BP Control Rates Research Articles

P155 WHAT ARE THE SEX DIFFERENCES IN THE USE OF SINGLE-PILL COMBINATIONS IN THE TREATMENT OF ARTERIAL HYPERTENSION? RESULTS FROM HOME BLOOD PRESSURE MONITORING IN SLOVAKIA IN 2022

Arterial hypertension (AH) is the leading risk factor for cardiovascular morbidity and mortality for both, men and women. Aim of the trial: To evaluate the share of single-pill combinations (SPC) according to the gender of doctors and their patients. To evaluate the efficacy of the AH treatment with HBPM and education. Patients and Methods: This project was conducted from April to June 2022 at 178 general physician practices. We have enrolled consecutive adult patients willing to complete a questionnaire and take office BP and HBPM measurements. Results: 4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. The mean office BP was higher in male (136,7 ± 10,9/ 81,9 ± 7,2 mmHg), vs female patients (135±7,2/ 80,2 ± 6,2 mmHg). Mean blood pressure at home (HBP) was also higher in males (134,1± 7,2/ 81,1± 6,3 mmHg). There were 72% (129) of female doctors, participating in the trial. The widest use of SPC was when male doctors treated male patients (70,7%). The lowest use of SPC was when female doctors treated female patients (52,1%). 44,6% of patients were treated with double SPC and 14,3% with triple. Dual SPC was the most preferred treatment when male patients were treated by male doctors (52,3%). Triple SPC strategy was used mostly when female doctors were giving care to male patients (16,8%). More patients reached optimal BP at home when treated by a male doctor (68%). Conclusion: Appropriate education of patients and their engagement via HBPM, led to 67% BP control. The preference for SPC by male doctors led to significantly better BP control at home, regardless of the gender of patients. By systematic rationalization of pharmacotherapy according to the 2023 ESH Guidelines, using SPC has the potential to improve adherence and increase the BP control rate in Slovakia to fulfill the initiative Charter 70/2023.

ARE THERE ANY ADVANTAGES TO USING A POLYPILL OR FREE PILL COMBINATION TO PROTECT PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA?

Objective: Arterial hypertension (AH) has been acknowledged as a leading cause of death. Treating AH alone may provide only limited benefits while it is recommendable to manage the total cardiovascular risk. The aim was to assess the treatment of AH and dyslipidemia (DLP) in patients in specialists’ offices. Design and method: This project was conducted from April to June 2023 in 51 specialists’ offices (SPO) (33% cardiology, and 67% internal medicine) in Slovakia. We have enrolled all 18-year-old pts who are willing to complete a short questionnaire and take office BP. Results: We enrolled 514 pts with AH (42% women), mean age 61,5 ± 17,2 years from SPOs. The mean OBP was 134,9 ± 10,9/ 80,3 ± 7,2 mmHg. The average total cholesterol (TC) was 5,7 mmol/l, LDL-C 3,0 mmol/l. TC (6,12 vs 5,15 mmol/l, p<0,01) was higher in male patients, and LDL-C was higher in female patients (3,05 vs 2,91 mmol/l). 76% pts experienced both AH and DLP simultaneously. In comparison to those without HLP, AH patients with HLP were given 0.5 active substances and 0.8 pills more. In total 79% pts with AH and HLP were treated with a free pill combination with a statin, while only 16% were treated with polypill. The use of polypill was more frequent in female pts (18%) vs male pts (14%). Target BP lower than 140/90 mmHg was reached in 68% pts with polypill, and in 53% pts without polypill. Non-HDL- C was lower in pts with polypill (3,6 vs 4,03 mmol/l). The current BP and non-HDL targets were reached more frequently in pts with polypill 56% vs 44% pts. Conclusions: Adherence to medications is important to achieve the full effect of antihypertensive and lipid-lowering drugs. We demonstrated that the use of polypill compared to a free pill combination of statin and AH therapy is more effective. 27% of patients reached BP and LDL targets when were treated by polypill. Using polypill in our pts we aim to reach a higher rate of BP and cholesterol control in Slovakia to meet the objectives of the Charter 70/2023 initiative.

