Prevalence Of Uncontrolled Blood Pressure Research Articles

Abstract MP24: Relationship of Socioeconomic Position on Incident Hypertension-related Hospitalization and Blood Pressure Control among participants in the Coronary Artery Risk Development in Young Adults (CARDIA)

Background: Hypertension hospitalization, defined as being admitted to the hospital with a primary diagnosis of hypertension, has been increasing among US adults. Individuals with low socioeconomic position have higher rates of uncontrolled blood pressure (BP). We evaluated the relationship of socioeconomic position on incident hypertension hospitalization and BP control rates following hospitalization. Methods: We analyzed data from CARDIA, a prospective cohort that enrolled 5,115 adults (2,637 self-identified Black and 2,478 White adults) 18 to 30 years old from 4 urban US areas in 1985-1986. Hypertension hospitalizations were ascertained by manual chart review over 34 years of annual follow-up. We compared the incidence rate of hypertension hospitalization and prevalence of uncontrolled BP, systolic/diastolic BP ≥140/90 mm Hg, at the study visit after hospitalization by socioeconomic position. Socioeconomic position included education, income, insurance status and neighborhood deprivation factor score at the last visit before hypertension hospitalization or last CARDIA visit attended for participants who were not hospitalized. Results: Overall, 67 CARDIA participants (1.3%) were hospitalized for hypertension. Participants hospitalized for hypertension had a median age of 47 years at time of hospitaliization, 51% were male, and 87% were Black. Among those hospitalized for hypertension, 12% had less than high school education, 44% had a family income < $25,000, 30% were on Medicaid or Medicare, and 58% lived in a socially deprived neighborhood. The risk of hypertension hospitalization was higher for participants with less education and who lived in more socially deprived neighborhoods ( Table 1 ). At the first study visit following hospital discharge, 67% of participants had uncontrolled BP and there was no difference by socioeconomic position. Conclusion: The incidence rate of hypertension hospitalization was higher among people with low socioeconomic position. Uncontrolled BP was common following hypertension hospitalization.

Abstract P404: Using Target: BP™ Initiative Resources and Awards To Improve Evidence-Based Practice Adoption And Blood Pressure Control

Target: BP™ is a national initiative created by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP). Committed to advancing health equity, Target: BP supports health care organizations to improve blood pressure control by leveraging AHA guidelines and scientific statements and the AMA MAP ™ framework; assists health care organizations in their journeys to improve and sustain BP control with professional education and resources; and recognizes health care organizations annually with achievement awards. Target: BP recognizes organizations that commit to improvement, adopt evidence-based BP activities, and achieve BP control rates ≥70 percent, currently defined as SBP<140 and DBP<90 mmHg in CMS Controlling High Blood Pressure #236. Evidence-based BP activities include 1) calibrating BP measurement devices, 2) checking to see if devices are validated, 3) training and, 4) testing care team members in BP measurement every 6-12 months, 5) using a protocol to measure and confirm BP measurements, and 6) posting a positioning graphic (job aid) next to every place where BP is measured. Since adding evidence-based activity award criteria, self-attested achievement levels have improved from 2021 to 2023 for device calibration from 47.9% to 65.3%, for team training from 67.6% to 85.5%, for team testing from 67.0% to 86.2%, for measurement protocol use from 83.3% to 94.4%, and for job-aid posting from 54.8% to 69.6%. For each activity, Target: BP provides no-cost education and resources to help achieve the criteria. Overall participation has grown from 330 to 1806 organizations since 2017, now caring for 8.6 million patients with hypertension. In 2023, 866 organizations reported BP control rates ≥70 percent and 1489 reported the adoption of ≥4 of 6 evidence-based BP activities. Future expansion of the evidenced-based activity criteria will address treatment intensification, lifestyle risk factors, self-measured blood pressure monitoring, and equitable health outcomes. In a 2023 survey of participating organizations, 85.2% of 230 respondents reported “improving patient outcomes” as their primary reason for participating in Target: BP. Among respondents, 95.7% agree or strongly agree that expanded criteria will help to focus QI priorities. Award incentives appear to play a positive role in encouraging organizations to adopt evidence-based practices and improve blood pressure control.

