Blood Pressure Control Rates Research Articles

Study on the application effect of the family doctor contract service mode of ‘basic package+personalised package’ in elderly hypertension management in Chengdu, China: a retrospective observational study

ObjectivesWe conducted this study to assess the application effect of the family doctor contract service mode of ‘basic package+personalised package’ in the management of hypertension patients.DesignObservational study.SettingThe study was conducted...

Innovative Remote Management Solutions for the Control of Hypertension.

We stand at a critical juncture in the delivery of health care for hypertension. Blood pressure control rates have stagnated, and traditional health care is failing. Fortunately, hypertension is exceptionally well-suited to remote management, and innovative digital solutions are proliferating. Early strategies arose with the spread of digital medicine, long before the COVID-19 pandemic forced lasting changes to the way medicine is practiced. Highlighting one contemporary example, this review explores salient features of remote management hypertensive programs, including: an automated algorithm to guide clinical decisions, home (as opposed to office) blood pressure measurements, an interdisciplinary care team, and robust information technology and analytics. Dozens of emerging hypertension management solutions are contributing to a highly fragmented and competitive landscape. Beyond viability, profit and scalability are critical. We explore the challenges impeding large-scale acceptance of these programs and conclude with a hopeful look to the future when remote hypertension care will have dramatic impact on global cardiovascular health.

Orally administered sodium nitrite prevents the increased α-1 adrenergic vasoconstriction induced by hypertension and promotes the S-nitrosylation of calcium/calmodulin-dependent protein kinase II

The unsatisfactory rates of adequate blood pressure control among patients receiving antihypertensive treatment calls for new therapeutic strategies to treat hypertension. Several studies have shown that oral sodium nitrite exerts significant antihypertensive effects, but the mechanisms underlying these effects remain unclear. While these mechanisms may involve nitrite-derived S-nitrosothiols, their implication in important alterations associated with hypertension, such as aberrant α1-adrenergic vasoconstriction, has not yet been investigated. Here, we examined the effects of oral nitrite treatment on vascular responses to the α1-adrenergic agonist phenylephrine in two-kidney, one clip (2K1C) hypertensive rats and investigated the potential underlying mechanisms. Our results show that treatment with oral sodium nitrite decreases blood pressure and prevents the increased α1-adrenergic vasoconstriction in 2K1C hypertensive rats. Interestingly, we found that these effects require vascular protein S-nitrosylation, and to investigate the specific S-nitrosylated proteins we performed an unbiased nitrosoproteomic analysis of vascular smooth muscle cells (VSMCs) treated with the nitrosylating compound S-nitrosoglutathione (GSNO). This analysis revealed that GSNO markedly increases the nitrosylation of calcium/calmodulin-dependent protein kinase II γ (CaMKIIγ), a multifunctional protein that mediates the α1-adrenergic receptor signaling. This result was associated with reduced α1-adrenergic receptor-mediated CaMKIIγ activity in VSMCs. We further tested the relevance of these findings in vivo and found that treatment with oral nitrite increases CaMKIIγ S-nitrosylation and blunts the increased CaMKIIγ activity induced by phenylephrine in rat aortas. Collectively, these results are consistent with the idea that oral sodium nitrite treatment increases vascular protein S-nitrosylation, including CaMKIIγ as a target, which may ultimately prevent the increased α1-adrenergic vasoconstriction induced by hypertension. These mechanisms may help to explain the antihypertensive effects of oral nitrite and hold potential implications in the therapy of hypertension and other cardiovascular diseases associated with abnormal α1-adrenergic vasoconstriction.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

BackgroundAwareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Materials and methodsAs part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. ResultsA total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. ConclusionThe survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status.

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

Prevalence and clinical characteristics of atrial fibrillation in hospitalized patients with coronary artery disease and hypertension: a cross-sectional study from 2008 to 2018.

The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF. This cross-sectional study was conducted in Chinese People's Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD. The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28% (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2 DS 2 -VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study.