Clinical characteristics, treatment, and blood pressure control in patients with hypertension seen by primary care physicians in Spain: the IBERICAN study.

To determine the clinical profile, according to the history of hypertension, the risk of developing hypertension, current antihypertensive treatment and BP control rates in patients with hypertension from the IBERICAN cohort. IBERICAN is an ongoing prospective cohort study, whose primary objective is to determine the frequency, incidence, and distribution of CVRF in the adult Spanish population seen in primary care settings. This analysis shows the baseline clinical characteristics of patients with hypertension. Adequate BP control was defined as BP <140/90 mmHg according to 2013 ESH/ESC guidelines. A total of 8,066 patients were consecutively included, of whom 3,860 (48.0%) had hypertension. These patients were older (65.8 ± 10.9 vs. 51.6 ± 14.7 years; p < 0.001), had more cardiovascular risk factors, target organ damage and cardiovascular disease (CVD) in comparison with those without hypertension. The risk of hypertension increased with the presence of associated CV risk factors and comorbidities, particularly diabetes, obesity and the metabolic syndrome, and decreased with the intensity of physical activity. Regarding antihypertensive treatments, 6.1% of patients did not take any medication, 38.8% were taking one antihypertensive drug, 35.5% two drugs, and 19.6% three or more antihypertensive drugs. Overall, 58.3% achieved BP goals <140/90 mmHg. A greater probability of BP control was observed with increasing age of patients and the greater number of antihypertensive drugs. Blood pressure control was lower in hypertensive patients with diabetes, obesity, the metabolic syndrome, increased urinary albumin excretion, higher pulse pressure, and lack of antihypertensive treatment. About half of patients attended in primary care settings have hypertension in Spain. Patients with hypertension have a worse CV clinical profile than non-hypertensive patients, with greater association of CVRF and CVD. Around four out of ten patients do not achieve the recommended BP goals, and higher use of combination therapies is associated with a better BP control.

Adherence to ESC guidelines for antihypertensive drug therapy: real-world survey from an EU country

Abstract Background Achieving optimal BP control in hypertensive patients (pts) remains a continuous challenge worldwide. Multiple factors are responsible for the low rates of BP control with suboptimal drug choice playing a key role. Practice guidelines should serve as evidence based foundation for optimal antihypertensive drug therapy but their impact in the real-world is variable. Purpose This retrospective study aimed: 1. To assess the prescription pattern of main classes of antihypertensive drugs and its association with comorbidities. 2. To compare prescription before and after the publication of the 2018 ESC/ESH guidelines for management of arterial hypertension, translated into local language (in 2019). Thus, prescriptions in the years 2018 and 2020 were compared. Dual combination of ACEi/ARB + CCB/thiazide-like diuretics (THI) or triple combination of ACEi/ARB + CBB + THI were considered as guidelines directed first line drugs (FLAD) i.e. adherence to guideline. Spironolactone (MRA) was considered as recommended drug for patients requiring ≥4 drugs. Methods We analysed prescribed drug therapy in a large patient cohort from the years 2018 and 2020 with 264 237 and 272 934 hypertensive pts, respectively. Pts were considered hypertensive after meeting at least one of two criteria: 1. Having been prescribed ≥ 121 standard drug doses of antihypertensive drugs in the year before the studied period. 2. Having at least 2 medical visits with the diagnosis of hypertension within 2 years before the studied period. Following comorbidities were considered as potential modifiers of drug therapy: ischemic heart disease (IHD), chronic heart failure (CHF), atrial fibrillation (AF), diabetes (DM) and chronic kidney disease (CKD). Results Overall, first line therapy was prescribed to 21.5% and 22.4% of pts in the year 2018 and 2020, respectively (p&amp;lt;0.0001). In pts taking ≥3 drugs 30.4% did not use THI, in those taking ≥4 drugs only 10.7% used spironolactone (MRA). Selected results are in the attached table. Conclusion Adherence to guideline recommended FLAD in this large survey improved but remained low during the first year after publishing ESC 2018 guidelines: only 22.4% of pts received FLAD in this cohort where 58.6% were free of comorbidities. In pts with AF, the use of FLAD was the lowest with 7.3%. Preferred use of BB and low use of THI and MRA were mostly behind this trend. BB (alone or in combination) were the most prescribed drug group – to 57.3% of pts both in 2018 and 2020. Their prescription was high in all pts with comorbidities, notably worrisome for diabetic pts (66.0%). Continuous efforts to improve dissemination of knowledge of FLAD according to guidelines appear mandatory.Attached table

