitive RCT. Methods: GP practices (n = 6) will be recruited and randomised to the intervention arm (n = 3) or usual care control arm (n = 3). Each practice will recruit 10 patient participants. For a patient to be eligible they must have a diagnosis of hypertension, be on two or more anti-hypertensive medications, must not be achieving recommended blood pressure levels, and be over the age of 65 years. Participants in the intervention arm will meet their GP and receive the MIAMI intervention twice over three months. Quantitative data collection will take place at baseline and three month follow up. A pilot health economic analysis and a qualitative sub-study will also be incorporated into the study. Discussion: This pilot cluster RCT of the MIAMI intervention will allow us to gather valuable acceptability and feasibility data to further refine the intervention so it optimally designed for both GP and patient use. In particular, the qualitative component will provide an insight into GP and patient experiences of using the intervention.

PREVALENCE OF PATIENT WITH TREATMENT-RESISTANT HYPERTENSION AND SCREENING RATE FOR PRIMARY HYPERALDOSTERONISM IN THAI AMBULATORY CARE SETTING

Objective: Patients with treatment-resistant hypertension (TRH) have significantly higher mortality outcomes when compared with controlled hypertension. Primary hyperaldosteronism (PA) is one of the common treatable causes of this condition. Although the practice guidelines recommend testing for PA among those with TRH, the screening rates in Thailand's ambulatory care setting are unknown. Design and method: This is a single-center cross-sectional study. All hypertensive adults followed at ambulatory clinics of a tertiary care hospital between January 2020, and May 2022 were screened. Patients who met one of two following criteria were diagnosed as TRH: 1) uncontrolled blood pressure (BP) despite the use of 3 antihypertensive drug classes, including diuretics 2) concurrent use of greater than or equal to 4 antihypertensive drug classes, regardless of BP control. Patients without data of consecutive office BP records at least one month apart or lack of laboratory results were excluded. Hypokalemia was defined as a low serum potassium level identified on at least 2 visits. Results: Among 2,047 patients diagnosed with hypertension, the prevalence of TRH was 9.4% (192 patients) with a mean (±SD) age of 74 (±10) years, 59% were women, and the mean number of antihypertensive agents was 3.8±0.7. The screening rate for PA in TRH and non-TRH groups were 3.1% and 0.8%, respectively (p = 0.001). Among those with TRH, the screened PA group significantly had more prevalence of hypokalemia than the non-screened group (33.3% vs 2.7%, p<0.001). From subgroup analysis of all patients with hypokalemia and without hypokalemia, the testing rates for PA were 18.2% and 0.6%, respectively (p<0.001). The average duration from first hypokalemia detection to receiving testing for PA was 19 months. Five of the 20 patients received screening were diagnosed with PA and had better BP control after receiving appropriate treatment. Conclusions: This is the first study in Thailand to examine a PA screening rate in a real-life, ambulatory care setting. The low screening rate reflects the unawareness and inertia of physicians to adhere to guideline-recommended practices. Initiatives to encourage PA screening should be more emphasized and barriers that caused low screening rate should be further explored.

Organisational and pedagogic conditions for forming the skills of foreign language professional communication in future physicians

The paper discusses the role of foreign language professional communication among future physicians. The authors actualise their attention to the development and implementation of organisational and pеdаgogic conditiоns for the fоrmаtion of fоreign lаnguаge profеssionаl cоmmunicаtion skills in future physicians because of the insufficient development of this problem in the field of foreign language education. To solve this problem, it is necessary to search for pedagogic conditions that would contribute to overcoming the linguistic inertia of future physicians in professional communication. The mаin purpоse of the аrticle is to idеntify the organisatiоnаl and pedаgogic conditiоns for the fоrmаtion of fоreign lаnguаge profеssionаl cоmmunicаtion skills in future physicians. The method of theoretical analysis of scientific and methodological sources and works and normative documents is applied. The concepts of “condition”, “formation”, “organisational and pedagogic condition” are specified. The organisational and pedаgоgic cоnditiоns for the fоrmаtion of fоreign languаge prоfessionаl communicаtion skills in futurе physicians аre substаntiated.

