Prevalence Of Uncontrolled Hypertension Research Articles

Poorly controlled hypertension among adults treated for hypertension in Tshwane District, South Africa.

Adequate control of hypertension (HTN) is essential to prevent complications such as cardiovascular and kidney diseases. Despite the use of established clinical protocols on the treatment of HTN in primary health facilities in South Africa, the HTN of many patients remains poorly controlled. The objectives of this study were to determine the prevalence of poorly controlled HTN as well as identify related associated risk factors in a sample of adult attendees in primary health care facilities. A cross-sectional study was conducted among adult hypertension clinic attendees at primary health care facilities in Tshwane District, South Africa. Data were collected using the WHO Stepwise instrument on chronic disease risk factor surveillance and anthropometric and blood pressure (BP) measurements. Stata Version 13 was used for data analysis. Of the 327 patients who participated in the study, 72.2% were female and 27.8% were male. Their mean age was 56 years (SD = 10.8 years). The prevalence of uncontrolled HTN was 58%, with the mean systolic BP and diastolic BP of 142.18 and 87.43, respectively. The prevalence of poorly controlled HTN increased with age. Factors associated with poorly controlled HTN were age, gender, being unemployed, source of income, smoking, alcohol use, lack of physical activity, and skipping of medication. By multi-variate analysis, both the mean systolic and diastolic blood pressures were found to be significantly associated with poorly controlled BP. The high prevalence of poorly controlled BP among patients who are on treatment suggests the need to re-consider the appropriateness of the current integrated management and treatment of HTN used in primary health care facilities in South Africa. The results suggest that the established clinical protocols and standard treatment for HTN are not beneficial for all patients and that physicians should use the treatment response of individual patients to make clinical decisions.

Is Ambulatory Blood Pressure Monitoring Required for Elderly Hemodialysis Patients during the Interdialytic Period? - Experience of a Tertiary Care Center in South India.

Introduction:Hypertension (HT) is a common and challenging problem in patients on dialysis. Routine peri-dialytic blood pressure (BP) recordings are unable to diagnose HT accurately and stratify cardiovascular risk. We report here an analysis of 2 years, single-center experience on 24-hour ambulatory blood pressure monitoring (ABPM) in elderly hemodialysis patients in the interdialytic period.Materials and Methods:Data of all the patients above 65 years of age undergoing hemodialysis between November 2017 and December 2019 in our hemodialysis unit and for whom 24-hour ABPM was done were collected. Demographics, clinical profile, pre- and post-dialysis BP recordings, 24-hour ABPM characteristics, and the outcome status were analyzed.Results:Of the 37 patients, 28 (75.7%) were males with a mean age of 67.73 years; 67.6% were diabetic. HT was found in all patients (100%), and uncontrolled HT was noted in 30 (81%) patients by ABPM. Patients with uncontrolled HT were also nondippers of BP (100%). A significant association was observed between nondippers and coronary artery disease (n = 27, 90%, P = 0.004). Masked HT was found in 9 (24.3%) patients with normal peridialytic BP (n = 9, 24.3%, P = 0.000). No significant difference was noted between diabetic and nondiabetic patients regarding dipping status or mortality. Among 37 patients, 9 (24.3%) died during follow-up with uncontrolled HT as a significant risk factor (P = 0.05).Conclusion:The prevalence of uncontrolled HT with blunted circadian rhythm was high as detected by ABPM in the interdialytic period among elderly hemodialysis patients and had a significant impact on mortality. Masked uncontrolled HT as measured by ABPM was not uncommon in patients with normal peridialytic BP.