Abstract P356: Hypertension Trends And Disparities Over Twelve Years In A Large Health System: Leveraging The Electronic Health Records

Introduction: The digital transformation of medical data has provided health systems with an opportunity to utilize electronic health records (EHR) for analyzing hypertension trends and identifying areas for improvement. Methods: We conducted a serial cross-sectional analysis of outpatients of the Sentara Healthcare System using EHR data from 2010 to 2021 to gain actionable insights about hypertension trends and disparities. Hypertension was defined as elevated visit blood pressure (BP &gt;= 140/90 mmHg) or use of antihypertensive medications. We compared four different definitions of hypertension and assessed age-adjusted prevalence, BP control rate, and coded diagnosis rate as outcome measures. Results: The study included 1,376,325 unique adults. Hypertension prevalence varied by the definition used, ranging from 36.5% to 50.9% in 2010, and steadily increased by approximately 5% over time. BP control rates initially ranged from 61.2% to 71.3% in 2010, stabilized, experienced an increase during 2018-2019, and declined during 2020-2021. The proportion of hypertensive patients with a coded diagnosis ranged from 45.5% to 60.2% in 2010, showing improvement over time. Non-Hispanic Black patients consistently had higher hypertension prevalence, mean age-adjusted BP, and lower BP control rates compared to other racial/ethnic groups. Conclusions: Over 12 years, hypertension prevalence increased within the regional health system. Although BP control rates improved, they remained below 73% and revealed significant racial disparities. The assessment of EHR data uncovered important trends and highlighted opportunities for enhancing health system performance.

Abstract 138: Treatment Initiation During The First Month Following Hypertension Diagnosis Improves Blood Pressure Control Up To 30 Months

Background: Adults with hypertension (HTN) have fewer cardiovascular events if controlled within the first 6 months after diagnosis, during which time they are excluded from many HTN control metrics. We compared BP control rates (BP &lt;140/90) from 6 to 42 months in adults with HTN who did or did not have treatment initiated during the first month following diagnosis, irrespective of subsequent treatment initiation or intensification (TI). Methods: A patient cohort from 5 diverse healthcare organizations, engaged in a quality improvement program, was identified with previously undiagnosed and untreated HTN. TI and BP control were assessed by measuring the period prevalence of visit BP control and TI on uncontrolled visits, then compared with the time since diagnosis (TSD) up to 42 months. Groups were stratified by treatment initiation status during the first month. Results: A prospective cohort of 14,328 newly diagnosed and untreated persons with HTN was identified, mean age 56.2±14.7 years. Patients with TI during the first month had higher rates of BP control at 6 (56.2% vs 46.2%, p&lt;0.001) through 30 months (65.9% vs 61.4%, p&lt;0.001) than those initially untreated. Patients initiated during the first month were less likely to receive additional intensifications (OR 0.68, 95% CI [0.63-0.74]). Conclusion: TI in the first month after diagnosis results in better BP control at 6 months, which has prognostic importance and coincides with the time when these individuals impact standard HTN control metrics. Of concern, TI during the first month after diagnosis was insufficient to achieve control rates ≥70% and lowered the probability of subsequent TI.

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers.