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: Protocol for a pilot cluster RCT of the MIAMI intervention

Background: Hypertension is one of the most important risk factors for stroke and heart disease. Recent international guidelines have stated that 'poor adherence to treatment – in addition to physician inertia - is the most important cause of poor blood pressure control'. The MaxImising Adherence, Minimising Inertia (MIAMI) intervention, which has been developed using a systematic, theoretical, user-centred approach, aims to support general practitioners (GPs) and people with hypertension to maximise medication use, through the facilitation of adequate information exchange within consultations about long-term antihypertensive medication use and adherence skill development. The aim of the MIAMI pilot cluster randomised controlled trial (RCT) is to gather and analyse feasibility data to allow us to (1) refine the intervention, and (2) determine the feasibility of a definitive RCT. Methods: GP practices (n = 6) will be recruited and randomised to the intervention arm (n = 3) or usual care control arm (n = 3). Each practice will recruit 10 patient participants. For a patient to be eligible they must have a diagnosis of hypertension, be on two or more anti-hypertensive medications, must not be achieving recommended blood pressure levels, and be over the age of 65 years. Participants in the intervention arm will meet their GP and receive the MIAMI intervention twice over three months. Quantitative data collection will take place at baseline and three month follow up. A pilot health economic analysis and a qualitative sub-study will also be incorporated into the study. Discussion: This pilot cluster RCT of the MIAMI intervention will allow us to gather valuable acceptability and feasibility data to further refine the intervention so it optimally designed for both GP and patient use. In particular, the qualitative component will provide an insight into GP and patient experiences of using the intervention.

Pragmatic and Early Usage of Statin in Patients with Diabetes for Prevention of Atherosclerotic Cardiovascular Disease

Background: An early initiation of statins in the diabetes population helps in prevention of atherosclerotic cardiovascular disease (ASCVD). However, there is a paucity of data on its use in young Indian patients with diabetes. This survey report aimed to provide opinion-based recommendations for pragmatic usage of statin in diabetes population of India. Material and Methods: Discussion and virtual survey (a questionnaire of 18 questions) was conducted at 16 round table meetings (RTMs) which included participation of health-care practitioners (HCPs) from India. On the basis of their opinions and discussion, general recommendations about early usage of statins in diabetes for prevention of ASCVD were derived. Results: Out of 261 HCPs participated, 56.1% recommended initiating statins in patients aged 41–50 years irrespective of their total/low-density lipoprotein cholesterol (LDL-C) levels. Among people with diabetes aged between 20 and 39 years, 38.9% of HCPs considered LDL-C >100 mg/dL and 77% of HCPs considered history of ASCVD as a risk factor for early statin initiation. Overall, 98.9% of HCPs agreed that early initiation of statin in people with diabetes and ASCVD risk factors will help reduce ASCVD. The majority of HCPs recommended initiating moderate-intensity (51.2%) and low-intensity (43.8%) statins and assess every 3 months for tolerance and compliance in people with diabetes (aged 20–39 years) and additional ASCVD risk factors. The use of rosuvastatin (78.5% of HCPs) was preferred for early initiation in people with diabetes. Majority of HCPs agreed (57.3%) or strongly agreed (36.2%) that rosuvastatin has more clinical utility compared to other statins due to better LDL-C-lowering effect and other pleiotropic effects. Physician's inertia limits the effective use of statins among young adults with diabetes (55.8%), and 65.8% of HCPs recommended screening of people with diabetes for additional ASCVD risk factors. Conclusion: The participating HCPs opined that early initiation of statin therapy in people with diabetes and ASCVD risk factors will help reduce ASCVD. Rosuvastatin is mostly recommended for early initiation of statin therapy among the diabetes population for prevention of ASCVD. There is a necessity of using a proactive approach to screen for additional ASCVD risk factors in young individuals with diabetes and further increase the awareness about benefits of initiating statin therapy from an early stage.

A practical approach to the guideline-directed pharmacological treatment of heart failure with reduced ejection fraction.

Over the last 15-20years, remarkable developments of heart failure (HF) pharmacotherapies have been achieved. However, HF remains a global healthcare challenge with more than 64 million patients worldwide. Optimization of guideline-directed chronic HF medical therapy is highly recommended with every patient visit to improve outcomes in patients with HF with reduced ejection fraction. However, the majority of patients in real-world settings are treated with doses that are lower than those with proven efficacy in clinical trials, which might be due to concerns of adverse effects and inertia of physicians. Likewise, a significant proportion of patients still do not receive all drug classes that could improve their prognosis. The recent European Society of Cardiology guidelines do not provide detailed recommendations on how these drug classes should be implemented in the treatment of inpatients to allow for both safety and a high likelihood of efficacy. We therefore propose a practical approach algorithm to support physicians to treat HF patients in their daily practice.