Risk factors for uncontrolled blood pressure among individuals with hypertension on treatment: the CONSTANCES population-based study.

We aimed to assess factors associated with uncontrolled blood pressure (BP) among individuals with hypertension on treatment, by sex. We conducted a nested cross-sectional analysis using data from the population-based cohort study CONSTANCES, designed as a randomly selected sample of French adults aged 18-69 years at study inception. We included 11 760 participants previously diagnosed with hypertension and taking antihypertensive medications. Uncontrolled BP was defined as mean systolic BP ≥140 mmHg and/or mean diastolic BP ≥90 mmHg. Sex-specific age-adjusted multivariable analyses were performed using logistic regression models stratified by stages of uncontrolled hypertension. The mean age of participants was 59.4 years. The prevalence of uncontrolled BP was 51.4%, and it was higher in men than in women [adjusted odds ratio (aOR), 1.80; 95% CI, 1.67-1.94]. In both sexes, the lower the age, the lower the prevalence of uncontrolled hypertension. Low level of education and history of cardiovascular events had, respectively, higher and lower odds of uncontrolled BP. In men, additional risk factors included overweight and obesity (aOR, 1.15; 95% CI, 1.00-1.32; and aOR, 1.45; 95% CI, 1.23-1.70, respectively), lack of physical activity (aOR, 1.20; 95% CI, 1.04-1.40), low adherence to a Dietary Approach to Stop Hypertension diet (aOR, 1.21; 95% CI, 1.05-1.40) and heavy alcohol consumption (aOR, 1.33; 95% CI, 1.08-1.63), with the last two factors persisting across different stages of uncontrolled BP. From a population-based perspective, socio-economic and behavioural characteristics were risk factors for uncontrolled hypertension, but they differed by sex and by stage of uncontrolled hypertension. Modifiable risk factors, such as weight, diet, physical activity and alcohol consumption, have an important role in the control of hypertension.

Prevalence and factors associated with uncontrolled blood pressure in dialysis patients using antihypertensive: a narrative review

Hypertension in patients with end-stage chronic kidney disease undergoing hemodialysis is difficult to control leading to a significant risk factor for a cardiovascular event. The aimed of this review is to summarize the prevalence of uncontrolled blood pressure in dialysis patients. This review hopefully can serve as a valuable reference and source of insight for clinicians in their efforts to attain controlled blood pressure in dialysis patients. The relevant literatures was undertaken from PubMed, Scopus, and Google Scholar for studies addressing the factor associated with uncontrolled blood pressure in hemodialysis patients using antihypertensives from 2013 to 2023. Combinations of search terms were "uncontrolled" and "blood pressure" and "dialysis" and "antihypertensive”. Any study in English, including randomized control trials, cohort, case-control, and cross-sectional studies was included. Uncontrolled blood pressure is very common among hypertension in dialysis patients (28.7 - 78.33% of cases). Factors affecting blood pressure in dialysis patients include age, obesity, and comorbidity (diabetes and stage of chronic kidney disease). Although the relationship between gender, the number of antihypertensive, the number of dialysis, and the length of dialysis sessions with blood pressure varies, some studies have shown a positive association.

Target:BP: A National Initiative to Improve Blood Pressure Control.