Quality of clinical practice guidelines for the management of hypertension in six Southeast Asian countries

ABSTRACT Background: The endemic of hypertension along with high prevalence of uncontrolled hypertension in Southeast Asia indicates an important role for high-quality clinical practice guidelines (CPGs) to optimize the management of hypertension. However, there was no reported quality appraisal of the CPGs for the management of hypertension in Southeast Asia. Objective: This study aimed to evaluate methodological quality across the CPGs for the management of hypertension in Southeast Asia with a validated quality appraisal tool. Methods: The CPGs for the management of hypertension in Southeast Asia were retrieved from the websites of the Ministry of Health or cardiovascular specialty societies of the individual countries of Southeast Asia. Two reviewers with academic backgrounds independently appraised the methodological quality of all the included CPGs using the Appraisal of Guideline ResEarch and Evaluation (AGREE II) instrument. Results: Six CPGs were identified, each of them from Thailand, Malaysia, Indonesia, Brunei, Singapore, and Vietnam. The highest-scoring quality domain was ‘clarity of presentation’ (mean=78.7 ± 14.6%), whereas the lowest-scoring quality domains were ‘applicability’ and ‘editorial independence’ (mean=8.4 ± 6.0% and mean=8.3 ± 18.6%, respectively). Except for the CPG originated from Malaysia which was “recommended“ for use in practice (standardized score for three domains was ≥50.0%), the remaining five CPGs were “weakly recommended” for use in practice (standardized score for one to two domains was ≥50%). Conclusion: More efforts are needed to improve the quality of the developed CPGs for the management of hypertension in Southeast Asia.

Prevalence of Controlled Systemic Hypertension and Its Associated Risk Factors among Hypertensive Patients at Mbeya Zonal Referral Hospital, Tanzania.

Objectives: To determine the prevalence of controlled systemic hypertension and its associated risk factors among the hypertensive patients who attended the clinic at Mbeya Zonal Referral Hospital in Tanzania. Methods: A descriptive cross-sectional quantitative study was used determine the prevalence to 252 hypertensive patients were recruited during clinic visit from September to November 2020 and participant was randomly selected interviews using structured self-administered questionnaires. Data was analyzed using chi square test to find the risk factors associated with controlled hypertension. Results: Among 252 participants, 94 (39.7%) individuals with controlled hypertension giving the prevalence of controlled hypertension. The proportion of females with controlled hypertension was slightly higher than male (49 females to 45 males). The prevalence of uncontrolled hypertension was 152 (60.3%) participants. The prevalence of controlled hypertension was higher among patients who have regular clinic visit (p<0.05) and have daily adherence to their anti-hypertensive medication. A similar trend was observed among participants without financial challenges to attend clinic, short duration of illness, higher level of education and there was no association between age, sex, marital status, smoking, alcohol consumption, having health insurance and having chronic illness. Conclusion: Prevalence of controlled hypertension is higher among patients who have regular clinic visit and have daily adherence to their anti-hypertensive medication. Also, it is higher among participants without financial challenges to attend clinic so they can have regular clinic visit and checkup. Reinforcement on regular drug intake and clinic visit, good nutrition and reduced salt intake and modifying lifestyles of patient with hypertension is important.

Prevalence of uncontrolled hypertension and associated factors among hypertensive patients attending medical outpatient clinic, Thika level 5 hospital, Kenya

Background: Uncontrolled hypertension is a key risk factor for stroke and heart and kidney disease. A study was conducted to determine the factors associated with the prevalence of uncontrolled hypertension among hypertensive patients (study participants) attending a medical outpatient clinic, Thika level 5 Hospital (TL5H), Kenya.Methods: The study adopted a cross-sectional study design and a mixed-methods approach. While the quantitative arm sampled 394 study participants using systematic random sampling, purposive sampling selected 18 health care workers who served as key informant sand 35 study participants took part in focus group discussions in the qualitative arm. Uncontrolled hypertension was defined as systolic and or diastolic blood pressure ≥140 and or ≥90 in one or both previous and current readings during clinic visits. Quantitative data including socio-demographic, socioeconomic, and clinical characteristics of study subjects were collected using interviewer-administered questionnaires. Qualitative data were collected using guides and checklists. Data were analysed descriptively and inferentially using Pearson’s chi-square statistics, Fishers exact tests and regression modelling to determine associations between independent variables and uncontrolled hypertension using STATA 14. Qualitative data were organized thematically using NVIVO.Results: 48% of the study participants had uncontrolled hypertension at the time of the study. Univariable analyses returned level of education (p=0.017), source of financing for hypertensive drugs (p=0.011), BMI (p=0.005) as significant factors.Conclusions: The study recommends community health promotion activities to increase awareness of how to modify these significant factors to reduce hypertension.

