Prior Diagnosis Of Hypertension Research Articles

Accuracy of Electronic Health Record Phenotypes to Detect Recognition of Hypertension in Pediatric Primary Care.

To evaluate the accuracy of extractable electronic health record (EHR) data to define clinician recognition of hypertension in pediatric primary care. We used EHR data to perform a cross-sectional study of children aged 3-18 years at well-visits in Connecticut from 2018-2023 (n=50,290) that had either: (1) incident hypertension (hypertensive BP at the well-visit and ≥2 prior hypertensive BPs without prior diagnosis of hypertension); or (2) isolated hypertensive BP at the well-visit without necessarily having prior hypertensive BPs. We tested the accuracy of EHR phenotypes to detect recognition of incident hypertension or hypertensive BP using structured elements, including diagnosis codes, problem list entries, number of BP measurements, orders, and follow-up information. The primary outcome of hypertension recognition was determined by chart review. Among 239 children with incident hypertension and a random sample of 220 children with hypertensive BP, 13% in each sample had clinician recognition of hypertension and hypertensive BP, respectively. An algorithm using ICD-10 encounter diagnosis code, ICD-10 problem list, or multiple BPs during the visit had the highest AUC for attention to incident hypertension (AUC, 0.84; sensitivity, 71.9%; specificity, 95.7%). Adding follow-up BP information to this algorithm had the highest AUC for attention to hypertensive BP (AUC, 0.85; sensitivity, 75.9%; specificity, 93.2%). For patients with hypertension recognition by chart review, ~20% had only free text documentation of hypertension without any structured elements. EHR phenotypes for hypertension recognition have high specificity and moderate sensitivity and may be used in clinician decision support to improve guideline-recommended care.

Factors associated with discussing high blood pressure readings in clinical notes.

Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension. Data from 2016-2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features. The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01). We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.

Midlife hypertension status does not mediate associations between childhood community advantage and MRI‐derived markers of late‐life brain health

AbstractBackgroundPrior research suggests living in an advantaged community in childhood is protective for late‐life cognition and MRI‐derived markers of brain health, independent of individual socioeconomic status. We examined the extent to which this effect is mediated by midlife hypertension status.MethodKHANDLE and STAR are racially/ethnically diverse cohorts of older adults residing in northern California. A random subset of participants underwent 3T MRI; regional brain volumes and white matter integrity were derived. Participants’ self‐reported birth address was geocoded and linked to historical county‐level Area Deprivation Indices (ADI) for the Census decade of residence (1920‐1970). Childhood community advantage was defined as ADI<20, (i.e., most advantaged quintile nationally). Midlife hypertension was derived from prospectively collected blood pressure (bp) at ages 30‐45 and defined as systolic/diastolic bp ≥130/80 or prior hypertension diagnosis. Generalized linear models estimated the direct (c’) and total effects (ab+c’) of ADI on imaging measures among participants age 65+, adjusting for age, sex, race/ethnicity, and education. Indirect effects (ab) via midlife hypertension were calculated by subtracting direct from total effects. Standard errors were bootstrapped with 500 replications.ResultImaging participants (n = 392) from advantaged childhood communities were younger (mean age = 72.6 vs. 76.4), had more education (15.3 vs. 14.3 years) and were less likely to have midlife hypertension (49% vs. 58%; Table 1). The total effect of childhood community advantage was associated with better MRI‐derived measures of brain health (e.g., total gray β = 0.26, 95%CI = 0.04, 0.48; lateral ventricle β = ‐0.22, 95%CI = ‐0.44, ‐0.003; log white matter hyperintensity volumeβ = ‐0.35, 95%CI = ‐0.56, ‐0.13; Table 2, column A). The direct effect of not having midlife hypertension was associated with better MRI‐derived measures of late‐life brain health (e.g., total gray β = 0.31; 95%CI = ‐0.10, 0.53); Table 2, column D). Null indirect effects (Table 2, column C) indicate the effects of childhood community advantage on MRI‐derived measures are not mediated by midlife hypertension status.ConclusionLate‐life brain health benefits among participants from an advantaged childhood community were not explained by the absence of midlife hypertension. Future work will investigate additional modifiable risk/protective factors as alternative mechanistic pathways by which community advantage may affect late‐life brain health.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

BackgroundPeople living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in people without HIV in sub-Saharan Africa.MethodsWe conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment.ResultsWe enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Among PLWH, 33.1% (95% CI: 25.7-41.4%) had kidney function impairment versus 12.9% (95% CI: 8.3-19.7%) among people without HIV, (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8-52.3%) versus 19.4% (95% CI:13.6-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04–7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07–1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06–3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02–4.67), p-value = 0.04) were significantly associated with kidney function impairment.ConclusionsHIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

Cardiometabolic Risk in a University Community: An Observational Study.