Background Hypertension is the leading risk factor for cardiovascular disease and death. Appropriate treatment of hypertension is necessary to reduce mortality. A prescription-based study is one of the most influential and helpful methods to examine physicians' irrational prescribing practices. This study was designed to investigate the antihypertensive prescription of physicians and their adherence to the treatment guidelines, as well as the blood pressure (BP) control rate in a general hospital in the Kingdom of Saudi Arabia. Methodology A retrospective, cross-sectional study was conducted between February 2020 and June 2021 in an outpatient department. Patients diagnosed with hypertension as per the 2020 International Society of Hypertension guidelines and those who received antihypertensive drugs were included. Study data included prescriptions, patient's age, duration of hypertension, comorbidities, BP, drug therapy type, and antihypertensive class. Results Overall, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (67.1%) were the most prescribed agents, followed by dihydropyridine-calcium channel blockers (62.6%), diuretics (26.1%), and β-blockers (10.1%). Comorbid and stage 2 hypertensive patients mainly received combination therapy (51.6%) rather than monotherapy (48.4%). The study revealed an 83.5% prescription adherence to the treatment guidelines. However, non-adherence was encountered in monotherapy, polytherapy, and elderly-treated patient groups. A 66.4% (at target BP in all cases <140/90 mmHg) and 39.3% (at target BP in comorbid patients <130/80 mmHg) rate of BP control was observed. Furthermore, the rate of BP control was significantly associated with prescription adherence (χ2 = 71.316; p < 0.001). Conclusions The degree of prescription adherence and rate of BP control were found to be compatible with other published hypertension studies. However, considerable scope exists for improvement in rational drug utilization and rate of BP control, particularly in high-risk patients. Therefore,treatment guidelines must be followed by clinicians to achieve BP goals and reduce cardiovascular events among the Saudi population.

The effectiveness of atrial fibrillation special clinic on oral anticoagulant use for high risk atrial fibrillation patients managed in the community

BackgroundService gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.MethodQuasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.ResultsAmong the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.ConclusionAFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.

Abstract WP21: Staged Implementation Of A Rapid, Intensive And Sustained Blood Pressure Protocol In Patients With Acute Intracerebral Hemorrhage

Background and Purpose: The potential benefit of blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients is time-dependent and is an easy and modifiable treatment applicable to different hospital scenarios. However, previous clinical trials did not establish consensus about the best BP strategy to achieve a rapid and sustained BP control. We aimed to assess the impact of learning a staged implementation of rapid-intensive-sustained BP protocol on time targets and BP control rate over the first 24 hours of ICH. Methods: We conducted a retrospective analysis of data prospectively collected of consecutive patients with spontaneous ICH (&lt;6h) and systolic BP (SBP) &gt;150 mmHg under a rapid (antihypertensive IV bolus by a stroke nurse at CT scan), intensive (SBP target &lt;140 mmHg within 1 hour after BP agent onset),and sustained (antihypertensive continuous infusion immediately after IV bolus) 24-hour BP protocol during a 6-year period. BP was recorded regularly according to the following schedule: every 15 minutes (0-6 hours); every 30 minutes (6h to 12h), and every 60 minutes (12h to 24h). We recorded the time from BP treatment onset to SBP target achievement and the rate of SBP sustention below target (&lt;140 mm Hg) at all time frames. The protocol implementation was divided in 6 consecutive year periods. Results: A total of 207 patients were included in the study. Compared between the periods, the frequency of SBP target achievement during the first hour was increased steadily over different periods(33.3% vs. 54.5% vs. 69.2% vs 69.4% vs 75% and 59.7%; P=0.024 ); median time to SBP target achievement tended to be lower during the evolution of protocol assessment (120 [45-240] min; 49.5 [30-101] min; 53 [29-82] min; 47 [28-74] min; 48 [27-66] min; 50 [30-85] min; P=0.054 ) and SBP sustention rate below the target improve during the acute phase at different time frames, including 2h (26.3% vs. 71.9% vs 60% vs 73.9% vs. 57,7% vs 59.5%; P= 0.012 ), 4h (57.1% vs. 63.3% vs 87.5% vs 85% vs. 61.5% vs. 69.2%; P= 0.05 ), 6h (60.9% vs. 58.6%, vs 95.5% vs 84.4% vs 58.3% vs. 75%; P=0.009 ). Conclusions: Rapid-intensive-sustained BP protocol is a good intervention to both achieve a rapid BP target and reduce time delays,and improve the rates of BP control over the acute phase of ICH patients.

Biomarker response to high-specific-activity I-131 meta-iodobenzylguanidine in pheochromocytoma/paraganglioma.