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled(<140/90mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P<.001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

ASSOCIATION OF OFFICE AND RESIDENTIAL BLOOD PRESSURE, PRESSURE CONTROL RATE AND NUMBER OF ANTI-HYPERTENSIVE AGENTS IN A BRAZILIAN MULTICENTRIC

Objective: Compare systolic (SBP) and diastolic (DBP) blood pressure, control rate, number of antihypertensive drugs (AH) and age group among hypertensive patients. Design and method: Analytical cross-sectional study, using the TeleMRPA platform database. Variables used: sex, age, SBP and DBP obtained by HBPM, office BP (PAc) and number of AH: 1 monotherapy, double, triple combination or with four or more. Elderly &gt; = 60 years old and non-elderly &lt;60 years old were considered. The chi-square test was used to compare proportions and the t-student test to compare means, 95% confidence interval and significance level p&lt;0.05. Results: 25,543 participated, 54.6% elderly (n = 13938; p&lt;0.001), more women in the elderly group (66.9%) than among non-elderly (58.6% - p&lt;0.001). The elderly group (71±8.0 years old) had a mean SBP of 136.7(±21.3) mmHg and DBPc of 80.6(±11.8) mmHg and MRPA SBP 129.0(±16) .0) mmHg and DBP 76.4(±9.6) mmHg. The non-elderly group (47±8.6 years old) had SBP of 129.6(±18.4) mmHg and DBPc of 86.4(±11.5) mmHg and by MRPA SBP 122.9(±14.6) mmHg and DBP 81.5(±9.5)mmHg; significant mean differences (p&lt;0.001) in both groups. Controlled BP rate (HBPM) among the elderly was 56.2% and among non-elderly 43.8%. The number of antihypertensive drugs in the elderly group was 38.2%, 38%, 18.5% and 5.3% for monotherapy, double, triple combination or with four or more AH respectively; among non-elderly people it was 47.8%, 36.6%, 12.3% and 3.3% (p&lt;0.001). Among the elderly, the BP control rate (HBPM) was 43.8% in monotherapy and 35.9% in four or more combinations (p&lt;0.001); among the non-elderly, the rate of BP control (HBPM) was 41.7% in monotherapy and 25.8% in combination with four or more drugs (p&lt;0.001). Conclusions: The elderly group had higher systolic values, both in the office and at home, and lower diastolic values, and a higher frequency of antihypertensive therapy in combination. The BP control rate was higher among the elderly and the greater the number of drugs used, the lower the BP control rate in both groups.

ACTUAL AND PERCEIVED BLOOD PRESSURE AND LDL-CHOLESTEROL CONTROL IN HYPERTENSIVE PATIENTS WITH DYSLIPIDEMIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN CROATIA (SNAPSHOT STUDY)

