Poor Blood Pressure Control Research Articles

Abstract P101: The Association Between Residing in a Food Desert and Hypertension in Victims of Sudden Death

Introduction: Sudden deaths, defined as unexpected deaths not attributable to suicide, trauma or cancer account for over 10% of deaths in adults aged 18-64 years. More evidence is needed to understand how socioeconomic factors interplay with physiological processes such as hypertension to contribute to sudden death. We hypothesized that residing in a food desert would be associated with hypertension and poor blood pressure (BP) control in people who died of sudden death. Methods: We screened Emergency Medical Services (EMS) records from 2013 to 2015 in Wake County, NC, which includes the capital city of Raleigh and >1 million residents, and adjudicated 399 sudden death victims using a standardized protocol. We collected medical history and BP measures from health records and linked geocoded patient addresses to census-tract data from the USDA’s Food Access Research Atlas. Of these, 350 victims had address data available, and of these 196 had blood pressures available. Residing in a food desert was defined as living in a low income and low access area, which is defined as no access to grocery stores within 1 mile in urban areas and 10 miles in rural areas. The ten most recent systolic BP measures prior to death were used to calculate average BP. We calculated unadjusted differences in mean BP by residence in a food desert. We also calculated unadjusted odds ratios (ORs) comparing the probability of having a hypertension diagnosis and of having controlled BP (systolic BP <130 mmHg) by residence in a food desert. Results: We examined 350 sudden decedents who were 33% Black (116 of 350), 64% White (224 of 350), 31% women (109 of 350), and a median age of 55. Of these, seventy-nine (23%) resided in a food desert, and these were more likely to have diabetes mellitus (38.0% vs. 26.6%), (30 of 79 and 72 of 271 respectively). Sudden decedents who resided in a food desert had higher systolic BP with a mean of 140 mmHg compared with 134 mmHg for those who did not reside in a food desert (mean difference 6.15, CI 6.012-6.298). Of those residing in a food desert, 60.8% (48 of 79) had a medical diagnosis of hypertension, and 33.3% (14 of 48) had controlled BP. There was no association between residing in a food desert and a diagnosis of hypertension (OR 1.04, 95% CI 0.62-1.74) or controlled BP (OR 1.73, 95% CI 0.85-3.54). Conclusion: Almost a quarter of sudden decedents resided in a food desert at the time of death. In this case group, residing in a food desert was associated with a small BP increase but not with diagnosed hypertension or controlled BP. Large population studies are necessary to investigate the risk of sudden death and poor blood pressure control associated with residing in a food desert.

Mechanisms of inflammation modulation by different immune cells in hypertensive nephropathy.

Hypertensive nephropathy (HTN) is the second leading cause of end-stage renal disease (ESRD) and a chronic inflammatory disease. Persistent hypertension leads to lesions of intrarenal arterioles and arterioles, luminal stenosis, secondary ischemic renal parenchymal damage, and glomerulosclerosis, tubular atrophy, and interstitial fibrosis. Studying the pathogenesis of hypertensive nephropathy is a prerequisite for diagnosis and treatment. The main cause of HTN is poor long-term blood pressure control, but kidney damage is often accompanied by the occurrence of immune inflammation. Some studies have found that the activation of innate immunity, inflammation and acquired immunity is closely related to the pathogenesis of HTN, which can cause damage and dysfunction of target organs. There are more articles on the mechanism of diabetic nephropathy, while there are fewer studies related to immunity in hypertensive nephropathy. This article reviews the mechanisms by which several different immune cells and inflammatory cytokines regulate blood pressure and renal damage in HTN. It mainly focuses on immune cells, cytokines, and chemokines and inhibitors. However, further comprehensive and large-scale studies are needed to determine the role of these markers and provide effective protocols for clinical intervention and treatment.

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

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

Overview of the Evolution of Hypertension: From Ancient Chinese Emperors to Today.