The objective of this study is to present the complete biomarker response dataset from a pivotal trial evaluating the efficacy and safety of high-specific-activity I-131 meta-iodobenzylguanidine in patients with advanced pheochromocytoma or paraganglioma. Biomarker status was assessed and post-treatment responses were analyzed for catecholamines, metanephrines, and serum chromogranin A. Complete biomarker response (normalization) or partial response, defined as at least 50% reduction from baseline if above the normal range, was evaluated at specified time points over a 12-month period. These results were correlated with two other study objectives: blood pressure control and objective tumor response as per RECIST 1.0. In this open-label, single-arm study, 68 patients received at least one therapeutic dose (~18.5 GBq (~500 mCi)) of high-specific-activity I-131 meta-iodobenzylguanidine. Of the patients, 79% and 72% had tumors associated with elevated total plasma free metanephrines and serum chromogranin A levels, respectively. Best overall biomarker responses (complete or partial response) for total plasma free metanephrines and chromogranin A were observed in 69% (37/54) and 80% (39/49) of patients, respectively. The best response for individual biomarkers was observed 6-12 months following the first administration of high-specific-activity I-131 meta-iodobenzylguanidine. Biochemical tumor marker response was significantly associated with both reduction in antihypertensive medication use (correlation coefficient 0.35; P = 0.006) as well as objective tumor response (correlation coefficient 0.36; P = 0.007). Treatment with high-specific-activity I-131 meta-iodobenzylguanidine resulted in long-lasting biomarker responses in patients with advanced pheochromocytoma or paraganglioma that correlated with blood pressure control and objective response rate. ClinicalTrials.gov number: NCT00874614.

Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns.

Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month , a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its inception in 2017, aimed at obtaining standardized BP measurements from members of the community to increase awareness of high BP and its associated risks. Adults participants (≥18 years) were recruited through opportunistic sampling across Australia during the month of May in 2017, 2018 and 2019. Trained volunteers recorded BP readings in a standardized manner and collected data on demographic, lifestyle factors and comorbidities. Hypertension was defined as SBP of at least 140 mmHg, or DBP of at least 90 mmHg, or taking antihypertensive medication. Data were collated centrally and analysis was carried out using regression models to evaluate the associations between BP and participant characteristics. A total of 10 046 participants were screened, of whom 3097 (31.0%) had hypertension, only 48.5% were aware of their condition and 44.4% were taking antihypertensive medication. Of those taking antihypertensive medication, 53.2% were controlled to less than 140/90 mmHg, whereas the remaining 46.8% of participants had BP of at least 140/90 mmHg suggestive of inadequately treated hypertension. Consecutive data obtained over a 3-year period in Australia demonstrated stagnating awareness, treatment and control rates with the latter two being substantially lower than global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to help overcome the unacceptably poor rates of BP treatment and control in Australia.

Understanding the management of hypertension in Asia: results of a literature search

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Servier, France Background Hypertension poses a significant healthcare burden in Asia. Detection, treatment and control of hypertension are suboptimal, despite the existence of clear international guidelines and the availability of safe and effective treatments. Purpose To understand hypertension management in Asia, based on the analysis of national guidelines, treatment patterns and patient characteristics. Methods A PubMed search was performed using four search strings relating to 1) hypertension; 2) treatment/management/drug therapy; 3) guideline, consensus, real world evidence; and 4) Asian countries. The search was restricted to English language articles published since January 2008 to July 2022. Articles were filtered by relevance to the research question, study size, scope, methodology, and country/region to identify a target of 100 final references. Results The search yielded 2,436 articles, of which 92 were selected as being most relevant. Compared with Europeans, Asians appeared to have higher systolic blood pressure (BP), diastolic BP, and mean arterial pressure, with stronger association between BP and stroke. Rates of severe hypertension were also higher. Trends identified in the literature suggested that calcium channel blockers are the most common monotherapy used in Asian countries, with a high variability across the region. In the available publications focused on the studies with RAAS inhibitors, the majority of them compared the use of angiotensin receptor blockers as mono/combination therapy versus combination therapy with ACE inhibitors, calcium channel blockers or diuretics. Among treated patients, the observed control rates were only ~35–40% (~10% or less in the general population). There is a lack of focus on selecting the most appropriate treatment for each individual patient. Areas for improvement in delivering guideline-directed therapy for improved BP control also included facilitating access to health care and compliance with medication (including support mechanisms like community programmes, telemedicine, mobile phone apps and home BP monitoring), improving diet (reducing salt intake) and encouraging exercise. Conclusions Asian patients and European patients have different clinical profiles, with more severe hypertension in Asians. Rates of BP control across Asia are low. The management of hypertension requires a focused multimodal and supportive approach with implementation of public health measures, more effective screening initiatives and evidence-based goal-driven recommendations for appropriate pharmacotherapy augmented by lifestyle changes.