The highest prevalence of cardiovascular risk factors has been associated with obesity, sedentary lifestyle, and elevated blood pressure due to high workload and work stress. This study aimed to analyze the cardiometabolic risk and lifestyles among the health sciences university academics and campus administrators at a private university in Spain. A cross-sectional study was conducted during the 2018-2019 academic year by the Nursing Department, using a self-administered questionnaire and face-to-face assessments of anthropometric variables related to cardiovascular risk in university personnel. The variables measured included sociodemographics, cardiovascular risk history, comorbidities, toxic habits, Mediterranean diet adherence, physical exercise, psychosocial stress, and physical, anthropometric, and analytical data. Cardiovascular risk was categorized into relative (<40 years), absolute, and vascular age (>40 years). Among the 101 participants, 61.4% were women, with a mean age of 41.3 years ± 9 years. The smoking prevalence was 21.8% (68.2% women), 27.7% were sedentary, and 51.0% adhered to the Mediterranean diet, with higher adherence among the academics. Emotional risk was present in 32.7% of the participants. A prior diagnosis of hypertension was significantly more frequent in the men (15.4%) compared to the women (3.2%). The blood pressure measurements were mostly optimal across both genders and professional groups, but the proportion of hypertension grade 1 was significantly higher among the academics (10%) compared to the administrators (4.5%) and among the men (11.1%) compared to the women (5.9%). The absolute cardiovascular risk among the university employees was generally low, but the men exhibited a more moderate risk compared to the women. It is necessary for the university to promote health within its community, with the Nursing Department playing a key role in health promotion and research.

P199 HYPERTENSIVE EMERGENCIES: CHARACTERISATION, TREATMENT, AND OUTCOMES IN A SINGLE-CENTRE STUDY

Objective: • Characterise patients admitted to the Coronary Care Unit with hypertensive emergency. • Analyse the reasons leading to hospitalisation. • Evaluate treatment and discharge diagnosis. Methodology A single-centre longitudinal prospective registry was conducted, including patients admitted to the Coronary Care Unit of the Spanish Hospital of Mendoza with a diagnosis of hypertensive emergency, from May 1, 2022, to April 30, 2024. Age, gender, pre-discharge treatment, cardiovascular risk, pre-existing diagnosis of hypertension, quantity and type of medications at admission, quantity and type of medications at discharge, presence of target organ damage, and diagnosis of secondary hypertension were recorded. Statistical analysis was performed using JAMOVI. Results: Fifty-nine patients with hypertensive emergency were admitted, 61% of whom were women. Sixty-four percent had a prior diagnosis of hypertension. Of these, 72% had no treatment at admission, 12% were on monotherapy, and 10% were on dual therapy. Only 10% of patients on combination therapy had preferred combination therapy. Twenty-five percent had low cardiovascular risk, 42% moderate, 25% high, and 6% very high. Fifty-four percent were diagnosed with target organ damage. Secondary causes were found in 31.5% of patients, including gestational hypertension or preeclampsia (19%), primary hyperaldosteronism (7%), renovascular hypertension (3%), and pheochromocytoma (2%). The mean number of medications at admission was 0.64 (CI=0.52,0.76) and at discharge was 2.90 (CI: 2.72,3.24). All were preferred combinations. No re-admissions were recorded during the 2-year follow-up. Conclusions: According to the data, non-adherence and medical inertia were the most frequent causes of hospitalisation for hypertensive emergency. Only 12% of patients had a diagnosis of secondary hypertension, and 19% of admissions were related to pregnancy. However, it is noteworthy that more than half of the patients had target organ damage, reclassifying patients at higher cardiovascular risk. Following guidelines and using preferred combinations controlled cardiovascular events 100% during follow-up.