Hypertension is one of the most commonly treated conditions in modern medical practice, but despite its long history, it was largely ignored until the midpoint of the 20th century. This article will review the origins of elevated blood pressure from when it was first appreciated in 2600 BC to its most recent emerging treatments. Awareness of sustained elevations in blood pressure goes back to the Chinese Yellow Emperor's Classic of Internal Medicine (2600 BC); even then, salt was appreciated as a contributor to elevated pressure. Early treatments included acupuncture, venesection, and bleeding by leeches. About 1000 years later, the association between the palpated pulse and the development of heart and brain diseases was described by Ebers Papyrus (1550 BC). But really, it has only been since well after World War II that hypertension has finally been appreciated as the cause of so much heart, stroke, and kidney disease. We review the development of effective treatments for hypertension while acknowledging that so many people with hypertension in need of treatment have unacceptably poor blood pressure control. We explore why, despite our considerable and growing knowledge of hypertension, it remains a significant public health problem globally.

Prevalence of Dyslipidemia, Drug Therapy Problems, and Medication Adherence in Type 2 Diabetes Mellitus Patients in North Central Nigeria

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

A Cross-Sectional Study about Demographic and Medical Characteristics of Hypertensive Pregnant Women in Two Secondary Healthcare Facilities, in Ilorin, Nigeria

Background Hypertension is one of the major causes of related maternal deaths worldwide and it is one of the most common medical disorders encountered during pregnancy. Aim This study aimed at assessing the demographic and medical characteristics of hypertensive pregnant women in two secondary healthcare facilities, in Ilorin, Nigeria Method This was a cross-sectional study among 104 pregnant women with hypertension attending the outpatient department of General Hospital and Civil Service Clinic, Ilorin between March and May 2021. A validated self-administered questionnaire was used to obtain information on sociodemographics. Data on the medical characteristics of the respondents and their medications were extracted from the respondent's medical files. Ethical approval was obtained from the Ministry of Health and General Hospital, Ilorin. For statistical analysis for categorical measurements, the frequencies and percentages were computed. Results Seventy-five percent of the correspondents were below 36 years old, 97% were married, 79% had tertiary education, and 74% were above 24 weeks of gestation. About 68% of the correspondents had blood pressure more than or equal to 140/90 and 10% had blood pressure more than 160 mm Hg systolic or more than 100 mm Hg diastolic. About 78.8% of the correspondents had a family history of hypertension, 13.5% had a family history of diabetes mellitus, and 22.1% had a family history of obesity. About 27.9% had pre-existing hypertension, 61.5% developed hypertension before the end of 20 weeks of gestation, and 10.6% developed hypertension after 20 weeks of gestation. About 24% had their antihypertensive medication changed during pregnancy, 38.5% were treated with methyldopa, 31.7% with nifedipine, and 27% with nifedipine and methyldopa. Majority (83.6%) of the respondents were not adherent to their medications. Conclusion Two-third of the patients had poor blood pressure control irrespective of the fact that all were under drug therapy. Family history and large body mass index are the main risk factors for the development of hypertension during pregnancy. Noncompliance may play a significant role in no drug response.

Evaluation of compliance and adherence to medications in diabetic and/or hypertensive patients during the lockdown period and the effect of COVID-19 lockdown on blood glucose levels and blood pressure levels

Background: To contain the COVID-19 pandemic, a nationwide lockdown was imposed, which affected the lives of people with diabetes and hypertension as the patients were not able to regularly follow up with the doctor. Aims and Objectives: This prospective observational study was conducted to find out the compliance and adherence to oral hypoglycemic agents and antihypertensives during lockdown, to consult with doctors during lockdown, and also to analyze the effect of lockdown on blood glucose levels and blood pressure control by comparing the pre- and post-lockdown blood pressure and blood glucose levels. Materials and Methods: A prospective observational study was conducted on 100 participants aged between 35 and 85 years. They were studied by a questionnaire for a period of 3 months. The majority belonged to the 55–65 years of age group, and a male predominance was seen across all age groups. The changes in lifestyle habits of the participants during lockdown and complications due to diabetes and hypertension were also studied. Results: There was a statistically significant decrease in the adherence to prescribed medications during lockdown due to various reasons, the most important of which was the lack of access to personal consultation with the doctor during lockdown. Patients also could not follow their diet and physical exercises due to lockdown. All these factors led to poor control of blood pressure and blood glucose levels, as evidenced by comparing the pre- and post-lockdown blood glucose levels and blood pressure. Conclusion: This study concludes that there was a significant decrease in adherence to medications during the COVID-19 lockdown and there was poor control of blood pressure and blood glucose levels due to the lockdown period.