Objective: Assess BP and LDL-C control rates and cardiovascular (CV) risk in hypertensive patients with dyslipidemia in Croatia, based on stricter recommendations from recent European guidelines, and compare them with physicians’ assessment. Design and method: The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 116 general practitioners in Croatia and included 1298 hypertensive patients with dyslipidemia. Results: 91.7% of patients had additional risk factors. 57.9% were 65 years-old or older (65.8±9.7 years), 47.3% men, 42.6% obese (mean BMI 29.6±4.6 kg/m2) and 17.6% smokers. 55.4% had comorbidities: diabetes mellitus (34.1%), coronary artery disease (21.0%), and peripheral arterial disease (9.6%). Mean systolic/diastolic BP was 135.5±13.3 / 80.3±8.5 mmHg, total cholesterol 203.2±52.7 mg/dL, HDL-C 53.9±13.8 mg/dL, LDL-C 119.4±45.1 mg/dL, triglycerides 160.8±109.7 mg/dL. Cardiovascular risk was estimated by investigators as “high”/“very high” for 30.1% and 31.4% of patients, respectively, whereas calculated CV risk according to guidelines (SCORE CHART 2-OP) was “high”/“very high” for 38.0% and 38.5% of patients, respectively. These results showed that 46.6% of investigators estimated CV risk accurately, while 34.3% underestimated it. Hypertension was treated in 99.1% of patients and BP considered as controlled by investigators in 79.5% of patients, whereas actual control based on guidelines’ recommendations was achieved by 23.9%. Similarly, dyslipidemia was treated in 79.4% of patients and LDL-C considered as controlled by investigators in 54.2%, whereas actual control was achieved by only 12.8% according to guidelines. Only 2.9% of patients were actually controlled for both BP and LDL-C whereas 45.3% of patients were considered as controlled for both BP and LDL-C by investigators. 66.4% of patients were treated with single-pill combinations for hypertension, 8.6% for dyslipidemia, and only 5.5% received treatment for both hypertension and dyslipidemia in a single pill. Conclusions: Actual BP and LDL-C control rates in Croatia remain rather low and are often overestimated by physicians. Physicians often underestimate CV risk, which is difficult to evaluate in clinical practice. Improving physician education about guidelines’ recommendations and need for treatment intensification could offer an opportunity to further improve risk factor control. Single-pill combination usage for dyslipidemia and for both hypertension and dyslipidemia remains rather low.

Abstract P165: Key Tenets for Lifestyle Programs Aiming to Improve Hypertension Control and Cardiovascular Health

Introduction: Promoting lifestyle changes, such as consuming a healthier diet, engaging in exercise, and quitting smoking can help control hypertension (HTN) and reduce the risk of adverse cardiac outcomes. To support public health practitioners and health care providers, the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) sought to develop a set of key tenets of lifestyle programs that support successful implementation and impact on HTN-related outcomes. Hypothesis: No a priori hypotheses. Methods: We conducted rapid evaluations of three lifestyle programs identified first through a broad call for nominations and then a panel of experts for final selections. We also performed a literature review to assess the landscape of lifestyle programs focused on managing HTN. To build upon these findings, a rigorous mixed-methods evaluation of a local YMCA’s (St. Louis Gateway Region) implementation of a Blood Pressure Self-Monitoring (BPSM) program was conducted to describe program characteristics and innovations and assess HTN outcomes. Results: The evaluation of a local YMCA included 333 participants with HTN (2018-2020) and reported a statistically significant average reduction of 2.6 mmHg in SBP from baseline to 16-week follow-up. Based on comprehensive findings from the project, DHDSP identified the following four key tenets for an effective program: 1) Implementing programs in community settings provides an opportunity to offer programming where people are already gathering and can build trust and commitment. Findings from rapid evaluation of a program held at churches and other community locations demonstrated increased BP control rates from 66.2% to 71.5% at 12-week follow-up. 2) A team-based approach with clinical and non-clinical staff allows for more impactful and effective implementation. Evaluation results demonstrated completion of a program with trained lifestyle coaches was associated with a decrease of 7.3 mmHg in SBP and 5.7 mmHg in DBP over a 16-week period. 3) Programs with shorter durations (between 3-24 weeks) allow for those not able to commit to a longer program to still benefit from learning to control BP and reduce other risk factors. Findings from rapid evaluation of a three-week program resulted in increased BP control from 28.4% to 61.3% by end of program period. 4) Targeting multiple lifestyle behaviors provide the opportunity to closely match participant needs with the type of activities that work best for them. Rapid evaluation of a 12-week program focused on exercise, diet, and reducing stress demonstrated an increase in BP control from 76.9% to 82.2%. Conclusion: Findings can be used as a resource to link patients to effective BP control and management programs that have implemented these key tenets. Strategies highlighted may also provide considerations for replication in other communities.

Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications.

Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.

Trends in using of antihypertensive medication among US CKD adults, NHANES 2001-2018.

