Previous Diagnosis Of Hypertension Research Articles

IMPACT OF PREVIOUS DIAGNOSIS OF HYPERTENSION ON RENAL FUNCTION IN HEART FAILURE PATIENTS

Objective: The aim of this study is to evaluate the impact of previous diagnosis of HTN in the reduction of the estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD) in heart failure (HF) patients by using real world data. Design and method: The study population was selected from a database with electronic health records information from 2012 to 2016 of patients older than 24 years of age. Patients with an active diagnosis of HF at some point during this period were selected, and then stratified according to the presence of previous diagnosis of hypertension. eGFR and Kidney Disease Global Outcomes (KDIGO) risk scale during the observational period were analyzed. Two events were studied using survival and Cox proportional hazards regression models: i) reduction of 20% compared to basal eGFR value and ii) increased risk in the KDIGO scale. Other clinically relevant factors were selected as adjustment variables: age, sex, comorbidities (atrial fibrillation, diabetes, dyslipidaemia and coronary heart disease) and drugs used for HF treatment or anticoagulation. Results: The study population included 80631 HF patients, 37426 of them classified with the KDIGO scale. The proportion of patients with hypertension was 87% and the mean baseline eGFR was 64.2 ml/min/1.73m2. The average age was 75.63 years and 54.7% women. Significant increments in risk were found in patients diagnosed of hypertension for the two events, being 1.28 (CI95% 1.21–1.36) for the eGFR reduction and 1.36 (CI95% 1.25–1.48) for the KDIGO increased risk (Figures). This effect increased as the baseline CKD risk was higher, with 1.45 (CI95% 1.37–1.53) times the risk in the case of base high-risk group (eGFR at baseline <60ml/min/1.73m2; N = 5980) compared to the low risk one (N = 15460). Conclusions: Hypertension is a very prevalent comorbidity of patients with HF, and has a negative impact on kidney function, increasing the risk of reduction of eGFR and development of CKD. The prognosis is significantly worse as the baseline risk is higher.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults.

Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension. We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status. Multivariable logistic regressions were performed to identify whether (1) frequency of depressive symptoms, (2) frequency of anxiety-related symptoms, (3) self-reported depression medication use, or (4) self-reported anxiety medication use predicted previous hypertension diagnosis. A total of 74,285,160 individuals were represented in our cohort. Participants that reported taking depression (OR 2.72; 95% CI 1.41-5.24; P = 0.009) and anxiety (OR 2.50; 95% CI 1.42-4.41; P = 0.006) medications had greater odds of hypertension. Individuals with depressive feelings daily, monthly, and few times per year were more likely to have hypertension. Respondents with daily (OR 2.28; 95% CI 1.22-4.24; P = 0.021) and weekly (OR 1.88; 95% CI 1.05-3.38; P = 0.040) anxiety symptoms were more likely to have hypertension. Low-income adults in the United States with symptoms of anxiety or depression have higher likelihood of hypertension than those with no symptoms. Respondents who indicated taking medication for anxiety disorders or depression were more likely to have been diagnosed with hypertension.

Insulin resistance drives cognitive impairment in hypertensive pre-diabetic frail elders: the CENTENNIAL study.

Pre-diabetes is a condition that confers an increased cardiovascular risk. Frailty is very common in hypertensive patients, and insulin resistance has been linked to frailty in older adults with diabetes. On these grounds, our aim was to evaluate the association between insulin resistance and cognitive impairment in hypertensive and pre-diabetic and frail older adults. We studied consecutive pre-diabetic and hypertensive elders with frailty presenting at the Avellino local health authority of the Italian Ministry of Health (ASL AV) from March 2021 to March 2022. All of them fulfilled the following inclusion criteria: a previous diagnosis of hypertension with no clinical or laboratory evidence of secondary causes, a confirmed diagnosis of pre-diabetes, age >65 years, Montreal Cognitive Assessment (MoCA) Score <26, and frailty. We enrolled 178 frail patients, of which 141 successfully completed the study. We observed a strong inverse correlation (r = -0.807; P < 0.001) between MoCA Score and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The results were confirmed by a linear regression analysis using MoCA Score as dependent variable, after adjusting for several potential confounders. Taken together, our data highlight for the first time the association between insulin resistance and global cognitive function in frail elders with hypertension and pre-diabetes.

Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV.

This national representative survey sought to assess hypertension's prevalence, awareness, treatment and control in Romania. A representative sample (by age, sex and residence) of 1477 Romanian adults (51.19 ± 16.61 years, range 18-80 years, 59.9% women) was multimodally evaluated during two study visits. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg or previously diagnosed hypertension, regardless of BP. Awareness was defined by knowledge of previous hypertension diagnosis or of current use of antihypertensive treatment. Treatment was defined by antihypertensive medication taken at least 2 weeks prior to enrolment. Control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg at both visits in treated hypertensive patients. Hypertension prevalence was 46% ( n = 680) consisting of 81.02% ( n = 551) known hypertensive patients and 18.98% ( n = 129) newly diagnosed hypertensive patients. Awareness, treatment and control of hypertension were: 81% ( n = 551), 83.8% ( n = 462) and 39.2% ( n = 181). Despite numerous pandemic-related obstacles in conducting a national survey, SEPHAR IV updates hypertension epidemiological data of a high-cardiovascular-risk Eastern-European population. This study confirms previous predictions of hypertension prevalence, treatment and control, which remain unfavourable because of unsatisfactory control of promoting factors.

Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015

INTRODUCTION: The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS: This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg. RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.

MIDO GDM: an innovative artificial intelligence-based prediction model for the development of gestational diabetes in Mexican women

Given the barriers to early detection of gestational diabetes mellitus (GDM), this study aimed to develop an artificial intelligence (AI)-based prediction model for GDM in pregnant Mexican women. Data were retrieved from 1709 pregnant women who participated in the multicenter prospective cohort study ‘Cuido mi embarazo’. A machine-learning-driven method was used to select the best predictive variables for GDM risk: age, family history of type 2 diabetes, previous diagnosis of hypertension, pregestational body mass index, gestational week, parity, birth weight of last child, and random capillary glucose. An artificial neural network approach was then used to build the model, which achieved a high level of accuracy (70.3%) and sensitivity (83.3%) for identifying women at high risk of developing GDM. This AI-based model will be applied throughout Mexico to improve the timing and quality of GDM interventions. Given the ease of obtaining the model variables, this model is expected to be clinically strategic, allowing prioritization of preventative treatment and promising a paradigm shift in prevention and primary healthcare during pregnancy. This AI model uses variables that are easily collected to identify pregnant women at risk of developing GDM with a high level of accuracy and precision.

The effect of urgent blood pressure reduction on left atrial strain in patients with hypertensive attack : Blood pressure lowering affects LA strain.

Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a "load-independent" parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study

ObjectiveElectronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known...

61. Older Age is the Strongest Risk Factors for Hypertension in Indonesia: Subgroup Analysis of The National Basic Health Survey 2018

Introduction: Among the threat of non-communicable diseases, hypertension is one of the potential health problems causing significant cardiovascular morbidity and mortality. Our recent study observed the prevalence of hypertension is as high as 41%, but the exact risk factors for hypertension are unknown. In this study we analyze the risk factors for hypertension in the Indonesian population, based on data from the National Basic Health Survey (Riset Kesehatan Dasar – Riskesdas) 2018. Methods: We included subjects age &gt;18 years and analyzed a large set of risk factors for hypertension: age, gender, body mass index, occupation status, level of education, consumption of salty food, consumption of fruit and vegetables, smoking, alcohol consumption, physical activity, comorbid condition (heart disease, diabetes, stroke), and access to healthcare facility. Hypertension defined as measurement of blood pressure based on JNC VII criteria and previous diagnosis of hypertension made by a physician. The associations between hypertension and risk factors were examined using multiple logistic regression models. Results: We included 389,093 subjects out of 713,783 subjects participated in Riskesdas 2018 survey. The majority of hypertensive subjects was female (62.6%) and within the age of 40–59 years (50.2%). Compared to normal-blood pressure group, hypertensive subjects were likely having lower education status (36.9% vs 54.8%), were more obese (19.2% vs 34.3%), physically less active (47.5% vs 53.3%), had more heart disease (1.7% vs 3.9%), more diabetes mellitus (1.8% vs 5.65%), and more stroke (0.4% vs 3.7%). Older age (&gt;60 years) was identified as a robust independent risk factor for hypertension (OR 2.01; 95% CI 1.76–2.29; p &lt; 0.001), beyond the influence of other risk factors such as obesity (OR 1.47; 95% CI 1.04–2.07; p = 0.02), low education status (OR 1.37; 95% CI 1.35–1.39; p &lt; 0.001), and unemployed (OR 1.1; 95% CI 1.08–1.12; p &lt; 0.001). While interactions within other traditional risk factors were necessary for the occurrence of hypertension (i.e., heart disease∗age, heart disease∗alcohol consumption, heart disease∗stroke, heart disease∗salty food consumption, heart disease∗diabetes, heart disease∗less physical activity, diabetes∗gender, diabetes∗salty food consumption, diabetes∗less physical activity). Conclusion: This study confirmed traditional risk factors play an important role in the development of hypertension in Indonesian population, particularly older age.