BP is a national initiative launched by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP) in the United States. BP provides support to health care organizations and health care teams, with no user fees, to improve the quality of care for adults with hypertension by providing education and resources and recognizing organizations committed to prioritizing and reporting their rate of BP control. Through Target:BP, the American Heart Association and the American Medical Association also collaborate to align policy with evidence through federal, state, and institutional policy advocacy and raise public awareness through media campaigns. In 2022, Target:BP recognized 1309 health care organizations serving 8.4 million patients with hypertension for prioritizing BP control, 675 of which affirmed performance of evidence-based BP measurement activities and 551 of which reported BP control rates ≥70%. With the proportion of US adults with controlled BP falling to 48.2% from 2017 to 2020, Target:BP remains focused on regaining lost ground in national BP control rates by emphasizing accurate BP measurement, rapid treatment intensification, healthful lifestyle changes, and evidence-based use of self-measured BP monitoring. BP also emphasizes adoption of team-based care models and prioritizing equitable health outcomes. More than 1.37 million unique users have visited https://targetbp.org/ and downloaded 98 341 Target:BP resources from 2017 to 2022.

Italian Society of Interventional Cardiology (GISE) and Italian Society of Arterial Hypertension (SIIA) Consensus document on the role of renal denervation in the management of the difficult to treat hypertension

Arterial hypertension is the most prevalent cardiovascular risk factor worldwide. Despite the availability of many and effective antihypertensive medications, the prevalence of uncontrolled blood pressure (BP) remains high. As sympathetic hyperactivity has long been recognized as a major contributor to resistant hypertension, catheter-based renal denervation (RDN) has emerged as a new strategy to reduce BP. RDN aims to interrupt the activity of renal sympathetic nerves by applying radiofrequency (RF) energy, ultrasound (US) energy, or injection of alcohol in the perivascular space. The Symplicity HTN-3 trial, the largest sham-controlled trial using the first-generation RF-based RDN device, failed to significantly reduce BP. Since then, new devices and techniques have been developed and consequently many sham-controlled trials using second-generation RF or US-based RDN devices have demonstrated the BP lowering efficacy and safety of the procedure. A multidisciplinary team involving hypertension experts, interventionalists with expertise in renal interventions and anesthesiologists, plays a pivotal role from the selection of the patient candidate for the procedure to the post-procedural care. The aim of this consensus document is to summarize the current evidence about the use of RDN in difficult to treat hypertension and to propose a management strategy from the selection of the patient candidate for the procedure to the post-procedural care.

Polygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors.

Blood pressure (BP) is often not at goal in stroke survivors, leaving individuals vulnerable to additional vascular events. Given that BP is a highly heritable trait, we hypothesize that a higher polygenic susceptibility to hypertension (PSH) leads to worse BP control in stroke survivors. We conducted a study within the UK Biobank evaluating persons of European ancestry who survived an ischemic or hemorrhagic stroke. To model the PSH, we created polygenic risk scores (PRSs) for systolic and diastolic BP using 732 genetic variants. We divided the PRSs into quintiles and used linear/logistic regression to test whether higher PSH led to higher observed BP, uncontrolled BP (systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg), and resistant BP (uncontrolled BP despite being on ≥3 antihypertensive drugs). We conducted an independent replication using data from the Vitamin Intervention for Stroke Prevention (VISP) trial. We analyzed 5,940 stroke survivors. When comparing stroke survivors with very low vs very high PSH, the mean systolic BP was 137 (SD 18) vs 143 (SD 20, p < 0.001), the mean diastolic BP was 81 (SD 10) vs 84 (SD 11, p < 0.001), the prevalence of uncontrolled BP was 42.8% vs 57.2% (p < 0.001), and the prevalence of resistant hypertension was 3.9% vs 11% (p < 0.001). Results remained significant using multivariable models (p < 0.001) and were replicated in the VISP study (all tests with p < 0.05). A higher PSH is associated with worse BP control in stroke survivors. These findings point to genetic predisposition as an important determinant of poorly controlled BP in this population.

TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting

BackgroundHypertension is the most important modifiable risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, hypertension remains poorly controlled in many stroke survivors. Black and Hispanic patients have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access to care contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) is a telehealth intervention that integrates remote BP monitoring (RBPM) including nursing telephone support, tailored BP infographics and telehealth video visits with a multidisciplinary team approach including pharmacy to improve post-stroke care and reduce stroke disparities.MethodsIn this pilot trial, 50 acute stroke patients with hypertension will be screened for inclusion prior to hospital discharge and randomized to usual care or TASC. Usual care patients will be seen by a primary care nurse practitioner at 1–2 weeks and a stroke neurologist at 1 and 3 months. In addition to these usual care visits, TASC intervention patients will see a pharmacist at 4 and 8 weeks and will be enrolled in RBPM consisting of home BP monitoring with interval calls by a centralized team of telehealth nurses. As part of RBPM, TASC patients will be provided with a home BP monitoring device and electronic tablet that wirelessly transmits home BP data to the electronic health record. They will also receive tailored BP infographics that help explain their BP readings. The primary outcome will be feasibility including recruitment, adherence to at least one video visit and retention rates. The clinical outcome for consideration in a subsequent trial will be within-patient change in BP from baseline to 3 months after discharge. Secondary outcomes will be medication adherence self-efficacy and satisfaction with post-stroke telehealth, both measured at 3 months. Additional patient reported outcomes will include depression, cognitive function, and socioeconomic determinants. Multidisciplinary team competency and fidelity measures will also be assessed.ConclusionsIntegrated team-based interventions may improve BP control and reduce racial/ethnic disparities in post-stroke care. TASC is a post-acute stroke care model that is novel in providing RBPM with tailored infographics, and a multidisciplinary team approach including pharmacy. Our pilot will determine if such an approach is feasible and effective in enhancing post-stroke BP control and promoting self-efficacy.Trial registrationClinicalTrials.gov NCT04640519

Uncontrolled blood pressure and contributing factors among patients with hypertension at outpatient care of Bedele General Hospital, Southwest Ethiopia: A cross-sectional study.

Objective:This study aimed to assess uncontrolled blood pressure and contributing factors among patients with hypertension.Methods:Hospital-based cross-sectional study was conducted from January to April 2021 at Bedele General Hospital. Data were collected using the semi-structured questionnaire. All patients with hypertension were included using consecutive sampling technique unless ineligible. EpiData 4.4.2 was used for data entry, and SPSS 24.0 was employed for analysis. Binary logistic regression analysis was performed to identify factors associated with uncontrolled blood pressure.Results:A total of 219 patients with hypertension were included in the study. About 60.3% of participants were male. The mean age of the study participants was 48.54 ± 12.93 years. The prevalence of uncontrolled blood pressure among the study participants was 56.2%. The factors significantly associated with uncontrolled blood pressure were age >60 years (adjusted prevalence ratio = 4.42; 95% confidence interval = (1.71, 11.46); p = 0.002) and the presence of comorbidity (adjusted prevalence ratio = 2.16; 95% confidence interval = (1.22, 3.82); p = 0.008).Conclusion:More than half of the study participants had uncontrolled blood pressure. Older age and comorbidity were the predictors of uncontrolled blood pressure. Attaining controlled blood pressure is important to avoid consequences of high blood pressure. So, healthcare provider should focus on achieving target blood pressure goal.

Impact of Variation in Pill/Package Appearance of Drugs on Patients' Behavior: A Systematic Review.

This systematic review aims to identify and critically evaluate the available evidence on the impact of switches in pill appearance/packaging on patient's behavior. Studies from inception to March 2021 were searched across MEDLINE through PubMed, the Cochrane Library, Embase, and Scopus. Included studies carried out an original evaluation in English or Spanish language that evaluated the impact of switches in pill appearance/packaging on patient's behavior. Two authors independently extracted study data and evaluated studies for methodological quality according to the STROBE guidelines. Ten studies were included, and the mean (SD) number of STROBE criteria satisfied was 17.2 (3.9). Three of 5 studies found a significant association between change in pill appearance and persistence to treatment; the 3 studies that evaluated the impact of a change on adherence to treatment found a significant association; 1 of the 2 studies that evaluated the relationship between a change a clinical outcome found a significant association with the prevalence of uncontrolled blood pressure; and 1 study showed lower rates of switchbacks to the branded product compared with patients who switched to generic drug products, with different appearance. This systematic review showed an impact of the change in pill/package appearance on patients' behavior in 7 of the 10 studies included. Generic switching may lead to unintended consequences on patients' behavior, mainly regarding adherence to treatment.