Blood pressure (BP) control rates among adult patients taking antihypertensive medications in the United States have not improved over the last decade. Many CKD adults require more than one class of antihypertensive agent to reach the BP target recommended by the guidelines. However, no study has quantified the proportion of adult CKD patients taking antihypertensive medication who are on monotherapy or combination therapy. National Health and Nutrition Examination Survey data during 2001-2018 was used, including adults with CKD taking antihypertensive medication (age ≥ 20 years, n = 4,453). BP control rates were investigated under the BP targets recommended by the 2021 KDIGO, the 2012 KDIGO, and the 2017 ACC/AHA guidelines. The percentages of uncontrolled BP among US adults with CKD taking antihypertensive medication were 81.4% in 2001-2006 and 78.2% in 2013-2018. The proportion of monotherapy of antihypertensive regimen were 38.6, 33.3, and 34.6% from 2001 to 2006, 2007-2012, and 2013-2018, with no obvious difference. Similarly, there was no significant change in percentages of dual-therapy, triple-therapy, and quadruple-therapy. Although proportion of CKD adults not treated with ACEi/ARB decreased from 43.5% in 2001-2006 to 32.7% in 2013-2018, treatment of ACEi/ARB among patients with ACR > 300 mg/g had no significant change. The BP control rates among US adult CKD patients taking antihypertensive medications have not improved from 2001 to 2018. Mono-therapy accounted for about one third of adult CKD patients taking antihypertensive medication and not changed. Increasing antihypertensive medication combination therapy may help improve BP control in CKD adults in the United States.

PS-C31-5: COMPARISON OF THE BLOOD PRESSURE MANAGEMENT BETWEEN SODIUM GLUCOSE CO-TRANSPORTER 2 INHIBITORS AND GLUCAGON-LIKE PEPTIDE 1 RECEPTOR AGONISTS

Background: Several large clinical studies using not only sodium-glucose co-transporter 2 inhibitors (SGLT-2is) but also glucagon-like peptide 1 receptor agonists (GLP-1Ras) showed the superiority on the renal outcome on patients with type 2 diabetes (T2DM). There is no direct comparison of renoprotective effects between these two drugs, further, the mechanism for the renoprotective effects is not fully understood. Our previous survey revealed the superiority of SGLT2i treatment for the renoprotective effects compared to GLP1Ra. We also reported the importance of the reduction of BP during treatment, however, there is no direct comparison between their BP lowering efficacies. Aim: This study aimed to compare the rates of achieving a target BP and the renal effects, with SGLT-2i and GLP-1Ra treatments, administered in Japanese patients with T2DM and poorly controlled BP. Methods: Kanagawa Physicians Association separately carried out retrospective surveys that included patients with T2DM receiving therapy with SGLT-2i or GLP-1Ra for more than one year. After excluding the patients who used both SGLT2i and GLP1Ra, 384 SGLT-2i- and 160 GLP-1Ra-treated patients, with a BP more than 130/80 mmHg, before treatment were included in this study. Propensity score (PS) for the SGLT2i treatment were calculated using logistic regression and the inverse probability weighting method with average effect for treatment (ATE) weight and the trimming of patients with 0.05 ≦ PS≦ 0.95. The BP control rates were compared using a generalized linear model. Results: In this study, the rage of the standardized difference between two treatments was form 0.02 to0.20. SGLT-2i treatment resulted in significantly higher BP control rates than GLP1Ra treatment (odds ratio [95%confidence interval] = 2.09 [1.08, 4.03], p = 0.03). Compared with GLP-1Ra-treated patients, SGLT-2i-treated patients had significantly larger decreases in diastolic BP, mean arterial pressure, and body weight (-3.8[-6.6, -1.1] mmHg, P = 0.006; -4.1[-7.2, -1.0] mmHg, P = 0.01; and -1.5 [-2.7, -0.4], P = 0.008, respectively) and increased annual estimated glomerular filtration rate (eGFR; 1.5 [0.05, 2.9] mL/min/1.73 m2/year, P = 0.04). Conclusion: In T2DM patients with poorly controlled BP, compared with GLP-1Ra, SGLT-2i treatment significantly improved BP management and increased eGFR. When the renoprotective effect is expected in the clinical practice, it is necessary to consider the degree of contribution to the achievement of BP control in addition to the characteristics of the drugs.