2. CHARACTERISTICS OF UNCONTROLLED HYPERTENSION AMONG END STAGE KIDNEY DISEASE (ESKD) PATIENTS ON CHRONIC HEMODIALYSIS IN DR. HASAN SADIKIN HOSPITAL BANDUNG

ABSTRACT Background: Prevalence of uncontrolled hypertension (UHT) in ESKD patient remained relatively high and increasing in trend nowadays, especially in black and Asian people. There is higher mortality among those people, yet hypertension is a leading cause of morbidity of ESKD. Therefore interdialytic weight gain (IDWG) independently associated with an increased BP, and affect outcomes in ESKD patients. Objective: The aim of this study is to determine characteristic among UHT in ESKD patient underwent hemodialysis (HD) in Dr. Hasan Sadikin Hospital Bandung. Method: We performed cross-sectional study with all ESKD patients with age &gt; 18 years old, underwent hemodialysis &gt; 3 months. Data collected from medical record. BP examined before each HD (3 times in a row). We used two kind of classification, BP &gt; 140/90 as UHT based on NKF-KDOQI 2014 and BP &gt; 130/80 based on AHA 2017. Result: 130 patients were included. Based on NKF KDOQI 2014 we found that 97 (74,6%) of the patients had UHT and only 9,3% of them had 3 kinds anti-HT agents compare to 21,2% in the controlled hypertension (CHT) group. Hypertension was the main etiology of ESKD (86,1%). The mean IDWG in UHT was 2,8 kgs compare to 2.6 kgs in CHT group. Conclusion: In summary, there were more patients in UHT 74,6% patients and most of them used less than 3 anti-HT agents. The average IDWG higher in UHT group. These could be primary data for analytical studies about correlation of UHT, its risk factor.

Abstract P878: Racial and Ethnic Disparities in Early Hypertension Control After Intracerebral Hemorrhage

Introduction: Survivors of Intracerebral Hemorrhage (ICH) are at high risk of recurrent stroke. This risk is inversely proportional to average Blood Pressure (BP) after ICH. Racial/ethnic minority ICH survivors in the US demonstrate greater hypertension severity after ICH and are at higher risk of recurrent cerebral bleeding. Since most recurrent strokes occur within 12-18 months of index ICH, rapidly achieving BP control is likely to be crucial. We investigated the frequency, prognostic impact, and racial/ethnic disparities in uncontrolled short-term hypertension (HTN) after ICH. Methods: We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital (MGH-ICH, n=1305) and the University of Hong Kong (HK-ICH, n=523). We classified HTN as controlled, uncontrolled or treatment-resistant and determined: 1) risk factors for uncontrolled and treatment-resistant HTN; and 2) whether HTN control at 3 months is associated with long-term BP control, stroke recurrence and mortality across self-reported race/ethnicity groups. Results: We followed 1828 ICH survivors (1128 White, 565 Asian, 59 Hispanic, 49 Black, 27 other) for a median of 46.2 months. Only 9 of 172 (5%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled HTN, 755 (41%) had undertreated HTN, and 360 (20%) had treatment-resistant HTN. BP measurements at 3 months were highly correlated with measurements during follow-up (p&lt;0.001). Black, Hispanic and Asian race/ethnicity were associated with higher prevalence of uncontrolled HTN at 3 months (all p&lt;0.05). Both undertreated and uncontrolled HTN at 3 months were associated with increased risk of recurrent stroke and mortality during follow-up (all p&lt;0.05). Conclusions: Most ICH survivors have inadequate HTN control 3 months after ICH, with under-treatment accounting for the majority of cases. Three-month BP measurements are associated with inadequate long-term HTN control, higher recurrent stroke risk and mortality. ICH survivors self-reporting as Black, Hispanic or Asian appear to be at highest risk for uncontrolled HTN. Optimizing HTN control at 3 months is a unique opportunity to address racial/ethnic disparities in quality of care among survivors of primary ICH.