Trends of antihypertensive use in a tertiary care hospital in Nadia district of West Bengal, India

Background: Being a major non-communicable disease hypertension contributes significantly to disease burden and mortality. Poor control of blood pressure (BP) increases the chance of recurrent stroke and mortality. Although various guidelines have been published to inform practitioners about hypertension and its management, it is necessary to monitor to how much extent the guidelines are being followed. Aims and Objectives: The study aimed to observe antihypertensive medication prescription pattern among indoor patients in a tertiary medical college hospital and to know whether such trend of prescription is relevant and in conformity with the national and international guidelines. Materials and Methods: A prescription-based survey was conducted over 6 months among patients admitted to the medicine ward in a medical college hospital in Nadia district of West Bengal. Relevant data were collected and used for analysis. Results: A total of 500 prescriptions were evaluated. Two hundred and seventy-three patients were female (54.6%) and 227 patients were male (45.4%). About 56.2% of patients were in the senior age group with a higher contribution by the female subjects. Only 17% of patients had Grade 1 hypertension reflecting poor BP control among hypertensive patients. Combination drug was advised in more than half of cases (54.6%), whereas single drug was advised in 44.2% of cases. Amlodipine was the highest prescribing drug (66%) both as monotherapy and in combination followed by Lasix (54.6%), labetalol (31.6%), and telmisartan (11.4%). The thiazide group of drugs was used only in 1% of cases. Conclusion: Overall, the management guidelines for hypertension were adhered in the prescriptions. The underutilization of thiazide-type diuretics remains an area of concern and needs necessary action. The public health delivery system may need to take appropriate measures to make people aware of BP control.

Barriers and Facilitators to Dietary Salt Reduction Among Patients With Hypertension in Southern Nigeria: A Hospital-based Qualitative Study.

Reduction in salt intake improves blood pressure control and reduces the risk of hypertension and other noncommunicable diseases (NCDs). However, salt intake remains high among Nigerians. This study aimed to identify barriers and facilitators to salt reduction among hypertensive patients attending a family medicine clinic in southern Nigeria. A focussed group discussion (FGD) exploring patients' perceptions of the barriers and facilitators to salt reduction was conducted with 8 groups of purposefully selected 74 hypertensives who consumed excess dietary salt, stratified by age and sex, using an FGD guide. Thematic analysis was then performed using Nvivo® version 12 pro. Ethical approval was obtained from Irrua Specialist Teaching Hospital (ISTH), and written informed consent was obtained from the patients before the FGD. Respondents had a mean age of 51.96 ± 8.98 years. The majority were females (47, 63.5%) and had uncontrolled blood pressure (66, 89.2%). Five major themes were identified, from which several minor themes emerged. Respondents rated their overall health as good but expressed concerns about their poor blood pressure control. Identified barriers to salt reduction included family pressure, ignorance, ready availability and affordability of salt and lack of affordable alternatives. Facilitators of salt reduction were measuring the amount of cooking salt, removing salt from the dining table and providing substitutes. Respondents, however, expressed willingness to reduce their salt consumption. The study identified barriers and facilitators to salt reduction. There is a need to create awareness of the safe amount of salt to be consumed and provide safe and readily available alternatives.

A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights.

Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.

Associated Factors to Poor Blood Pressure Control in Hypertensives Followed Up at the Campus University Hospital of Lome (Togo)

Associated Factors to Poor Blood Pressure Control in Hypertensives Followed Up at the Campus University Hospital of Lome (Togo)

Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford Kidney Study.