S-33-3: EVALUATING THE PREVALENCE, AWARENESS, AND CONTROL OF HYPERTENSION: A COMMUNITY, BASED CROSS SECTIONAL STUDY

Objective: The main objectives of our screening survey is to detect the prevalence, control, awareness and risk factors of hypertension Design and method: This cross-sectional screening survey was conducted among 23168 adults, during the May Measurement Month 2018 campaign in six states. Volunteers ≧ 18 years were recruited through opportunistic sampling. Each participant had three blood pressure measurements and completed a questionnaire on demographic and medical history. Hypertensive patients were defined as those having systolic BP ≧ 130mmHg or diastolic BP ≧ 80 mmHg, or taking antihypertensive medication, control of hypertension was defined a systolic BP ≦140 mmHg and a diastolic BP ≦ 90 mmHg. Results: The overall prevalence of hypertension was 25.9% among the study participants (14.8% for males and 11.1% for females). The majority of identified hypertensive participants (74.1%) had no previous history of known hypertension. Overall 63.0% were on treatment and 35.6 % had controlled blood pressure. In the multivariable regression model, factors associated with increased awareness of having hypertension included female sex (OR 1.37 95% CI 1.12: 1.69), older age &gt; 60 years (OR 1.81 95%, CI 1.36: 2.40), frequently measured their BP (OR 21.3 95% CI 15.3: 29.7), and presence of comorbidities (P &lt; 0.001), Compared to individuals with a normal BMI, overweight participants were more likely to have hypertension (OR 1.63, 95% CI 1.48: 1.79) and more likely to have the disease uncontrolled (OR1.47, 95% 1.33: 1.63). Diabetic patients also had less BP control, while a history of myocardial infarction or stroke did not influence the rates of BP control among hypertensive subjects. Conclusion: Our study suggests that the prevalence of hypertension is increasing. Our data also demonstrated a striking lack of awareness of the disease and alarming levels of poor disease control particularly among young adults, overweight subjects and diabetics.

RAG-SACA-3: ROLE OF PRIMARY CARE PHYSICIAN TO MANAGE HYPERTENSION IN A LOW-RESOURCE SETTING

Hypertension is a primary care clinical condition that is therefore best detected, managed, and followed at a primary care level by a primary care team led by a physician. However, the delivery of primary care services is not unique in all countries, especially in low- or lower-middle-income countries where primary care physicians used to manage hypertension in low-resource settings (LRS). This presentation will focus on the concept of LRS, a list of potential roles played by a primary care physician, and possible challenges usually face. Usually, the settings where health care systems do not meet the minimum standards set by the World Health Organization or any other quasigovernmental organization are considered LRS. However, there is no explicit definition for LRS. The major roles of a primary care physician in LRS are identification of an individual at high risk for HTN, proper screening, diagnosis with a proper communication strategy to inform about the diagnosis, cost-effective rational treatment with counseling, and finally follow-up. The primary care physician is at the heart of a team-based HTN care in an LRS and will provide supportive supervision to the team to ensure the best outcome: (i) increased patient enrollment, (ii) increased patient treatment rate, (iii) improve BP control rate, (iv) high treatment compliance (v) reduction of drug stock-outs. In LRS, without team-based care and shifting of tasks, it will be very difficult to ensure proper management. In general, a primary care physician will play a leadership role in a resource-poor setting to successfully implement an HTN management program.