Family physician services and blood pressure control in China: A population-based retrospective cohort study.

Given the importance of continuous family physician (FP) care in the management of hypertension, we explored the effects of such care among hypertensive patients in China, a country where such care is generally underutilized. We examined the longitudinal association between the use and continuity of FP services and health outcomes including blood pressure (BP) control rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP). We conducted a population-based cohort study using data from the retrospective regional electronic health record database in Xiamen City, China. The study considered 18,119 hypertensive patients aged over 18 years who had at least two visits to a health center in the preceding 12months. The generalized estimating equation model was adopted to estimate the longitudinal association between FP service utilization and health outcomes. Hypertensive patients treated by their own FPs had a higher BP control rate (OR = 1.14, 95% CI: 1.02-1.28) and lower DBP (-0.36mmHg, 95% CI: -0.52 to -0.20) than those without a FP or those with a FP but treated by a general community physician (GCP). Compared with hypertensive patients treated exclusively by GCPs, patients treated continuously and exclusively by a FP were 45% more likely to have their BP under control (OR = 1.45, 95% CI: 1.32-1.60), and their SBP and DBP were lower by 0.6mmHg (95% CI: -0.78 to -0.39) and 0.6mmHg (95% CI: -0.79 to -0.47), respectively. Hypertensive patients continuously treated by their own FPs performed better in terms of BP control rate, SBP and DBP values. In addition, the number and continuity of FP visits were associated with better BP control.

PS-C16-6: POSTAL MEDICINE DELIVERY FOR STAGE-2 HYPERTENSIVE PATIENTS IN COVID-19 SITUATION: TURNING CRISIS TO OPPORTUNITY

Introduction: The COVID-19 pandemic has influenced healthcare systems, particularly in the areas of non-communicable diseases, such as hypertension, where the majority of patients require medication therapy and frequent visits. The postal medicine delivery (PMD) approach was an innovative solution to keep antihypertensive drugs accessible under the social distance regulation. Objective: We aimed to investigate the effectiveness of the PMD in terms of blood pressure (BP) control (&lt; 140/90 mmHg), and target organ damage (TOD) including myocardial infarction, heart failure, acute stroke, and progression of chronic kidney disease) during the use of PMD. Design and method: This was a cross-sectional study in a university hospital, conducted between 11th March to 27th May 2020 when the hospital policy stated that outpatient departments’ service would be reduced, and physicians were encouraged to use PMD. Patients without a history of TOD and who had a history of well BP control (&lt; 140/90 mmHg) for the last 2 weeks, were enrolled. All of the patients used smartphones and LINE® applications for contacting the nurse coordinator every 3 months to report their home BP. After 6 months of PMD, patients were assigned to have a follow-up visit at the hospital for office BP measurement and having metabolic panel checked. Results: Thirty-eight patients met the inclusion criteria, and 68% were women. Most of the patients (97.4%) had used home BP monitoring (HPBM). The rate of BP control in goal was 64.2%. There was no TOD during the PMD approach. The medication boxes were sent successfully via postal service within 5–10 days, with no loss or damage recorded. All of the patients reported that they had been taking their antihypertensive medications. More than two-thirds (68.4%) continued to follow a low-sodium diet, while 76.3 percent continued to exercise regularly. Conclusions: In the COVID-19 epidemic, the PMD method could be another effective and safe strategy to enhance medicine access, if suitable enrolment criteria and communication between healthcare practitioners and patients are maintained. Keywords: COVID-19 pandemic, antihypertensive drugs, postal medicine delivery, efficacy, safety

Super hypertension or very severe hypertension in a sub-Saharan country: Epidemiological, clinical, therapeutical and evolutive patterns

High blood pressure occurs early in sub-Saharan Africa and its forms are frequently severe with rapid damage to target organs. To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaoundé University Teaching Hospital. This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaoundé and were aged 18 years or over. Of a total of 6519 people, 1875 (28.8%) presented a high blood pressure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly reviewed, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, it was mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow-up due to acute kidney injury. Super hypertension or very severe high blood pressure is a youth's pathology. Its early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.

PS-C15-8: SUPER HYPERTENSION OR VERY SEVERE HYPERTENSION IN A SUB-SAHARAN COUNTRY: EPIDEMIOLOGICAL, CLINICAL, THERAPEUTICAL AND EVOLUTIVE PATTERNS

Backgroung: To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaounde University Teaching Hospital. Methodology: This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over. Results: Of a total of 6.519 people, 1.875 (28.8%) presented a high blood presure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex- ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly rewieved, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow up due to acute kidney injury. Conclusion: Super hypertension is a yout s pathology. The early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.