HYPERTENSION AND BLOOD PRESSURE CONTROL AMONG RESPONDENTS LIVING IN DHAKA DIVISION, BANGLADESH

Objective: In Bangladesh, 67% of all deaths are due to non-communicable diseases (NCDs), of which17% are attributable to cardiovascular diseases (CVD). Hypertension is a major risk factor for CVD. We conducted a baseline survey titled SHASTO (Strengthening Health Systems through Organizing Communities) to estimate the prevalence of hypertension, their risk factors, health care seeking behaviour among residents living in Dhaka division of Bangladesh. Design and method: This cross-sectional study was conducted among residents aged &gt;30 years living in Dhaka north, Dhaka south, Narsinghdi and Gazipur district of Dhaka division. The respondents were interviewed using a modified version of STEPS questionnaire and physical measurements were taken following a standard operating procedure. Hypertension was defined as systolic blood pressure (BP) &gt; = 140 mm of Hg and/or diastolic BP &gt; = 90 mm of Hg and/or persons with already diagnosed hypertension. Results: A total of 4930 respondents participated in the study and mean age of male and female respondents was 48 and 45 years respectively. Overall, 31% of the respondents were hypertensive and the prevalence was higher among urban (37%) and female (38%) respondents than their rural (31%) and male (24%) counterparts. A higher prevalence of hypertension was also observed among respondents currently not working (not working: 47% vs working: 30%), consumed inadequate fruits and vegetables (inadequate: 32% vs adequate: 28%), performed inadequate physical activities (inadequate: 43% vs adequate: 28%) and overweight or obese (overweight/obese: 39% vs not overweight/obese: 24%). About 75% of hypertensive patients were aware of their status and 64% of them sought care. More than half (54%) of them were taking medication, however, 44% of them had uncontrolled BP. The prevalence of uncontrolled BP was found higher among female (63%), rural (89%), overweight or obese (60%), and nuclear family (63%) respondents. Conclusions: The prevalence of hypertension and uncontrolled BP was high among respondents living in Dhaka division of Bangladesh. The government should implement hypertension control and prevention programmes to tackle the burden and its associated complications.

Prevalence of Uncontrolled Blood Pressure and Drug Related Problems in Adult Hypertensive Patients: A Comparative Study

DRPs are one of the major challenges to health care providers as this may affect morbidity, mortality and patients’ quality of life...

Association of Geographic Differences in Prevalence of Uncontrolled Chronic Conditions With Changes in Individuals’ Likelihood of Uncontrolled Chronic Conditions

The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.

Factors associated to uncontrolled hypertension in Brazilian adults: National Health Survey