Prevalence and risk factors of uncontrolled hypertension in the urban population of Kerala

Background: Hypertension is leading risk factor for cardiovascular diseases and stroke, and leads to 12.8% of all deaths in the world. Uncontrolled hypertension doubles the risk of cardiovascular disease among the adults with hypertension. Globally 65% of the treated hypertensive have uncontrolled hypertension and in Kerala about three forth of the treated hypertensive have poor blood pressure control. The burden of uncontrolled hypertension is suggestive of preventable deaths and cardiovascular events.Methods: A cross-sectional study was conducted among 1210 residents of Kochi Corporation of Kerala aged 18 years and above during the period of Sept. 2014 to Sept. 2016. Pre-tested, semi-structured questionnaire was used to collect data on socio-demographic factors such as age, sex, occupation, socio-economic status, education and marital status. Behavioural factors such smoking, alcohol intake, physical activity and dietary factors were collected. Data was analysed by using statistical package for social sciences software version 20.0.Results: The prevalence of uncontrolled hypertension was 13.14% among the study population. Majority of the uncontrolled hypertensive were females (67.3%) and belonged to the age group 45 years and above (92.5%). The independent predictive factors of uncontrolled hypertension were additional salt intake (aOR 3.62; 95% CI 1.36-9.66), health education by a doctor (aOR 3.58; 95% CI 1.48-8.64), poor adherence to medication (aOR 4.45; 95% CI 1.23-16.03) and patients having no other co-morbidity (aOR 3.24; 95% CI 1.36-7.72).Conclusions: The burden of uncontrolled hypertension was high in this urban setting. A comprehensive measure involving doctors and healthcare workers have to be adopted to achieve optimum blood pressure among the hypertensive.

A Stronger Effect of Body Mass Index and Waist Circumference on the Prevalence of Uncontrolled Hypertension among Caucasian Men than Women

Background: Gender-related differences in fat distribution may affect blood pressure (BP) control in hypertensive subjects. The aim of the study was to assess how body mass (BM), BMI, and waist circumference (WC) influence the effectiveness of antihypertension therapy in hypertensive men and women in daily clinical practice. Patients and Methods: The observational study involved 12,289 adult hypertensive Caucasians (6,163 women) declaring regular use of antihypertensive drugs. BP control was scored based on the mean values of 2 attended office BP measurements. WC thresholds for visceral obesity were adopted from definitions of the International Diabetes Federation (≥94/80 cm for men/women) and National Cholesterol Education Program Adult Treatment Panel III (≥102/88 cm for men/women). Stepwise backward multivariable logistic regression was used to analyse correlates of the effectiveness of hypertension therapy. Results: The predictive value of BMI ≥30 (for uncontrolled hypertension) was stronger than that of visceral obesity, regardless of the criteria used. In men, BP control rapidly deteriorated with BMI (odds ratio [OR] up to 8.58 [95% CI: 5.74–12.83]) and WC (OR up to 5.09 [3.84–6.74]), while in women, the association was more flattened (OR up to 3.63 [2.78–4.74] and 1.93 [1.59–2.35], respectively). However, the highest risk of uncontrolled BP occurred in women with BM ≥110 kg (OR = 10.47 [5.05–21.71]) and men with BM ≥125 kg (OR = 9.66 [5.86–15.94]). Conclusions: (1) Obesity and visceral obesity limit the effectiveness of antihypertension therapy more in men than in women. (2) This phenomenon should be taken into account in the prescription of adequate doses of antihypertensive drugs.

Knowledge, Attitudes, Practices and Blood Pressure Control of Hypertensive Patients at a South African Primary Health Care Centre

Hypertension is a serious global and South African public health problem. The high prevalence of uncontrolled hypertension is related to a patient’s lack of knowledge and healthy practices. The study aimed to assess the knowledge, attitudes and practices of hypertensive patients and their blood pressure control at a rural community health centre. This was a prospective cross-sectional study conducted on diagnosed cases of hypertension at the centre. Binary logistic regression analysis was conducted to determine the factors for the control of hypertension. Two hundred and ninety-seven known hypertensive patients were recruited, the majority of which were female. Eighty-eight percent were older than 45 years, and almost all had a monthly income of less than R3000 (USD 190). More than half controlled their blood pressure. It was found that 46% had poor knowledge, 64% had good attitudes and 60% were practising positively regarding the control of hypertension. Hypertensive patients attending the centre had poor knowledge but good attitudes and practices towards hypertension. The study revealed an urgent need for improved health promotion and educational efforts to increase the knowledge of hypertension in rural communities and to address poverty as a major obstacle to healthy lifestyle choices.