Population Preferences for Primary Care Models for Hypertension in Karnataka, India

Hypertension contributes to more than 1.6 million deaths annually in India, with many individuals being unaware they have the condition or receiving inadequate treatment. Policy initiatives to strengthen disease detection and management through primary care services in India are not currently informed by population preferences. To quantify population preferences for attributes of public primary care services for hypertension. This cross-sectional study involved administration of a household survey to a population-based sample of adults with hypertension in the Bengaluru Nagara district (Bengaluru City; urban setting) and the Kolar district (rural setting) in the state of Karnataka, India, from June 22 to July 27, 2021. A discrete choice experiment was designed in which participants selected preferred primary care clinic attributes from hypothetical alternatives. Eligible participants were 30 years or older with a previous diagnosis of hypertension or with measured diastolic blood pressure of 90 mm Hg or higher or systolic blood pressure of 140 mm Hg or higher. A total of 1422 of 1927 individuals (73.8%) consented to receive initial screening, and 1150 (80.9%) were eligible for participation, with 1085 (94.3%) of those eligible completing the survey. Relative preference for health care service attributes and preference class derived from respondents selecting a preferred clinic scenario from 8 sets of hypothetical comparisons based on wait time, staff courtesy, clinician type, carefulness of clinical assessment, and availability of free medication. Among 1085 adult respondents with hypertension, the mean (SD) age was 54.4 (11.2) years; 573 participants (52.8%) identified as female, and 918 (84.6%) had a previous diagnosis of hypertension. Overall preferences were for careful clinical assessment and consistent availability of free medication; 3 of 5 latent classes prioritized 1 or both of these attributes, accounting for 85.1% of all respondents. However, the largest class (52.4% of respondents) had weak preferences distributed across all attributes (largest relative utility for careful clinical assessment: β = 0.13; 95% CI, 0.06-0.20; 36.4% preference share). Two small classes had strong preferences; 1 class (5.4% of respondents) prioritized shorter wait time (85.1% preference share; utility, β = -3.04; 95% CI, -4.94 to -1.14); the posterior probability of membership in this class was higher among urban vs rural respondents (mean [SD], 0.09 [0.26] vs 0.02 [0.13]). The other class (9.5% of respondents) prioritized seeing a physician (the term doctor was used in the survey) rather than a nurse (66.2% preference share; utility, β = 4.01; 95% CI, 2.76-5.25); the posterior probability of membership in this class was greater among rural vs urban respondents (mean [SD], 0.17 [0.35] vs 0.02 [0.10]). In this study, stated population preferences suggested that consistent medication availability and quality of clinical assessment should be prioritized in primary care services in Karnataka, India. The heterogeneity observed in population preferences supports considering additional models of care, such as fast-track medication dispensing to reduce wait times in urban settings and physician-led services in rural areas.

Symptoms and Risk of Obstructive Sleep Apnea in Patients Attending Primary Health Care Clinics in Riyadh, Saudi Arabia.