P165 HEMODYNAMIC PROFILES OF ISOLATED DIASTOLIC HYPERTENSION IN AMBULATORY BLOOD PRESSURE MONITORING

Background and Objective: Isolated diastolic hypertension (IDH) is a prevalent form of high blood pressure (BP), especially among young individuals. Yet, its association with cardiovascular disease risk and the necessity of treatment remain subjects of ongoing debate. Our research endeavors to elucidate hemodynamic profiles using a non-invasive method applied to 24-hour ambulatory blood pressure monitoring (24-h ABPM). However, uncertainty persists regarding whether distinct hemodynamic profiles exist within IDH patients, considering they are characterized by normal total arterial compliance (Ct). This study aims to shed light on potential variations in hemodynamics within the IDH population, providing valuable insights for personalized treatment. Methods: A cross-sectional study was conducted, involving 7,202 patients referred to an outpatient cardiology center for suspected arterial hypertension. These patients underwent 24-h ABPM. The study included individuals over 18 years old without a prior diagnosis of hypertension and not taking antihypertensive medication. Two groups were included: those with IDH, defined as diastolic blood pressure &gt;80 mmHg (24-h ABPM), and those with normotension. Hemodynamic parameters were estimated using a published method to estimate Ct. Silhouette analysis determined the number of underlying groups within the IDH cohort, while cluster analysis classified these subgroups. Results: Among the participants, 59.0% were female, with an average age of 49.0±14.0 years. Of the total patients included, 3,424 (47.5%) had isolated diastolic hypertension (IDH). Silhouette analysis effectively distinguished two groups. Group IDH-1 exhibited normal Ct and systemic vascular resistance (SVR), elevated heart rate (HR), and higher cardiac index (CI) (P value &lt;0.001). Conversely, group IDH-2 demonstrated high Ct and SVR, lower HR, and CI (P value &lt;0.001) (Table). Conclusions: The delineation of two distinct hemodynamic profiles within IDH is significant. The first group demonstrates a cardiogenic hypertension profile, indicated by elevated CI, whereas the second group presents a profile characterized by heightened SVR. These contrasting hemodynamic patterns offer valuable insights for tailoring treatment strategies to individual patient needs. Table. Comparison of hemodynamic variables between normotensives (NT) and two isolated diastolic hypertension (IDH) profile, utilizing ANOVA for statistical analysis.

Abstract P401: Documentation of Elevated Blood Pressure Measurements in the Emergency Department: Exploratory Analysis of Factors Associated with Discussion and Comparison to Other Settings

Introduction: Asymptomatic hypertension is common among emergency department (ED) patients. However, follow-up occurs infrequently. Because recognition of elevated readings is a prerequisite for referrals, we investigated the factors associated with the documentation of discussion of elevated BP in provider notes. Methods: We used electronic medical record data to identify patients who had an outpatient ED, primary care, or urgent care visit with elevated BP (&gt;=140/90 mm Hg) and no prior hypertension diagnosis, 2017-2021. We calculated the percentage of visits in which provider clinical and/or discharge notes mentioned hypertension or elevated BP, beyond the reporting of vitals. We modeled the probability that the notes mentioned elevated BP or hypertension. Covariates included the busyness of the care setting at the time of the visit, patient demographics, visit vitals, and diagnoses. Results: We identified 13,777 distinct patients with 18,036 ED visits, 3,563 urgent care visits, and 27,895 primary care visits with elevated BP levels. BP was discussed in the notes for 27% of ED visits compared to 51.4% of primary care and 51.1% of urgent care visits. The probability of mentioning BP did not rise with the degree of BP elevation for ED visits, but it did for primary care and urgent care visits (See Figure). Elevated BP was more likely to be discussed in the notes of ED visits when the visit was related to a cardiac complaint, when elevated BP was mentioned in previous notes, and when the ED was less busy than normal. Conclusions: Elevated BP levels are frequently not discussed in ED clinical notes. Discussions of BP measurements in notes may be an easy-to-measure marker for clinical recognition of elevated BP measurements.

Prevention and management of hypertensive crises in children with pheochromocytoma and paraganglioma.