Blood Pressure and Control Factor in Hypertensives Monitored at the Referral Hopsital in Boma. Democratic Repubic of the Congo

Uncontrolled hypertension remains a significant problem in daily clinical practice worldwide. Few data are available on blood pressure control in hospitals. The aim of this study was the frequency of uncontrolled hypertension and associated risk factors in hypertensive patients followed at the general referral hospital of Boma in the province of Kongo Central in the Democratic Republic of Congo From January 1 to May 31, 2019; we conducted a cross-sectional and descriptive study at the Boma reference hospital located in the southeast and 440 Km from Kinshasa, the capital of DR Congo. Included was any hypertensive patient aver 18 years and informed consent. Information on demographic parameters, behavioral lifestyles, anthropometric and biological (blood sugar, creatinine, urine strip and lipid profile ) and blood pressure (BP) measurements was obtained. Hypertension was defined as an average of two BP ≥ 140/90 mmHg. Independent factors associated with control hypertension were identified using logistic regression analysis. P&lt;0.05 defined the level of statistical significance. The prevalence of uncontrolled hypertension was 62 % BP control was observed in 150 (38.0%) of 395 treated hypertensive participants mainly in men than women (68.3 vs 53.3 %; p=0.001). Age &lt;60 years (p=0.005), no smoking ( p=0.047), no Central obesity (p=0.008), CKD ( stade 1 vs 2 ) (p=0.065) , and no hypercholesterolemia ( p= 0.014) emerged as associated with control hypertension. Uncontrolled hypertension was common in our hospitals.Therapeutic lifestyle changes and pharmacological treatment are necessary for hypertensive participants.

Epidemiology of hypertension in Japan: beyond the new 2019 Japanese guidelines.

From the national surveys of Japan over a 55-year period (1961-2016), a steady decrease was observed in systolic blood pressure (BP) levels among all age groups of men and women, but not in diastolic BP levels-particularly among men. Hypertension prevalence remains high: over 60% of men aged ≥50 years and womenaged ≥60 years had hypertension in 2016. However, the control rates of hypertension have continuously improved over a 36-year period, and were ~40% in 2016. Nonetheless, the over 50% prevalence of uncontrolled hypertension is a major risk factor for future cardiovascular diseases. Of the estimated 43 million hypertensives in Japan, most (31 million, 72%) were under poor control. According to new Japanese hypertension guidelines (JSH 2019), there will be only a small increase (2.2 million, 2.1 percentage points) in adults who are recommended for antihypertensive medication compared with 2014 guidelines. However, an additional 5.3 million (22.1 percentage points) adults taking antihypertensive medication would have a BP above the target defined by JSH 2019. The number of hypertensives with poor control was targeted to decrease by 7 million-from 31 million in 2017 to 24 million in 2028-when the followings are achieved: (1) the prevalence of hypertension decreases by 5 percentage points; (2) the treatment rate of hypertension among hypertensives increases by 10 percentage points; and (3) the control rate of hypertension, defined as BP <140/90 mmHg, among individuals taking antihypertensive medication increases by 10 percentage points. Both high-risk and population strategies to manage and prevent hypertension deserve greater priority.