Abstract Background Hypertension is the main risk factor for cardiovascular diseases, contributing significantly to the increase in the number of deaths and disabilities worldwide. Moreover, hypertension control is a major action for NCDs prevention. Although pharmacological treatment has been shown effective, high rates of uncontrolled hypertension remain. The objective is to estimate the prevalence of uncontrolled arterial hypertension and the factors associated to this outcome in a representative adult Brazilian population under a pharmacological treatment. Methods This is a cross-sectional study conducted with 10,016 Brazilian adults over 18 years old who participated in the National Health Survey in Brazil carried-out in 2013. The sample comprised of residents from all Federative Units, Poisson multivariate regression was used to calculate the prevalence ratio (PR) and 95% confidence interval. Results 45% (95% CI: 44; 48) of hypertensive adults under drug treatment have uncontrolled blood pressure levels. Female gender [PR = 0.92; CI: 0.85; 0.99] and not having previous hospitalizations due to complications from hypertension or other causes [PR = 0.86; CI: 0.78; 0.94] were associated to low the prevalence of uncontrolled blood pressure. Participants aged 60 years old or more [PR = 1.31; CI:1.04; 1.64], who self-declared as black [PR = 1.19; CI: 1.04; 1.36], without health insurance [PR = 1.15; CI: 1.05; 1.27] and not attending the health service because of arterial hypertension [PR = 1.10; CI:1.01; 1.20)] presented higher prevalence of uncontrolled blood pressure. Conclusions The prevalence of uncontrolled hypertension among Brazilian adults was high among the male gender, black people, elderly, without previous hospitalizations, without health insurance and not regularly attending the health service. These results may alert the need for a reassessment of the assistance provided, in addition to raising awareness of a possible change in public policies in these groups. Key messages Evidence the magnitude of people who are at risk of hypertension even under pharmacological treatment. Highlight inequities related to the uncontrol of hypertension.

Renal denervation: mechanisms and clinical aspects

Hypertension is a global health issue of paramount importance, which has not spared the African continent where an unacceptably high prevalence of uncontrolled blood pressure prevails among its population. Renal denervation (RD) represents an invasive management option for resistant hypertension, acting via several different physiological pathways – mostly predicated on modification of the renal autonomic nervous system. The evidence base for RD has recently been expanded by three randomised, sham-controlled clinical trials, which demonstrated significant blood pressure reductions under a variety of clinical conditions. In this review, both the renal mechanisms underlying RD, as well as the clinical aspects of its application to hypertension, are discussed.

Prevalence of uncontrolled blood pressure in Meknes, Morocco, and its associated risk factors in 2017.

BackgroundUncontrolled high blood pressure (UBP) can lead to various cardiovascular complications causing an estimated nine million deaths per year worldwide. In Meknes, epidemiologic data on UBP are scarce, depriving programs from evidence-based information that would allow a better management of hypertension. Hence, we aimed to assess UBP prevalence in hypertensive patients treated in Meknes and identify UBP-associated risk factors.MethodsBetween November and December 2017, we conducted a cross-sectional study enrolling 922 hypertensive patients managed at Meknes’s primary health care facilities using the multistage sampling method. We interviewed patients face to face to collect their socio-demographic-characteristics, lifestyle behaviours, clinical parameters and the triad care system-patient-physician. Another questionnaire was self-administered by physicians to characterize therapeutic inertia. A multivariate logistic regression analysis highlighted the risk factors associated with UBP.ResultsUBP prevalence was 73% with a mean age of 61±11 years (mean±standard deviation) and a male/female ratio of 1/3. Risk factors associated with UBP were: therapeutic inertia (adjusted odds ratio to other variables (AOR) = 18.2, 95% CI [8.35–39.84]), drug non-adherence (AOR = 1.8, 95% CI [1.07–3.04]), obesity/overweight (AOR = 1.6, 95% CI [1.03–2.58]), unemployment (AOR = 1.9, 95% CI [1.09–3.01]), low income (AOR = 2.6, 95% CI [1.01–6.86]), family history of hypertension (AOR = 1.5, 95% CI [1.07–2.08]) and male sex (AOR = 1.6, 95% CI [1.04–2.58]).ConclusionUBP prevalence is high in Meknes. Prevention should firstly focus on raised awareness of hypertensive patients’ self-care management. Secondly, health professionals should better comply to the guidelines of anti-hypertensive treatments. Lastly, health professionals should frequently be reminded to reach therapeutic goals to overcome therapeutic inertia.

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mmHg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.