ISH-PP-7: SCALING-UP HYPERTENSION CARE IN RESOURCE-CHALLENGED SETTINGS GLOBALLY

High blood pressure (BP) is the leading modifiable risk factor for death. More than 1.4 billion people suffer from hypertension worldwide. BP control remains less than 30% in high-income countries and &lt; 10% in low- and middle-income countries (LMIC) rural areas, leading to significant disparities in hypertension-related cardiovascular mortality. Immediate action is needed to address suboptimal hypertension care globally and related inequalities. Evidence shows that strategies that leverage the existing infrastructure to deliver hypertension care are more likely feasible and rapidly scalable at marginal cost. The Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) trial demonstrated that a community health worker-led multicomponent intervention tailored to rural settings improved BP control. It was also cost-effective and affordable (less than US$2 per capita annually). Likewise, community health worker-led models of hypertension care were beneficial in urban slums in Argentina, China, Colombia, India, Indonesia, Malaysia, Nepal, Pakistan, and Kenya. The partnership between WHO and Resolve to Save Lives is an excellent initiative to focus national attention on hypertension treatment in many low- and middle-income countries. Strong advocacy and multi-sectoral collaborations are also needed to implement policy strategies for hypertension prevention, including access to healthy foods and the built environment to promote physical activity. A (proposed) Global Hypertension Care Task Force jointly led by WHO and ISH could catalyse improvement in BP control rates. Every country should establish a dedicated national coordinating center for stewardship and implementing the hypertension control agenda through multifaceted, cost-effective strategies, including population-level policy initiatives and health systems strategies targeting high-risk individuals. Such efforts could save the lives of more than 100 million people aged 30–70 years, who would otherwise die prematurely by 2030, and help achieve Sustainable Development Goal 3.4

Digital redesign of hypertension management with practice and patient apps for blood pressure control (PIA study): A cluster-randomised controlled trial in general practices.

Long-term hypertension control prevents heart attacks and other cardiovascular diseases, yet implementation is insufficient worldwide. The redesign of hypertension management by information and communication technology (ICT) improved hypertension control, e.g., by transmission of blood pressure (BP) measurements to a central webspace. However, an easy-to-use secure patient app connected with a practice management centre is lacking. This study evaluates the effectiveness of the newly developed PIA (PC-supported case management of hypertensive patients to implement guideline-based hypertension therapy using a physician-defined and -supervised, patient-specific therapeutic algorithm) intervention with PIA-ICT and eLearning for general practices. The effectiveness of the PIA intervention was evaluated in a cluster-randomised study. Practices were randomly allocated (1:1) to the intervention or the control group (usual care). Group allocation was unmasked for participants and researchers. The primary outcome was the BP control rate (BP<140/90mmHg) after 6-12months. Secondary outcomes included BP changes and satisfaction with PIA-ICT. The trial is registered in the German Clinical Trials Register (DRKS00012680). Starting from December 1, 2019, 64 general practices were recruited over 1 year during the COVID-19 pandemic. Overall, 848 patients were enrolled between April 15, 2020 and March 31, 2021. The study was completed Sept 30, 2021. At baseline, 636 patients (intervention: 331; control: 305) of 50 general practices met the inclusion criteria. The final dataset for analyses comprised 47 practices and 525 patients (intervention 265; control 260). In the adjusted hierarchical model, the PIA intervention increased the BP control rate significantly by 23.1% points (95% CI: 5.4-40.8%): intervention 59.8% (95% CI: 47.4-71.0%) compared to 36.7% (95% CI: 24.9-50.3%) in the control group. Systolic BP decreased by 21.1mmHg in the intervention and 15.5mmHg in the control group. The PIA redesign of care processes improved BP in an outcome-relevant way. Prospectively, it may constitute an important model for hypertension care in Germany. This study is funded by the German Innovation Fund (Grant number: 01NVF17002).