Background Obstructive sleep apnea (OSA) is a breathing disorder that occurs while sleeping, characterized by periods of partial or complete airway collapse associated with a drop in oxygen saturation or arousal from sleep. OSA is associated with significant health consequences, including hypertension, obesity, coronary artery disease, metabolic dysfunction, cognitive decline, and cancer progression. Methods A cross-sectional study was conducted at the four primary healthcare centers in the Ministry of National Guards Health Affairs (MNGHA) in Riyadh, Saudi Arabia. The study included every adult 18- 65 years old. After informed consent was obtained, interviews were conducted using the Berlin questionnaire (BQ) to assess participants' prevalence and risk (OSA). SAS software version 9.4 was used to enter and analyze the data. Results A total of 400 primary care attendants were approached. The overall prevalence of high-risk apnea was 21%. There was a significant difference in the high risk of apnea between a BMI greater than 30 and a BMI lower than 30 (p< 0.0001). There was a significant difference in the high risk of apnea between hypertension and normal blood pressure (p< 0.0001). Conclusion The BQ assessed the predictive factors related to the development and prevalence of OSA and showed a predominance in those with a BMI over 30 Kg/m2 or with a previous diagnosis of hypertension with no significant related risk among gender and age factors.

PS-BPP02-8: BRIDGING THE GAPS IN HYPERTENSION CARE IN NIGERIA: END-LINE EVALUATION OF COMMUNITY ACTION AGAINST NON-COMMUNICABLE DISEASES (COMAAND) PROJECT

Title: Bridging the Gaps in Hypertension care in Nigeria: End-line Evaluation of COMmunity Action Against Non-communicable Diseases (COMAAND) Project Objective: Non-Communicable Diseases (NCDs) have become a global public health burden leading to at least 70% of deaths globally. Cardiovascular Diseases (CVDs) are the primary drivers of this epidemic, and hypertension is the leading determinant of CVD mortality. We implemented an innovative community-based strategy focused on early detection and timely management of hypertension in three communities in Anambra state, Nigeria entitled COMmunity Action Against Non-communicable Diseases (COMAAND). We conducted a baseline study to establish hypertension's prevalence, awareness, treatment, and control in implementing communities. In this study, we set out to assess the same metrics we evaluated at baseline, and also compared them with the findings at baseline to establish the impact made by the project. Design and Methods: We conducted a cross-sectional survey (at baseline and end-line) using an adapted version of the May Measurement Month (MMM) questionnaire. Blood pressure was measured following the 2018 ESC/ ESC Guideline for treatment of arterial hypertension, and anthropometry was taken in line with the Diet Anthropometry and Physical Activity (DAPA) measurement toolkits of the National institute for health research, Medical Research Council (MRC) the UK. Hypertension was defined as blood pressure (BP) &gt; = 140/90 mmHg, and/or self-reported treatment of hypertension with antihypertensive medication in the last 2 weeks. Awareness of hypertension was defined as a self-report of any previous diagnosis of hypertension by a healthcare professional. Treatment of hypertension was self-reported use of prescription medication for management of hypertension during the previous 2 weeks. Control of hypertension is a pharmacological treatment of hypertension associated with an average BP &lt; 140/90 mmHg Results: 360 participants were sampled across three participating communities, and are averagely 47 years old (there was no significant difference in the age of participants at end-line vs baseline. Body mass index and systolic BP reduced significantly at the end-line compared to baseline (23.8 kg/m2 vs 26.2 kg/m2, 130.1 mmHg vs 135.0 mmHg) respectively, as well as habits such as cigarette smoking and alcohol intake reduced at end-line compare to baseline (5.3% vs 26.6%, and 40.3% vs 62.1%) respectively. Hypertension prevalence reduced by 17.3%, Awareness increased by 36.8%, treatment increased by 111.1%, and control decreased by 18.6% at the end-line compared to baseline. Conclusion: COMAAND project has helped in bridging the gaps in hypertension care, especially in increasing awareness, and improving uptake of treatment.

Associations between HIV status and self-reported hypertension in a high HIV prevalence sub-Saharan African population: a cross-sectional study

ObjectivesThis study examined whether HIV status and antiretroviral therapy (ART) exposure were associated with self-reported hypertension in Zimbabwe.DesignStudy data were taken from a cross-sectional, general population survey, which included HIV...