MO076LONGITUDINAL CHANGES AND OUTCOME OF HIGH BLOOD PRESSURE IN EUROPEAN CHILDREN ON RENAL REPLACEMENT THERAPY

Abstract Background and Aims Few studies have focused on trends of hypertension (HTN) and status of blood pressure (BP) control over time in children on renal replacement therapy (RRT). In this study, we aimed to evaluate the 5-year trend in BP antihypertensive medications (AHs) use, as well as the association between HTN and mortality among RRT patients enrolled within the ESPN/ERA-EDTA Registry. Method 25.223 BP measurements from 5.032 patients who started RRT before 20 years of age, between 2007-2016, were included. Mixed models were used to analyse trends of BP, the JointPoint regression to assess prevalence of uncontrolled HTN (uHTN) over time, and multivariable Cox proportional hazard models to evaluate association of BP with mortality. Results Mean systolic BP (SBP) at RRT initiation was 1.66(+0.15), 1.05(+0.15) and 1.09(+0.08) SDS in HD, PD and transplanted (Tx) patients, respectively, while it was 1.41(+0.19), 1.12(+0.18), and 0.79(+0.06) SDS in the corresponding RRT categories after 5 years. Patients on HD showed a significant decrease in the prevalence of uHTN over time (57.1% at dialysis start vs 41.4% after 5 years; annual percentage change [APC] -4%; 95% CI: -5.7;-2.2; p&amp;lt;0.05), coupled with a significant reduction in AHs use (APC -3.5%; 95% CI: -6.7;-0.2). PD patients showed a similar reduction in uHTN prevalence (APC -4.9%; 95% CI: -7.2;-2.6; p&amp;lt;0.05), but a significant increase in AHs use (APC +3.6%; 95% CI: 0.6;6.6; p&amp;lt;0.05). After 5 years, Tx patients showed a significant reduction in both prevalence of uHTN (APC -4.8%; 95% CI: -7.8;-1.7; p&amp;lt;0.05) and use of AHs (APC -2.2%; 95% CI: -4.1;-0.3%; p&amp;lt;0.05). Having uHTN was not associated with mortality (HR 0.95; 95% CI: 0.68-1.33). Conclusion A more adequate control of BP over time seemed to be obtained in children on RRT. Findings in PD patients suggest that this requires a progressive increase in the use of AHs.

Multidisciplinary Consensus Document on the Management of Uncontrolled Hypertension in India

Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in uncontrolled hypertension (UHT). The prevalence of UHT is high in India, with only about 9-20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT. A multidisciplinary panel, comprising of specialists in cardiology, nephrology and internal medicine, was convened to address the diagnosis and management of UHT in the Indian population. The panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting.

Perspectives of patients and physicians regarding hypertensive management from an online survey for excellence: a subanalysis of the PARADOX study by physician categories

An existing clinical problem in Japan is the high prevalence of uncontrolled hypertension despite the availability of various effective therapies. Here, we analyzed survey data to gain insight into this paradox from physicians’ perspectives, with results categorized according to specialty (i.e., with or without certification by the Japanese Society of Hypertension [JSH]), institution type, gender, and age. A web-based survey of typical educational activities for patients regarding hypertension management was conducted in Japan between October 19 and 31, 2017. Differences between physician groups were investigated per category. Survey results from 541 physicians were analyzed: 59 JSH certified (i.e., ‘specialist’) vs 482 non-JSH certified (i.e., ‘nonspecialist’) physicians; 192 general practitioners vs 349 hospital physicians; 500 males vs 41 females; and 178 younger (mean age: 40.7 years), 174 middle-aged (52.0 years) or 189 older (61.3 years) physicians. The most statistically significant differences between groups were observed in the category of physician specialty. Compared with nonspecialists, specialist physicians were more conscious of providing education on patient lifestyle modifications, more aware of patient- and physician-derived issues, and understood and followed the treatment guidelines. General practitioners cared more about the patient’s burden than did hospital physicians. Younger physicians identified the need to incorporate the patient’s perspective into their treatment. This analysis shows that the provision and perceptions of education differ between physician categories. Compared with specialist physicians, nonspecialists were less likely to provide adequate guidance on lifestyle modifications, possibly due to their uncertainty in understanding treatment guideline recommendations. Further education of nonspecialists on hypertension management may be warranted.

Medication Errors and Blood Pressure Control Among Patients Managed for Hypertension in Public Ambulatory Care Clinics in Botswana.