S-53-4: HYPERTENSION AND ITS ASSOCIATIONS WITH MULTIMORBIDITY: AN ANALYSIS OF 4 MILLION PARTICIPANTS FROM MAY MEASUREMENT MONTH 2017–2019

Objective: Hypertension is a leading cause of global morbidity and mortality and is a principal risk factor for cardiometabolic multimorbidity. Evidence regarding the prevalence of hypertension, hypertension treatment and blood pressure (BP) control is scarce in people with cardiometabolic long-term conditions (LTCs). May Measurement Month is the largest annual, global BP screening campaign providing one of the largest datasets on BP and cardiometabolic status. This study explores the association between cardiometabolic LTCs and hypertension, hypertension treatment, BP control, and mean BP. Design and methods: A total of 3,397,746 participants (≧18 years) from the three MMM campaigns in 2017–2019 arising from 103 countries were included. Data on three LTCs were collected: diabetes, myocardial infarction and stroke. Participants were subdivided based on number of LTCs. Hypertension was defined as having a systolic BP≧140mmHg and/or diastolic BP≧90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. Multiple imputation was used to estimate BP readings if any readings were missing. Controlled hypertension was defined as a BP&lt; 140/90mmHg on treatment. Results: Amongst all participants, 316940 (9.3%), 62731 (1.8%), and 28491 (0.8%) reported having one, two or three LTCs, respectively. There was a graded effect of increasing number of LTCs on rates of hypertension: 29.6% in those with no LTCs, and 63.0%, 68.6% and 71.2% in those with one, two or three LTCs, respectively. A similar graded effect was seen for the percentage of hypertensive participants on antihypertensive medication: 44.0% in those with no LTCs, and 79.6%, 87.1% and 89.8% in those with one, two or three LTCs, respectively. Despite higher treatment rates, BP control rates (&lt;140/90mmHg) were similar in those with no LTCs, one or two LTCs (57.6%, 56.4% and 56.0%, respectively) but higher in those with three LTCs (67.9%). This was reflected in the average BPs of participants on treatment, with similar average BPs in those with no LTCs, one, or two LTCs (134/82mmHg, 135/81mmHg and 135/81mmHg, respectively) compared with lower BP (129/78mmHg) in those with three LTCs. Conclusions: With an increasing number of cardiometabolic LTCs, there was a graded increase in the likelihood of having hypertension, and amongst hypertensives, of being treated. Control rates were similar in those with two or fewer LTCs but higher in those with three LTCs, although BP control was suboptimal in all groups. Focused efforts in the higher-risk population with cardiometabolic LTCs are needed to reduce the global burden of hypertension.

PS-BPC04-4: PREVALENCE AND CLINICAL CHARACTERISTICS OF HYPERTENSION SUBTYPES ACCORDING TO HOME BLOOD PRESSURE CONTROL IN TREATED HYPERTENSIVE PATIENTS: A CROSS-SECTIONAL STUDY

Objective: To identify the prevalence and clinical characteristics of the different hypertension subtypes according to home blood pressure (BP) control in treated hypertensive patients. Design and method: This study was conducted in Siriraj hospital, Mahidol University, Thailand during 2019 to 2020. We included treated hypertensive patients with at least 1 antihypertensive medications and had self-home BP measurement. Hypertension subtypes were normotension (NT) (all home BPs were less than 135/85 mmHg), isolated morning hypertension (MHT)(morning BPs were only at least 135/85 mmHg), isolated evening hypertension (EHT)(evening BPs were only at least 135/85 mmHg) and sustained uncontrolled hypertension (SHT)(all home BPs were at least 135/85 mmHg). We analyzed the clinical data to evaluate blood pressure control rate and identify the associated clinical factors in the other groups. Results: Our study included 1,435 participants. The prevalence of home BP control was 55.82%, 12.61%, 7.32%, and 24.25% in NT, MHT, EHT, and SHT, respectively. Overall mean age was 63 years. There were 39.58% men. SHT group had significantly the highest body mass index, proportions of alcohol drinking and evening administration of antihypertensive medications. The participants in EHT group used the highest number of antihypertensive medication classes and chronic kidney disease was most found in this group. The multivariable analysis showed the significant association of history of CVD with MHT (OR 2.93, 95%CI (1.46 to 5.85)). The albuminuria of at least 300 mg/g was the significant associated factor of EHT (OR 3.05, 95%CI (1.23 to 7.57)) and SHT (OR 2.20, 95%CI (1.14 to 4.27)). Aging (OR 0.98, 95%CI (0.96 to 0.99)), use of thiazide diuretics (OR 3.38, 95%CI (1.03 to 11.11)), sprironolactone (OR 5.68, 95%CI (1.38 to 23.33)) and peripheral alpha1 blockers (OR 3.90, 95%CI (1.16 to 13.11)) were also strongly associated with SHT. Conclusions: BP control rate was fair. There were different clinical characteristics and independent associated factors in each subtypes.