444. Effect of multidisciplinary management of CKD on proteinuria in people with HIV

Abstract Background Optimizing management of chronic kidney disease in people with HIV has become a more pressing priority both to minimize morbidity and preserve HIV antiretroviral options. Part of standard care is employing the beneficial effects of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) in patients with clinically significant proteinuria. Our analysis looks at the proteinuria outcomes of PWH with CKD co-managed by a multidisciplinary team of infectious disease and nephrology physicians nested in a Ryan White-funded clinic in New Orleans. Methods Patients with HIV and at least grade 3 CKD or with significant proteinuria were referred to the multidisciplinary clinic. Patients were evaluated by an HIV specialist and nephrologist at the initial visit for a jointly developed management plan. Renal function and proteinuria were measured at baseline and longitudinally per standard of care. Change in proteinuria and GFR over time were calculated. Patients were also assessed for whether they were prescribed ACE/ARB therapy, if appropriate. Patients included in this analysis were evaluated between January 1, 2021 and March 31, 2022. Results During the analysis period, 46 patients with at least CKD 3 or proteinuria were evaluated. 35 patients were Black non-Hispanic, 9 were White non-Hispanic, and 2 were Hispanic. 39 were male, and 7 were female. 35 had a previous diagnosis of hypertension, and 10 had diabetes mellitus. Of the 42 with a recorded baseline urine protein measurement, 24 were found to have clinically significant proteinuria. Of those with proteinuria, 16 were on an ACE or ARB at their baseline evaluation. 20 were on ACE/ARB’s the end of the analysis period (p=0.058). Average baseline proteinuria was 1,158 mg/g, while average final was 938 mg/g, which was less but not significantly different (p=0.54). Mean baseline GFR was not significantly different from final GFR (50.8 mL/min vs 50.5 mL/min, p=0.67). Conclusion A multidisciplinary model of managing CKD among people with HIV may improve adherence with management guidelines and limit progression of proteinuria and decrease in GFR. In general, the natural history of kidney disease with proteinuria is to worsen over time, so while not significant, proteinuria in this cohort did decrease over time Disclosures All Authors: No reported disclosures.

The impact of hypertension on longitudinal cognitive decline in cognitively unimpaired individuals

AbstractBackgroundMid‐life hypertension (HTN) is considered a risk factor for the development of clinical Alzheimer´s Disease (AD). Yet, it is not known whether late‐life hypertension relates to AD´s pathophysiology, with current literature being contradictory. We recently demonstrated that a vascular risk factor composite, which includes HTN, interact with the AD pathophysiology to promote cognitive decline. Here, we aimed to assess whether late‐life HTN alone and AD biomarkers interact to promote longitudinal cognitive decline, and if controlling the blood pressure affects this relationship.MethodWe evaluated 503 cognitively unimpaired (CU) individuals from the ADNI cohort, with available baseline medical data and cerebrospinal fluid (CSF) Elecsys biomarkers (Aβ1‐42 and p‐tau181), as well as longitudinal clinical assessments with neuropsychological testing (up to 6 years). Individuals with both Aβ1‐42 and p‐tau181 positivity were defined as having preclinical AD ((AT)+), and individuals with previous diagnosis of HTN or those taking anti‐hypertensive medication were considered HTN+. These participants were further divided based on two different measures of systolic blood pressure, being classified as controlled (C) if at least one of them was inferior to 140 mmHg, or non‐controlled (NC) if both measures were over 140 mmHg. The modified version of Preclinical Alzheimer’s Cognitive Composite (mPACC) was used as the outcome to evaluate the cognitive trajectory.ResultLinear mixed‐effects (LME) models showed that HTN interacted with the AD pathophysiology to promote longitudinal cognitive decline (HTN X AD pathophysiology X Time, β= ‐0.45, p= 0.014), and when the individuals with HTN were further stratified between C and NC, we could see that this effect was seen only in the NC group (HTN+C X AD pathophysiology X Time, β= ‐0.29, p=0.13; Group HTN+NC X AD pathophysiology X Time, β= ‐0.79, p=0.002).ConclusionWe observed that in CU individuals, HTN acted as a risk factor for cognitive decline in (AT)+ patients. Additionally, HTN + NC had an increased risk compared with HTN + C individuals. Thus late‐life HTN is a risk factor for the emerging of cognitive symptoms among the elderly and controlling the blood pressure may reduce this risk.