Predictors of uncontrolled blood pressure in hypertensive treated individuals–The CONSTANCES cohort study

A broad range of factors has been identified to contribute to poor blood pressure (BP) control. But further epidemiologic data in France are needed. We aimed to assess sociodemographic, clinical and behavioral predictors of uncontrolled BP among treated hypertensive individuals. We conducted cross-sectional analysis using data from the CONSTANCES cohort study. We included 11,159 participants previously diagnosed with hypertension and taking antihypertensive medications. Uncontrolled BP was defined as mean systolic BP ≥ 140 mm Hg and/or mean diastolic BP ≥ 90 mm Hg. Alcohol use disorder severity was defined according to the French version of the Alcohol Use Disorders Identification Test (AUDIT). Dietary assessment was done based on adherence to French dietary guidelines using the modified National Program on Nutrition and Health (mPNNS). Depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). Gender specific age-adjusted multivariable analyses were performed using logistic regression models. Adjusted mean systolic BP were studied across selected variables using the General Linear Model. The prevalence of uncontrolled BP was 60.2% and it was higher in men than in women (66.5% vs. 52.5%, P < 0.0001). A higher proportion of men had both SBP and DBP not at goal (42%) compared to women (34%). We found a significantly lower SBP with better dietary compliance ( P = 0.003 in men), high physical activity ( P = 0.048 in women) and low risk of alcohol use disorder ( P < 0.01, both sexes). There was no significant relationship with depression represented by CES-D. In both sexes, predictors of uncontrolled HTN were increasing age, history of CVD and dyslipidemia. In men, additional factors included diabetes (adjusted odds ratio 0.74; P = 0.036), increased BMI (ORa 1.26, P = 0.01), heavy alcohol drinking (ORa 1.59, P < 0.001) and high dietary adherence (ORa 0.69, P = 0.05) In this population-based study, clinical and behavioral characteristics were predictors of uncontrolled HTN. Modifiable risk factors such as weight, diet, alcohol use and physical activity influence the SBP and BP control.

Re-Classifying Hypertension in the Venezuelan EVESCAM Database Using 2017 AHA/ACC Criteria: High Prevalence, Poor Control, and Urgent Call for Action.

Background:In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN).Objective:To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria.Methods:The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria.Findings:The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130–139/80–89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled.Conclusion:Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.

A2993 Prevalence of uncontrolled hypertension and patient characteristics in a middle-income sub-Saharan African country

Objectives: According to a 2014 national non-communicable diseases (NCD) risk factors survey, Botswana has 29.3% prevalence of hypertension among adults aged 15–69 years. There is a need to understand whether healthcare services are responding by controlling this high burden of disease, and if not who is affected. We thus aimed to describe the prevalence of uncontrolled blood pressure (BP), and factors associated with uncontrolled BP, among known hypertensives. Methods: Out of 4,070 adults surveyed, a subset of 1,080 known hypertensives was analyzed. Descriptive and bivariate analyses using STATA v12 were performed to describe patient demographic, behavioral and clinical characteristics and to assess association with uncontrolled BP (defined as mean systolic BP > 140 or mean diastolic BP > 90, of three BP measurements). Results: Median age 44 years(IQR: 33–55), 838(78%) female. 446(41%) on BP medicines. 575(53%) had uncontrolled BP; 104(10%) severe (systolic BP > 180 or diastolic BP > 110). Uncontrolled BP was associated with male gender (p = 0.008), age > 30 years (p < 0.000), low education (p < 0.000), tobacco use (p = 0.001), BMI > 25 (p < 0.000), being on antihypertensive medicines (p < 0.000), receiving lifestyle counseling (p = 0.008). Conclusion: We found high proportion of uncontrolled BP, and an association (unadjusted) with being male, of low socioeconomic status and having modifiable risk factors. Findings from logistic regression modelling will be presented, and may suggest areas of targeted public health and healthcare service interventions to improve control of hypertension. Further studies are needed to understand better how patient and health system factors contribute to uncontrolled hypertension in Botswana.