BackgroundThe prevalence of hypertension in low‐ and middle‐income countries is rapidly increasing, with most cases undiagnosed and many poorly controlled among those diagnosed. Medication reconciliation studies from high‐income countries have demonstrated a high occurrence of antihypertensive medication errors and a strong association between medication errors and inadequate blood pressure control, but data from low‐ and middle‐income countries are lacking.Methods and ResultsWe conducted a cross‐sectional study from April to October 2018 of adult patients on pharmacologic management for known hypertension at 7 public health facilities in Kweneng East District, Botswana. Our aims included to evaluate the frequency of uncontrolled hypertension, the frequency and type of medication errors causing discrepancies between patient‐reported and prescribed antihypertensive medications, and the association between medication errors and uncontrolled hypertension. Descriptive analyses and multivariable logistic regression were used. The prevalence of uncontrolled hypertension was 55% among 280 enrolled adult patients, and 95 (34%) had ≥1 medication error. The most common errors included patients taking medications incorrectly (11.1%; 31/280), patients omitting medications (7.9%; 22/280), and unfilled prescriptions caused by pharmacy stock outs (7.5%%; 21/280). Uncontrolled hypertension was significantly associated with having ≥1 medication error compared with no errors (adjusted odds ratio, 3.26; 95% CI, 1.75–6.06; P<0.001).ConclusionsMedication errors are strongly associated with poor blood pressure control in this setting. Further research is warranted to assess whether medication reconciliation and other low‐cost interventions addressing root causes of medication errors can improve the control of hypertension and other chronic conditions in low‐ and middle‐income countries.

Uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa: protocol for a systematic review and meta-analysis

BackgroundUncontrolled hypertension is the most important risk factor and leading cause of cardiovascular diseases. It is predicted that the number of people with hypertension will increase, and a large proportion of this increase will occur in developing countries. The highest prevalence of uncontrolled hypertension is reported in sub-Saharan Africa, and treatment for hypertension is unacceptably low. Hypertension commonly co-exists with comorbidities and this is associated with poorer health outcomes for patients. This review aims to estimate the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa.Methods and analysisAll published and unpublished studies on the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa will be included. MEDLINE via OVID, Embase, and Web of Science will be searched to identify all relevant articles published from January 2000 to June 2019. Experts in the field will be contacted for unpublished literature, and Open SIGLE will be reviewed for relevant information. No language restriction will be imposed. Two reviewers will select, screen, extract data, and assess the risk of bias while a third reviewer will arbitrate the disagreements. A meta-analysis will be performed on variables that are similar across the included studies. Proportions will be stabilized before estimates are pooled using a random effects model. The presence of publication bias will be assessed using Egger’s test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported in accordance with the PRISMA-P protocol guidelines. Results will be stratified by country, comorbidity, and geographic region.DiscussionThis systematic review and meta-analysis is expected to quantify the magnitude of uncontrolled hypertension among patients with certain comorbid conditions in sub-Saharan Africa to guide policies and interventions. This review is registered in PROSPERO International Prospective Register of Systematic reviews CRD42019108218.

P2648Uncontrolled hypertension is common among patients with implanted pacemaker

Abstract Background Given the significance of hypertension (HTN) as a major risk factor for cardiovascular disease, stroke, HF, and mortality, uncontrolled HTN remains a large public health problem. Pacemaker patients are well trapped in the healthcare system, and hence are expected to have a lower rate of uncontrolled HTN than general HTN patient population. However, incidence of uncontrolled HTN in pacemaker patients is not well characterized. Purpose We sought to characterize the prevalence of uncontrolled HTN in pacemaker patients using real-world EHR data. Methods Patients who received an implanted pacemaker were identified from a large EHR de-identified database of a cohort of patients with or at risk of cardiovascular disease from 01/2007 to 03/2017. The data were queried to determine prevalence of uncontrolled HTN. Results From a total of 11,472,727 patients in the EHR dataset, a total of 140,701 (1.23%) had implanted pacemaker with implant date available. Of these 72,846 (51.8%) had systolic blood pressure (SBP) available within 60 days of device implant. Depending on SBP cut-off, the proportion of patients with uncontrolled HTN ranged from 32.9% (SBP&gt;140 mmHg) to 11.5% (SBP&gt;160 mmHg) at the time of implant. A subset (11,676, 16%) had SBP available at implant and one-year post-implant. At one year time point uncontrolled HTN in these patients ranged from 20.8% (SBP&gt;140 mmHg) to 2.4% (SBP&gt;160 mmHg) (Figure). Conclusion A significant proportion of pacemaker patients have uncontrolled HTN at the time of implant. While there is a decline in this proportion at one year, substantial proportion of pacemaker patients remain with uncontrolled HTN. In addition to better guideline directed medical therapy, there may be an opportunity for better monitoring and alternative therapeutic strategies in these patients. Acknowledgement/Funding Medtronic Inc.