Improving hypertension awareness and management in Vietnam through a community-based model

Hypertension prevalence in Vietnam is high, but few people are aware of their disease status. Detection, diagnosis, and treatment are limited, so new approaches are needed to improve awareness and manage the condition, especially at the primary health care level. The Communities for Healthy Hearts programme operated in four districts of Ho Chi Minh City, with the aim of increasing awareness and ensuring linkage to care. Interventions focused on extending services beyond health facilities to convenient community locations; training cadres of community volunteers to screen, refer, and follow up with clients; training health workers in facilities to diagnose, educate, and manage patients referred from the community; and supporting the process with digital case tracking. Community-based blood pressure screenings took place in client homes, commune health stations, and non-traditional sites such as coffee shops, dentists’ offices, marketplaces, neighbourhood watch/security posts, and tailor shops. In total, 121,273 adults aged 40 and older were screened. Of these, 25.1% had elevated blood pressure or a previous hypertension diagnosis and were referred to health facilities. Of those referred, 56.2% were confirmed to have hypertension, and of those confirmed, 75.2% were treated. Of those treated, 51.0% achieved blood pressure control, a favourable outcome over past programmes.

Abstract 11861: Reach Out Behavioral Intervention for Hypertension Initiated in the Emergency Department Connecting Multiple Health Systems: A Randomized Control Trial

Introduction: Hypertension (HTN) is the most important modifiable risk factor for cardiovascular disease and disproportionally impacts Black and low-income people. The emergency department (ED) cares for medically underserved populations, many of whom have HTN. Mobile health (mHealth) strategies initiated in safety-net EDs may be one approach to control blood pressure (BP) in a medically underserved population. Hypothesis: A multicomponent, ED initiated multiphase optimization strategy would identify intervention components that reduce BP at 12 months. Methods: Reach Out is a health system focused, health theory based, mHealth 2x2x2 factorial behavioral trial to reduce BP among hypertensive patients evaluated in a safety-net ED. Intervention components included: 1) healthy behavior text messaging (yes vs. no), 2) prompted BP self-monitoring (SMBP) (weekly vs. daily), and 3) facilitated primary care provider (PCP) appointment scheduling and transportation (yes vs. no). The primary outcome was change in systolic BP (SBP) from baseline to 12 months. We fit linear regression models accounting for intervention components, age, sex, race and prior use of BP medications. Results: We randomized 488 participants to the intervention and 211 (43%) participants completed 12-month follow-up. The mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a PCP, 10% were uninsured, 21% lacked transportation, 21% did not have a previous diagnosis of HTN and 51% were not taking BP medications. SBP declined in all 8 groups. Overall, across all groups, SBP declined (-9.2 mmHg, 95%CI, -12.2 to -6.3) after 6 months and (-6.6 mmHg, -9.3 to -3.8) after 12 months. In fully adjusted models, no intervention components were associated with a change in systolic BP at 12 months. Conclusions: Higher intensity of the intervention components were not associated with greater reduction in BP. Overall, participants receiving lower intensity levels of our intervention had reductions of BP that were clinically relevant. Future studies should focus on further tailoring intervention components to the needs of participants.

Barriers to effective hypertension management in rural Bihar, India: A cross-sectional, linked supply- and demand-side study.

Effective management of hypertension in low- and middle-income settings is a persistent public health challenge. This study examined supply- and demand-side barriers to receiving quality care and achieving effective hypertension management in rural Bihar, India. A state-representative household survey collected information from adults over 30 years of age on characteristics of the hypertension screening, diagnosis, and management services they received. A linked provider assessment determined the percent of providers who provided quality hypertension care (i.e., had a functioning BP measurement device, measured a patient's BP, could correctly diagnose hypertension, had at least one first-line antihypertension medication, and could prescribe correctly based on standard guidelines). Patients were linked with their provider to determine the quality-adjusted coverage of hypertension management and logistic regression analysis was conducted to determine characteristics associated with receiving quality care. A total of 14,386 patients and 390 providers were studied. Nearly a quarter (22.5%) of adults had never had their BP measured before and 8.1% of adults reported a previous hypertension diagnosis. Less than one third (31.0%) of all interviewed providers demonstrated ability to provide quality hypertension care, and quality varied between provider types (14.8% of private homeopathic, 25.2% of informal, 40.0% of private modern medicine, and 60.0% of public providers gave quality care). While 95.8% of diagnosed individuals received some treatment, only 10.9% of patients received care from quality local providers. Nearly 45% of individuals with hypertension received care from non-local providers. Individuals from the general caste with comorbidities living in villages with more high-quality providers were most likely to receive quality care from a local provider. Whereas the coverage of services for individuals diagnosed with hypertension is high, the quality of these services is suboptimal for economically and socially vulnerable populations, which limits effective management and control of hypertension in rural Bihar. Efforts should be targeted towards providers to initiate quality treatment upon diagnosis, including correct prescription of antihypertensives.