Hypertension is commonly observed in patients living with chronic kidney disease (CKD). Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD. There remains variability in antihypertensive treatment practices. To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients. The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002. All patients are followed up annually, and their medical records including the list of medications are updated until they reach study endpoints [starting on renal replacement therapy or reaching estimated glomerular filtration rate (eGFR) expressed as mL/min/1.73 m2 ≤ 10 mL/min/1.73 m2, or the last follow-up date, or data lock on December 31, 2021, or death]. Data on antihypertensive prescription practices in correspondence to baseline eGFR, urine albumin-creatinine ratio, primary CKD aetiology, and cardiovascular disease were evaluated. Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis. Kaplan-Meier analysis demonstrated differences in survival probabilities. Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included. The median age was 65 years. A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages (53% of eGFR ≤ 15 mL/min/1.73 m2 vs 26% of eGFR ≥ 60 mL/min/1.73 m2, P < 0.001). An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased (category A3: 62% vs category A1: 40%, P < 0.001), with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers. The prescription of three or more antihypertensive agents was associated with all-cause mortality, independent of blood pressure control (hazard ratio: 1.15; 95% confidence interval: 1.04-1.27, P = 0.006). Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed (log-rank, P < 0.001). Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm. Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents. Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.

Referral to hepatologists or a second-line examination requirement is common in patients with type 2 diabetes mellitus

Background and aimsTo estimate the number of patients who required a referral to hepatologists following the 2016 EASL–EASD–EASO guideline and a second-line vibration controlled transient elastography (VCTE) examination following the 2021 EASL guideline according to obesity, glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) control status in patients with type 2 diabetes mellitus (T2DM). Methods and resultsA total of 2515 T2DM patients who were hospitalized were cross-sectionally assessed. When we applied the 2016 EASL–EASD–EASO guideline, 26.8 %–46.4 % (depending on the scores used for diagnosing fibrosis) of T2DM patients needed a referral to hepatologists. When we applied the 2021 EASL guideline, a VCTE examination was required in 10.9 %–35 % (depending on the scores used for diagnosing fibrosis) of T2DM patients. The referral rates and the VCTE requirement were even higher in patients who were obese and/or had poor HbA1c, BP, and/or LDL-C control. ConclusionsApplication of the screening guidelines would lead to a referral to hepatologists or a second-line VCTE examination requirement for a substantial number of T2DM patients, regardless of obesity and metabolic goal attainment status.

Telmisartan Plus Amlodipine as the Preferred Initial Combination in Newly Diagnosed Indian Patients with Hypertension: An Expert Consensus Statements.

Hypertension (HTN) remains one of the most important risk factors for cardiovascular (CV) diseases and a leading cause of mortality worldwide. Despite improvement in detection and treatment, poor blood pressure (BP) control rates are observed globally. The situation in India is alarming with only 22.5% of patients maintaining their BP under control. Initiating early and effective treatment for HTN helps control BP within normal limits and reduces associated health risks. In India, currently, there are no guidelines on the choice of dual combination treatment that can be considered an initial treatment for newly diagnosed HTN patients to achieve effective BP control and reduce CV risks. To provide consensus recommendations for preferred initial combinations in newly diagnosed Indian patients with HTN. A core group of 100 experts with HTN expertise conceptualized and formulated the four key questions based on answerability, effectiveness, potential for translation to clinical practice, novelty, and potential impact on the healthcare burden. A mix of Delphi and Child Health and Nutrition Research Initiative (CHNRI) methods was adopted for acceptance or refusal of recommendations. Likert scale 1-9 was used for scoring. A score of ≥7 was considered "statement accepted," >6.50 "near to acceptance" and <6.50 "not accepted." A vote of ≥7 by at least two-thirds of the experts (66.66%) was mandatory for acceptance of the recommendation. Combination therapy could be necessary for a majority of newly diagnosed Indian patients for effective BP control. It can manage HTN with better clinical outcomes. Based on mean rating scores from experts, telmisartan plus amlodipine can be considered the preferred initial combination in the management of newly diagnosed Indian patients with HTN to achieve better BP control and improve CV outcomes.

Therapeutic inertia in the management of hypertension by moroccan general practitioners