Hypertensive crises in pediatric patients are rare conditions. However, determining their precise prevalence is more challenging than in adults due to the heterogeneity in the definition itself. These crises frequently occur without a prior diagnosis of hypertension and may indicate an underlying cause of secondary hypertension, including pheochromocytoma/paraganglioma (PPGL). The mechanisms of hypertensive crises in the pediatric population with PPGL are directly related to different types of catecholamine excess. Noradrenergic tumors typically present with sustained hypertension due to their predominant action on α1-adrenoceptors in the vasculature. Conversely, adrenergic tumors, through epinephrine binding to β2-adrenoceptors in addition to stimulation of α1- and α2-adrenoceptors, more frequently cause paroxysmal hypertension. Furthermore, the biochemical phenotype also reflects the tumor localization and the presence of a genetic mutation. Recent evidence suggests that more than 80% of PPGL in pediatric cases have a hereditary background. PPGL susceptibility mutations are categorized into three clusters; mutations in cluster 1 are more frequently associated with a noradrenergic phenotype, whereas those in cluster 2 are associated with an adrenergic phenotype. Consequently, the treatment of hypertensive crises in pediatric patients with PPGL, reflecting the underlying pathophysiology, requires first-line therapy with alpha-blockers, potentially in combination with beta-blockers only in the case of tachyarrhythmia after adequate alpha-blockade. The route of administration for treatment depends on the context, such as intraoperative or pre-surgical settings, and whether it presents as a hypertensive emergency (elevated blood pressure with acute target organ damage), where intravenous administration of antihypertensive drugs is mandatory. Conversely, in cases of hypertensive urgency, if children can tolerate oral therapy, intravenous administration may initially be avoided. However, managing these cases is complex and requires careful consideration of the selection and timing of therapy administration, particularly in pediatric patients. Therefore, facing these conditions in tertiary care centers through interdisciplinary collaboration is advisable to optimize therapeutic outcomes.

Assessing the Accuracy of Reporting of Hypertension on Death Certificates in Australia.

There is insufficient evidence of how accurately hypertension is reported on death certificates, which are the primary evidence of causes of death. This study assesses the accuracy of reporting of hypertension on death certificates of decedents in Australia who previously had their blood pressure measured. Blood pressure data from the 2014-2015 and 2017-2018 National Health Surveys were linked to death registration data from July 2015 to December 2021 (average 3.3 years from survey to death). The percentage of decedents with hypertension reported on the death certificate was calculated according to blood pressure level and previous diagnosis of hypertension. Hypertension was reported on the death certificate of 20.2% (95% confidence interval 12.1%-28.3%) of decedents who had very high to severe blood pressure (160/100 mm Hg and above), 14.5% (10.3%-18.8%) who had high blood pressure (140 to <160 / 90 to <100 mm Hg), 14.1% (10.8%-17.4%) who had normal to high blood pressure (<140/90 mm Hg) and who took hypertension medication, and 17.8% (13.6%-22.0%) who had been diagnosed with hypertension. Where the decedent had very high to severe blood pressure, hypertension was reported for 27.9% (14.1%-41.8%) of deaths if they had been diagnosed with hypertension, and 21.7% (9.6%-33.7%) where another cardiovascular disease was reported on the death certificate. Hypertension mortality in Australia is only reported for a minority of deaths of people with high or very high to severe blood pressure; this is also found for those with a prior diagnosis of hypertension.

Cumulative Blood Pressure Load and Incident CKD

The association of long-term cumulative blood pressure (BP) loads with the risk of incident chronic kidney disease (CKD) remains a matter of debate. This study investigated this association among healthy Korean adults with normal kidney function. Prospective cohort study. We analyzed 5,221 participants without CKD in the Korean Genome and Epidemiology Study. Cumulative systolic and diastolic BP (SBP and DBP) loads were calculated as the ratios of the areas under the curve (AUC) for SBP≥120mm Hg or≥80mm Hg for DBP divided by the AUC for all SBP or DBP measurements during the exposure period. These AUCs were categorized into 4 groups: group 0 (reference), cumulative BP load of 0 and groups 1-3, tertiles of cumulative BP loads. Primary end point was incident CKD defined as a composite of an estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m2 or proteinuria greater than 1+on dipstick examination for at least 2 consecutive measurements≥90 days apart. Multivariable Cox proportional hazards regression to estimate the independent association of cumulative BP loads with incident CKD. Higher cumulative SBP and DBP loads were associated with an increased risk of incident CKD (HR, 1.23 [95% CI, 1.12-1.35] for SBP; and HR, 1.14 [95% CI, 1.04-1.26] for DBP loads for each 1.0-unit greater load). Compared with SBP group 0, groups 2 and 3 were associated with 1.94- and 1.89-fold greater risk of incident CKD. Compared with DBP group 0, groups 2 and 3 were associated with 1.42- and 1.54-fold greater risks. These associations of high cumulative BP loads with an increased risk of incident CKD remained consistent even in the subgroups not taking antihypertensive agents or without prior hypertension diagnosis. The assessment of CKD outcomes relied on eGFR and spot urine tests. These findings highlight the association between high cumulative SBP and DBP loads and the occurrence of CKD, even in individuals with normal BP levels. Although hypertension is a major risk factor for chronic kidney disease (CKD), most studies have focused on single-point blood pressure (BP) measurements. To explore the association between long-term cumulative BP load and the development of CKD, 5,221 Korean adults with normal kidney function were included in this study. Cumulative systolic BP and diastolic BP load both exhibited a significant association with an increased risk of incident CKD. Notably, the association of cumulative BP loads with elevated risk of incident CKD was evident also in individuals who were not taking antihypertensive agents or who had no previous history of hypertension. These findings underscore the importance of managing long-term exposure to high BP, even in individuals with normal BP levels.