A machine learning approach to evaluate the state of hypertension care coverage: From 2016 STEPs survey in Iran.

The increasing burden of hypertension in low- to middle-income countries necessitates the assessment of care coverage to monitor progress and guide future policies. This study uses an ensemble learning approach to evaluate hypertension care coverage in a nationally representative Iranian survey. The data source was the cross-sectional 2016 Iranian STEPwise approach to risk factor surveillance (STEPs). Hypertension was based on blood pressure ≥140/90 mmHg, reported use of anti-hypertensive medications, or a previous hypertension diagnosis. The four steps of care were screening (irrespective of blood pressure value), diagnosis, treatment, and control. The proportion of patients reaching each step was calculated, and a random forest model was used to identify features associated with progression to each step. After model optimization, the six most important variables at each step were considered to demonstrate population-based marginal effects. The total number of participants was 30541 (52.3% female, median age: 42 years). Overall, 9420 (30.8%) had hypertension, among which 89.7% had screening, 62.3% received diagnosis, 49.3% were treated, and 7.9% achieved control. The random forest model indicated that younger age, male sex, lower wealth, and being unmarried/divorced were consistently associated with a lower probability of receiving care in different levels. Dyslipidemia was associated with reaching diagnosis and treatment steps; however, patients with other cardiovascular comorbidities were not likely to receive more intensive blood pressure management. Hypertension care was mostly missing the treatment and control stages. The random forest model identified features associated with receiving care, indicating opportunities to improve effective coverage.

Associations of + 138 Ins/del A and + 5665 G/T polymorphisms of endothelin-1 gene with hypertension in Burmese people in Magway, Myanmar

BackgroundHypertension is one of the major public health problems worldwide, and is one of the recognized causes of premature deaths every year in the world. The purpose of this study was to investigate the associations between the + 138 insertion/deletion of adenine (Ins/del A) and + 5665 guanine-to-thymine (G/T) polymorphisms of the endothelin-1 gene and hypertension in the residents of Magway Township, Myanmar.MethodsThis study was a cross-sectional comparative study including 60 hypertensive patients and 60 control subjects in Magway Township, Myanmar. The inclusion criterion for hypertension was blood pressure ≥ 140/90 mmHg or previous diagnosis by a physician as hypertension and/or taking antihypertensive drugs. The control group had blood pressure < 140/90 mmHg and no previous diagnosis of hypertension. The genotyping was done by polymerase chain reaction and restriction fragment length polymorphism method.ResultsIn this study, the genotype distribution of the + 138 Ins/del A variant was significantly different between hypertensive patients and the control group, especially in the 3A4A genotype (odds ratio [OR], 2.451; 95% confidence interval [CI], 1.138–5.280; P = 0.022). Adenine insertion genotypes (3A4A and 4A4A) were significantly associated with hypertension in the dominant model (OR, 2.494; 95% CI, 1.179–5.276; P = 0.017). In addition, there was a significant association between the 4A allele and hypertension (OR, 1.771; 95% CI, 1.026–3.056; P = 0.040). The genotype and allelic distributions of the + 5665 G/T polymorphism were not significantly different between the hypertensive patients and the control group (P > 0.05). In this study, there was no significant association between the genotype and allele frequency, and hypertension (P > 0.05). The linkage disequilibrium was weak between the + 138 Ins/del A and + 5665 G/T loci (D’ = 0.108, r2 = 0.009).ConclusionsThis study provides evidence that the + 138 Ins/del A rather than + 5665 G/T polymorphism is associated with hypertension in Burmese people.