Abstract Background Hypertension is an important and remediable risk factor for cardiovascular disease. Therapeutic inertia has been identified as one of the main factors associated with poor blood pressure control. Purpose This study aims to evaluate predictive factors of therapeutic inertia in the management of hypertension among moroccan general practitioners. Methods We conducted a descriptive and analytical cross-sectional study, from October 2021 to January 2022, involving moroccan general practitioners using a standardized, anonymous questionnaire, covering numerous areas; their socio-demographic characteristics, assessment of hypertension knowledge, reasons not to intensify therapy and clinical scenarios. A univariate analysis was performed using the Chi-square test for the comparison of percentages. A multivariable logistic regression analysis was also applied to study variables possibly associated with therapeutic inertia. Results A total of 130 physicians participated in our study. The majority of the practitioners were female (62.3%). The average age was 38.61 years (±13,95). The percentage of physicians who had practiced for 5 years or less was 51.5% vs. 48,5% having practiced for more than 5 years. The median number of patients seen per day was estimated at 30 patients with an interquartile range of [15, 50]. The average medical visit time was estimated at 11,88 ± 7,03 minutes. The overall frequency of therapeutic inertia among general practitioners was estimated at 78,5% CI 95% [70,4-85,2]. Furthermore, the two main reasons for therapeutic abstention reported by physicians were: the importance of improving patient compliance, lifestyle and dietary measures before intensifying treatment (81,5%), in addition to the fact that the office blood pressure does not reflect the patient's "true" BP and didn’t need any further ambulatory monitoring (43,8%). Multivariable regression showed that when the patient is diabetic, the general practitioners tend to be 4 times more ‘therapeutically inert’ [OR 4.42 (95% CI 1.2–7.23)]. A patient’s history of ischemic stroke was also positively associated with TI [OR 1.53 (95% CI 1.23–4.23)]. Conclusion This study revealed a significant frequency of therapeutic inertia in primary care. A good understanding of the determinants of this phenomenon will lead to better management of hypertension and therefore better blood pressure control. According to our study, a history of diabetes or stroke was positively associated with inertia, even though this would normally require exhaustive BP control. Thus, the development of operational and consensual definitions based on empirical data and the exploration of the intimate mechanisms underlying this inertia is of crucial importance.Table 1

Hypertension and poor control of systolic blood pressure after a myocardial infarction with non-obstructive coronary arteries are associated with incident heart failure

Abstract Introduction Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in up to 10% of all acute myocardial infarctions. Although previously believed to be a benign condition, recent studies have observed an increased risk for long-term adverse cardiovascular events in this group. However, data on risk markers for specific outcomes following MINOCA are limited. Hypertension is an important risk factor for heart failure (HF), but it is yet unknown whether blood pressure control after MINOCA is associated with incident HF. Aims To investigate whether history of hypertension and control of systolic blood pressure at two-month follow-up visit after MINOCA were associated with hospitalization for HF during long-term follow-up. Material and Methods This was a nationwide cohort study using data from SWEDEHEART and the National Patient Registry. Patients with first-time MINOCA between 2005-2020 were included and divided into grades of hypertension based on systolic blood pressure (SBP) in mmHg at a two-month follow-up visit. The grades were low normal (&amp;lt;120), normal (120-129), high normal (130-139), grade 1 hypertension (140-159), grade 2 hypertension (160-179) and grade 3 hypertension (&amp;gt;180). MINOCA was defined as a discharge diagnosis of AMI combined with a coronary angiography showing less than 50% stenosis in all coronary arteries. Patients with a diagnosis of heart failure or cardiomyopathy one month or earlier before index hospitalization with MINOCA were excluded. After the two-month visit all patients were followed in the registries regarding hospitalization for HF, until December 2020. The association between SBP and time to first HF hospitalization was studied with univariate and multivariate Cox regression models, using high normal SBP as the reference group. Results Among the 5018 included patients (57.8% women, mean age 62.6 years), 197 (3.9%) were hospitalized for HF during a median follow-up of 6.5 years (IQR 3.2-9.9). A diagnosis of hypertension at index hospitalization for MINOCA was associated with hospitalization for HF, both in univariate analysis (HR 1.97 95% CI 1.49-2.62) and after age and sex adjustments (HR 1.45 95% CI 1.09-1.93). The highest hospitalization rate of 7.6% was seen among patients with grade 2-3 hypertension at the two-month follow-up visit. In univariate analysis a SBP &amp;gt;160 mmHg was associated with hospitalization for HF (HR 2.17 CI 1.36-3.45). After exclusion of patients with 30-49% stenosis, these findings remained after age and sex adjustments (HR 1.71 CI 1.04-2.83). Conclusions Both history of hypertension and a poor blood pressure control two-months after MINOCA were associated with hospitalization for HF during long-term follow-up. These findings highlight the importance of adequate blood pressure control following MINOCA. To better detect and treat high SBP should be seen as an opportunity to reduce HF hospitalizations in this group of patients.