Diabetic Foot Ulcers in a Kenyan Referral and Teaching Hospital: Risk Factors, Patient Characteristics and Clinical Outcomes

Introduction: The burden of diabetes mellitus (DM) is increasing in resource-poor settings leading to a rise in diabetic complications. Foot complications result in almost half of all hospital admissions among diabetic patients and may result in amputations or death. Objective: To investigate the sociodemographic, clinic-laboratory characteristics and clinical outcomes of patients with diabetic foot ulcers (DFU) in a clinical setting. Materials and Methods: A cross-sectional study of 84 adult consecutive inpatients and outpatients at Kenyatta National Hospital (KNH) with any type of DM and having active DFU was conducted over 12 months. History and physical examinations findings were recorded through a structured questionnaire. Relevant data on the most recent blood tests and clinical outcomes for patients with foot ulcers were retrieved from the patients’ medical notes and analysed. Results: Majority (68%) were inpatients. The mean age was 60.30 years with 68% living in urban areas and 60% having minimal or no formal education. 8% were newly diagnosed with DM. The median duration of DM was 6.5 years. A majority (96%) had type 2 diabetes mellitus (T2DM). 45% were on insulin only, 18% on oral drugs only and 32% on a combination of both. The median random blood sugar was 9.60 mmol/L and glycated haemoglobin was 8.80%. Although 61% of patients had co-morbid hypertension, only about 40% had elevated systolic blood pressure (BP) while 23% had elevated diastolic pressures. A majority of the patients had good lipid profile, 85% with desirable total cholesterol and 70% having ideal low-density lipoproteins. The mortality rate among patients with DFU was 11%. Conclusion: There are poor outcomes for patients with DFU in this setting such as poor wound healing, high recurrence rates, increased amputations and mortality compared to previous studies. However, the prevalence of uncontrolled hypertension, dyslipidaemia and neuropathy was much lower than earlier local reports.

Unhealthy behavior and risk of uncontrolled hypertension among treated individuals–The CONSTANCES cohort study

Poor lifestyle behaviors have been identified to contribute to poor blood pressure (BP) control. We aimed to examine the individual and combined associations of unhealthy behavior with uncontrolled hypertension (HTN) among treated hypertensive adults. We conducted cross-sectional analysis using data from the CONSTANCES cohort study. Volunteer participants who have been diagnosed with HTN and were taking antihypertensive medications were included. Uncontrolled BP was defined as mean systolic BP ≥ 140 mmHg and/or mean diastolic BP ≥ 90 mmHg. Lifestyle factors were assessed using validated questionnaires. Dietary adherence assessment was done using the modified National Program on Nutrition and Health (mPNNS) score and then categorized into low, medium and high. We considered heavy alcohol drinking, sedentary level PA, low/medium dietary adherence and overweight/obese (body mass index ≥ 25 kg/m 2 ) as unhealthy behaviors. Using logistic regression models we estimated the association between control of hypertension and unhealthy behaviors. Statistical analyses were stratified by sex and were performed with SAS 9.4 (SAS Institute). A total of 8,927 participants were analyzed. The prevalence of uncontrolled HTN was of 53.3% and it was more common in men than in women (66.3% vs. 42.6% respectively, P < 0.001). The odds of uncontrolled HTN increased with low dietary adherence in men only ( P = 0.038), overweight and obese men ( P < 0.001), heavy alcohol drinking in both men and women ( P < 0.05 for both) compared to moderate/light (never) drinking. However, there was no statistically significant association with physical activity in both genders. The frequency of uncontrolled HTN increased with the number of unhealthy behaviors in both sexes ( P < 0.001 for men and P = 0.008 for women). Men and women reporting three unhealthy behaviors had 1.53–fold and 1.73-fold increase of the odds of uncontrolled HTN, respectively. An unhealthy lifestyle including low/medium adherence to dietary recommendations, high alcohol consumption and overweight/obesity was associated with uncontrolled HTN among treated hypertensive individuals.