The cost of adding rapid screening for diabetes, hypertension, and COVID-19 to COVID-19 vaccination queues in Johannesburg, South Africa

BackgroundNon-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program.MethodsWe conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD.ResultsOf the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs.ConclusionsWe show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities.

Prevalence of Hypertension, Its Risk Factors and 10-year Cardiovascular Disease Risk among Bank Employees in Lagos State, Nigeria.

Hypertension is a significant global public health concern, with unique risk factors affecting those in the banking sector due to their work environment. This study aimed to determine the prevalence of hypertension among bank employees and identify specific contributing risk factors. A cross-sectional survey of 250 bank employees used pretested structured questionnaires. Various measurements, including body mass index (BMI), blood pressure, lipid profile parameters and cardiovascular events, were recorded. Data were analysed using SPSS software. Categorical variables are presented as frequencies and percentages. Binary logistic regression was employed to identify independent predictors of hypertension (P < 0.05). The study participants had a mean age of 37.56 ± 8.98, with 54.5% being female. The majority (98.8%) had tertiary education, and 94.7% resided in urban areas. The prevalence of hypertension was 33.3%. Higher BMI is significantly associated with increased odds of hypertension. For each unit increase in BMI, the odds of having hypertension are approximately 1.98 times higher. Hypertension was also significantly more prevalent in those participants with prior hypertension diagnosis, those with a family history of hypertension, smokers and those who added salt to their food on the table (P < 0.05). The alarmingly high prevalence of hypertension underscores the need for targeted intervention and health promotion initiatives. With recognised risk factors, emphasis must be placed on the importance of lifestyle modifications and workplace wellness programmes to mitigate the burden of hypertension.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda.

People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in HIV-uninfected people in sub-Saharan Africa. We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment. We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Overall, the prevalence of kidney function impairment was 23.0% (95% CI:18.4%-28.4%); 33.1% (95% CI: 25.7%-41.4%) versus 12.9% (95% CI: 8.3%-19.7%) among people living with and without HIV (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8%-52.3%) versus 19.4% (95% CI:13.6%-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04-7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07-1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06-3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02-4.67), p-value = 0.04) were significantly associated with kidney function impairment. HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

Risk of Major Adverse Cardiovascular Events After Emergency Department Visits for Hypertensive Urgency.

Chronic hypertension is an established long-term risk factor for major adverse cardiovascular events (MACEs). However, little is known about short-term MACE risk after hypertensive urgency, defined as an episode of acute severe hypertension without evidence of target-organ damage. We sought to evaluate the short-term risk of MACE after an emergency department (ED) visit for hypertensive urgency resulting in discharge to home. We performed a case-crossover study using deidentified administrative claims data. Our case periods were 1-week intervals from 0 to 12 weeks before hospitalization for MACE. We compared ED visits for hypertensive urgency during these case periods versus equivalent control periods 1 year earlier. Hypertensive urgency and MACE components were all ascertained using previously validated International Classification of Diseases, Tenth Revision Clinical Modification codes. We used McNemar test for matched data to calculate risk ratios. Among 2 225 722 patients with MACE, 1 893 401 (85.1%) had a prior diagnosis of hypertension. There were 4644 (0.2%) patients who had at least 1 ED visit for hypertensive urgency during the 12 weeks preceding their MACE hospitalization. An ED visit for hypertensive urgency was significantly more common in the first week before MACE compared with the same chronological week 1 year earlier (risk ratio, 3.5 [95% CI, 2.9-4.2]). The association between hypertensive urgency and MACE decreased in magnitude with increasing temporal distance from MACE and was no longer significant by 11 weeks before MACE (risk ratio, 1.2 [95% CI, 0.99-1.6]). ED visits for hypertensive urgency were associated with a substantially increased short-term risk of subsequent MACE.