Abstract 16702: Associations Between Knowledge, Attitudes, and Practices and Blood Pressure Control Among Iraqi and Syrian Refugees in the United States

Introduction: Displacement due to war or persecution has resulted in an unprecedented refugee crisis. Refugees face increased cardiovascular disease risk and poor blood pressure (BP) control. Yet, insights into their knowledge, attitudes, and practices (KAP) influencing BP management are limited. Objective: To examine associations between KAP and BP control among Iraqi and Syrian refugees resettled in the United States. Method: Refugees from Iraq and Syria diagnosed with hypertension were recruited using a patient list at a federally qualified health center in San Diego. They completed a KAP survey and measured home BP (HMBP) using digital cuffs for at least 3 days/week for 4 weeks. Scores were computed for each KAP sub-scale; knowledge (0-16), attitude (1-20), and practice (1-8). Scores were categorized into quartiles (poor-excellent). The outcome was BP control calculated from an average of HMBP readings over 3 days for 4 weeks. Mixed effect logistic regression was used to assess the relationship between each KAP quartile and BP control (&lt;130/80 mmHg). Results: Final analysis included 95 refugees (79% Iraqis, 21% Syrians). Participants were male (56%), with mean age 58.4 (±16.34) years, 86% unemployed, 22% had at least a Bachelor's degree, 66% had limited English proficiency and only 3.6% had annual income ≥$35,000. The mean scores were as follows: BP 129/79 mmHg, with 61% having uncontrolled BP, knowledge 13.2 (± 2.37), attitude 14.6 (± 2.38), and practice 6.5 (± 1.17). Higher knowledge correlated with higher odds of BP control (adjusted Odds ratio (aOR): 1.89,95% Confidence Interval (CI): 1.39 - 2.55). Those who had fair and good attitude had lower odds of BP control (aOR: 0.63, 95% CI: 0.52 0.77; OR: 0.58, CI: 0.45 - 0.75) respectively (Table). Conclusion: Findings suggest poorer BP knowledge correlates with BP control in Syrian and Iraqi refugees who are receiving BP care. Tailored health interventions for refugees are needed to promote cardiovascular health equity.

Impaired Sodium Dipping Is Associated with Poor Blood Pressure Control in Patients on Peritoneal Dialysis

Impaired Sodium Dipping Is Associated with Poor Blood Pressure Control in Patients on Peritoneal Dialysis

Real-world trends in pre-dialysis blood pressure levels of patients undergoing dialysis in Japan using a web-based national database.

The prevalence of hypertension is high among patients undergoing dialysis. We extracted data of patients undergoing dialysis between 2012 and 2020 with recorded pre-dialysis systolic blood pressure (SBP) using a web-based national database in Japan. Following the 2019 Japanese Society of Hypertension guidelines, we classified SBP and assessed its trends over time based on sex, age, diabetes status, and the anti-hypertensive medication use. Using the 2020 database, we examined 336,759 Japanese patients undergoing dialysis (114,249 female; 222,510 male). The mean age was 69.4±12.5years, and the mean SBP was 152.3±24.7mm Hg. The prevalence rate of pre-dialysis hypertension was 70.2%, with 32.5%, 24.5%, and 13.2% of patients having grade I, grade II, and grade III hypertension, respectively. From 2014 to 2020, prevalence rate of pre-dialysis hypertension and absolute values of pre-dialysis SBP were higher in dialysis patients with diabetes than in those without diabetes across all age groups and sexes. Younger patients with diabetes or those on anti-hypertensive medication exhibited an SBP of approximately 160mm Hg. Cerebrovascular death in patients with diabetes was associated with a higher rate of pre-dialysis hypertension than that in those without diabetes, and there was a significant difference in the prevalence of grade III hypertension between the two groups. In conclusion, the mean pre-dialysis SBP among patients undergoing dialysis remained high, and younger patients with diabetes or those receiving anti-hypertensive medications had poor blood pressure control. Optimal blood pressure management may be necessary to reduce the risk of cardiovascular mortality.

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

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