New perspectives for hypertension management: progress in methodological and technological developments.

Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.

Implementation of the 2018 ESC/ESH Guidelines for the management of hypertension in primary care: the HYPEDIA study

The HYPEDIA study aimed at evaluating the implementation of the 2018 European guidelines for treating hypertension in primary care. A nationwide prospective non-interventional cross-sectional study was performed in consecutive untreated or treated hypertensives recruited mainly in primary care in Greece. Participants’ characteristics, office blood pressure (BP) (triplicate automated measurements, Microlife BPA3 PC) and treatment changes were recorded on a cloud platform. A total of 3,122 patients (mean age 64 ± 12.5 [SD] years, 52% males) were assessed by 181 doctors and 3 hospital centers. In 772 untreated hypertensives (25%), drug treatment was initiated in the majority, with monotherapy in 53.4%, two-drug combination in 36.3%, and three drugs in 10.3%. Angiotensin receptor blocker (ARB) monotherapy was initiated in 30%, ARB/calcium channel blocker (CCB) 20%, ARB/thiazide 8%, angiotensin converting enzyme inhibitor (ACEi)-based 19%. Of the combinations used, 97% were in single-pill. Among 977 treated hypertensives aged <65 years, 79% had BP ≥ 130/80 mmHg (systolic and/or diastolic), whereas among 1,373 aged ≥65 years, 66% had BP ≥ 140/80 mmHg. ARBs were used in 69% of treated hypertensives, CCBs 47%, ACEis 19%, diuretics 39%, beta-blockers 19%. Treatment modification was decided in 53% of treated hypertensives aged <65 years with BP ≥ 130/80 mmHg and in 62% of those ≥65 years with BP ≥ 140/80 mmHg. Renin-angiotensin system blocker-based therapy constitutes the basis of antihypertensive drug treatment in most patients in primary care, with wide use of single-pill combinations. In almost half of treated uncontrolled hypertensives, treatment was not intensified, suggesting suboptimal implementation of the guidelines and possible physician inertia.

An Effective Strategy to Activate Physicians to Promote High Cardiovascular Risk Patients to Quit Smoking.

Adult patients cared for by cardiologists, neurologists, and diabetologists are highly vulnerable to cardiovascular diseases (CVDs), which are worsened by smoking. In the past, physicians of these three specialties at major hospitals in Taiwan always referred patients to family medicine and chest medicine departments for smoking cessation programs. However, the participation rate in these programs was unsatisfactory. To encourage cardiologists, neurologists, and diabetologists to provide smoking cessation treatment services (SCTSs) to their patients through an annual contest. Sequential expert meetings, group training, a contest to reward service quantity and abstinence rate, and an annual awards ceremony were held over the past 3 years. More than 350 cardiologists, neurologists, and diabetologists were certified to provide SCTSs, and in the second half of 2020, 3716 high CVD risk patients entered smoking cessation treatment programs, with an abstinence rate exceeding 30% at 3 months. The strategy used in this study was effective in overcoming physician inertia to provide SCTSs and encourage high CVD risk smokers to quit smoking.

Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities.

Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.

Hypertension control during the COVID-19 pandemic: results of the MMM2021 in Russia

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p&lt;0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic.Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Hypertension control during the COVID-19 pandemic: results of the MMM2021 in Russia

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p&lt;0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic.Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

IDF21-0400 Cross-sectional ObservaTional Study to assess Effectiveness, Safety of VildaglIptin/ MetfOrmin In T2D Patients – ACTION

Background: The high burden of T2D in South East Asians has been debated on several mechanisms including reduced beta cell function, impaired insulin resistance owing to low oxidative skeletal fibre mass and/or ectopic fat deposition making the choice of DPP-4/Biguanide, a relevant combination especially in Indian settings. In addition, the treatment challenges on physician and patient inertia often alludes for complimentary strategies to reduce pill burden while complying with International recommendations on target goals especially with early intensification of therapy as highlighted by AACE.