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

BackgroundHypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR).MethodsWe conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min.Results237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable.ConclusionsOur study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.

Risk and protective factors for Long COVID in Brazilian adults (CUME Study).

Most people recover from COVID-19, however, between 5 to 20% have experienced new, recurring, or continuous health problems four or more weeks after being infected, a phenomenon called Long COVID, and whose reasons for its manifestation are incipient. Our objective was to analyse the risk and protective factors for Long COVID in Brazilian adults participating in the CUME Study. The CUME Study is a prospective cohort conducted with graduates from federal universities in the State of Minas Gerais, Brazil. In this study, 390 participants who answered the baseline questionnaire in 2016 and the third follow-up questionnaire in 2022 (which contained a block of questions about occurrence of COVID-19 and Long COVID) were included. The diagnosis of Long COVID was based on self-reporting of persistence of signs and symptoms of COVID-19 between 30 days and 6 months after remission of the disease. To estimate the risk and protective factors for Long COVID, a hierarchical multivariate statistical analysis was conducted using the Poisson regression technique. Long COVID was observed in 48.9% of the participants. The following characteristics were identified as risk factors for the outcome: female sex (RR = 1.56; 95% CI = 1.22-1.99); prior diagnosis of hypertension (RR = 1.46; 95% CI = 1.19-1.80); having contracted COVID-19 in the first (RR =1.38; 95% CI = 1.07-1.79) or in the second waves (RR = 1.33; 95% CI = 1.07-1.65) of the pandemic period; and having presented three or more signs and symptoms during the acute phase of COVID-19 (RR = 2.99; 95% CI = 1.08-8.24). On the other hand, having a doctoral/postdoctoral educational level (RR = 0.69; 95% CI = 0.50-0.94) was identified as a protective factor for the outcome. Health system managers and healthcare professionals should be aware of the socioeconomic profile and disease history of patients who have had COVID-19 because women, people with a prior diagnosis of hypertension, and those who manifested multiple signs and symptoms of COVID-19 during the acute phase of the disease were at greater risk of developing Long COVID.

Abstract TMP29: Plasma Proteomics Demonstrates Immune Dysregulation in Chronic Post-Stroke Fatigue

Introduction: Post-stroke fatigue is a common and impactful complaint of stroke survivors. As with fatigue from other causes, our understanding of the biological underpinnings of post-stroke fatigue is poor. Here we used plasma proteomics to better understand post-stroke fatigue. Methods: We report here on 97 participants 5 months to 10 years after ischemic stroke. Functional Assessment of Chronic Illness-Fatigue (FACIT) scale was used to assess fatigue. Disability and self-reported mood was measured using the modified Rankin Scale (mRS) and the Stroke Impact Scale’s mood subset (SIS3), respectively. We dichotomized participants into non-fatigued (FACIT &gt;41) and fatigued (FACIT ≤41) groups and employed a binary logistic regression to examine associations with clinical variables. Aptamer-based proteomics (Somalogic) was used to quantify 7288 plasma proteins, after which we performed pathway analyses. Results: Fatigue was present in 49.4% of our cohort. 39.2% was female and the mean age was 64.2±12.8. When adjusted for age and sex, a prior diagnosis of hypertension (OR=2.7, 95% CI 1.09-6.75, p=0.032) or any psychiatric disorder (OR=8.8, 95% CI 2.54-31, p&lt;0.001) was associated with fatigue. Adjustment for time since stroke did not affect these associations. Higher mRS (rho=-0.49) and worse SIS3 (rho=0.59) were associated with more fatigue. 215 proteins had an absolute correlation coefficient greater than 0.3 and differed between fatigued and non-fatigued patients (p&lt;0.001). Pathway analysis revealed dysregulation of both innate and adaptive immune responses and cytoskeletal regulation. The JAK/STAT pathway was highly dysregulated. In fatigued patients, plasma levels of several components were significantly elevated (log2Fc); CCL5 (0.81), JAK2 (0.73), and STAT3(0.53). The largest downregulation was in fetuin (AHSG, log2Fc -5.5), which contributes to the most down regulated pathway, regulation of ossification, and is an immunosuppressant. Conclusion: Immune dysregulation after stroke may be associated with fatigue, particularly upregulation of the JAK/STAT pathway and downregulation of fetuin. More studies are needed to replicate these findings and to probe mechanisms.

Comparison of Home Blood Pressure Monitoring with and without Training: Does Adherence to the Recommended Instructions Overlook Hypertension?

Home blood pressure monitoring (HBPM) is commonly used to diagnose hypertension (HT), with a diagnostic threshold of ≥135/85 mm Hg, the same as daytime ambulatory BP monitoring (ABPM). This study hypothesizes that training and adherence to HBPM guidelines will yield more accurate BP readings compared to ABPM. The study involved 129 patients with elevated office BP but no prior HT diagnosis. After a two-week observation period with lifestyle advice, HBPM was conducted over a week before and after structured measurement training, with ABPM performed in each period. Adherence to instructions post-training was also assessed. Post-training, mean systolic and diastolic home BP values significantly decreased (from 128 ± 13.1/84.9 ± 8.2 to 122.6 ± 12.7/81.8 ± 7.8; P < 0.001 for both), while daytime ABPM values remained unchanged (131.7 ± 11.1/86.7 ± 9.3 before vs. 130.7 ± 11.7/85.9 ± 8.6 after; P = 0.185). Although HBPM values were consistently lower than ABPM values, the discrepancy grew post-training. The number of patients reaching the HT threshold via HBPM decreased significantly post-training [71 (55%) to 54 (41.9%); P = 0.006], whereas the number via daytime ABPM remained similar [82 (64.3%) vs. 84 (65.1%); P = 1.000]. Training and adherence to HBPM guidelines led to lower BP readings and fewer HT diagnoses. Contrary to the hypothesis, this method under "ideal conditions" underestimated HT prevalence when compared to daytime ABPM. Further studies with clinical endpoints are needed to refine HBPM methods and establish new BP thresholds for more accurate HT detection.

A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring

Few primary care patients complete guideline-recommended out-of-office blood pressure (BP) monitoring prior to having hypertension diagnosed. To evaluate the effectiveness of a behavioral theory-informed, multifaceted implementation strategy on out-of-office BP monitoring (ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) among patients with new hypertension. This 2-group, pre-post cluster randomized trial was conducted within a primary care network of 8 practices (4 intervention practices with 99 clinicians; 4 control practices with 55 clinicians) and 1186 patients (857 intervention; 329 control) with at least 1 visit with elevated office BP and no prior hypertension diagnosis between October 2016 and September 2017 (preimplementation period) or between April 2018 and March 2019 (postimplementation period). Data were analyzed from February to July 2023. Usual care (control group) or a multifaceted implementation strategy consisting of an accessible ABPM service; electronic health record (EHR) tools to facilitate test ordering; clinician education, reminders, and feedback relevant to out-of-office BP monitoring; nurse training on HBPM; and patient information handouts. The primary outcome was patient completion of out-of-office BP monitoring within 6 months of an eligible visit. Secondary outcomes included clinician ordering of out-of-office BP monitoring. Blinded assessors extracted outcomes from the EHR. A total of 1186 patients (857 intervention; 329 control) were included, with a mean (SD) age of 54 (16) years; 808 (68%) were female, and 549 (48%) were Spanish speaking; among those with race and ethnicity documented, 123 (10%) were Black or African American, and 368 (31%) were Hispanic. Among intervention practices, the percentage of visits resulting in completed out-of-office BP monitoring increased from 0.6% (0% ABPM; 0.6% HBPM) to 5.7% (3.7% ABPM; 2.0% HBPM) between the preimplementation and postimplementation periods (P = .009). Among control practices, the percentage of visits resulting in completed out-of-office BP monitoring changed from 5.4% (0% ABPM; 5.4% HBPM) to 4.3% (0% ABPM; 4.3% HBPM) during the corresponding period (P = .94). The ratio of relative risks (RRs) of out-of-office BP monitoring in the postimplementation vs preimplementation periods for intervention vs control practices was 10.5 (95% CI, 1.9-58.0; P = .01). The ratio of RRs of out-of-office BP monitoring being ordered was 2.2 (95% CI, 0.8-6.3; P = .12). This study found that a theory-informed implementation strategy that included access to ABPM modestly increased out-of-office BP monitoring among patients with elevated office BP but no hypertension diagnosis. ClinicalTrials.gov Identifier: NCT03480217.