Knowledge of hypertension and impacts of dietary habits of hypertensive patients on blood pressure control in cardiology departments in the Kara region

Introduction: Hypertension is a major public health problem because of its prevalence and mortality, to which unhealthy diet contributes 30%. The objective of this study was to determine the associated risk factors and to evaluate their knowledge and the impact of dietary habits of hypertensive patients on the control of the pathology. Patients and methods: This was a descriptive and analytical study which took place from June to August 2021 and which concerned hypertensive patients followed for at least one year in the cardiology departments of the CHU and CHR Kara. Results: The study included 186 hypertensive patients with a mean age of 55.59 years The age group of [50 - 59 years] was the most represented with 30.11% of the cases. The male/female sex ratio was 0.92. The main associated risk factors were physical inactivity (67%), pathological waist circumference (65%) and overweight (53%). The BP control rate was 41.94%. An average level of knowledge was noted in the patients. Excessive salt consumption (90%) was the risk factor most known by patients. Insufficient intake of vegetables and fruits (26%) was the least known. Only 21% of patients adopted healthy dietary habits. The adoption of healthy dietary habits was significantly associated with a high rate of BP control (72%, p&lt;0.001). Daily consumption of vegetables (20%) and fruit (5%) was considered low. However, this consumption was associated with a high rate of BP control; 58% (p=0.014) and 67% (p=0.073) respectively. In 52% of regular garlic consumers, 60% had controlled BP compared to 22% of nonconsumers of this spice (p&lt;0.001). Knowledge of the effect of foods on BP was not accompanied by healthy consumption of these foods. Conclusion: This study confirmed the need to adopt healthy dietary habits and/or a healthy lifestyle to control hypertension. Substantial consumption of vegetables and fruits and garlic is highly recommended while alcohol, salt, and fast foods should be consumed in moderation. The adoption of these dietary habits by the general population will contribute to the decrease in the prevalence of hypertension in Togo.

Impact of Adapted Physical Activity on Blood Pressure and Hypertension Control in the Militaries of Kinshasa Garrison, Democratic Republic of Congo: A Randomized Controlled Trial

Context and objective. Major handicap for operational conditioning of troops, hypertension requires innovative approaches for its prevention and management. The present study aimed to evaluate the impact of adapted physical activity (APA) on BP level of sedentary soldiers from Kinshasa garrison and the rate of hypertension control in those with high BP. Methods. Open, parallel randomized controlled trial carried out at Camp Lt-Colonel Kokolo (CVEC) from June 2016 to October 2017) in sedentary soldiers (57.6 %, hypertensives) allocated for 8 weeks to APA (n=119) or control (n=110). The randomization procedure used permuted blocks of four consecutive participants. The outcomes were baseline-adjusted betweengroup difference in BP level (all participants), in rate of BP control among hypertensives. Results. At the last available visit in 226 participants (119 vs 107), the baseline-adjusted BP difference between active and control group by intentionto- treat was 5.1 (95 % CI 1.2 -10.8)/3.0 (0.1-6.9) mmHg lower in the active group. The effect of APA was also significant across pre-specified categories of participants based on age, officers’ rank, and hypertension status. Among 129 analyzed drug treated hypertensives (68 vs 61), the rate of BP control remained unchanged in the control group (43.8 to 44.3%) but increased (43.5% to 85.3 %) in the active group yielding a baseline-adjusted between group difference of 40.7 (32.2; 49.2) %. The probability to achieve hypertension control was greater (HR: 3.38 [95% CI: 1.48- 4.84] in the active group. PP analysis of 122 soldiers (80 vs 42) with data at all scheduled visits yielded confirmatory results for BP reduction and for hypertension control by APA. The changes in BP were positively correlated with concomitant reductions in heart rate. Conclusion. Exercise training induced a significant BP reduction in sedentary militaries and improved the control rate among those with drug treated hypertension.

Preoperative oral diazepam for intraoperative blood pressure stabilisation in hypertensive patients undergoing vitrectomy under retrobulbar nerve block anaesthesia: study protocol for a randomised controlled trial

BackgroundAs a type of local anaesthesia, retrobulbar nerve block is often used in vitrectomy, with patients remaining conscious during the operation. The increase in systolic blood pressure (SBP) caused by tension and fear during the operation—especially in patients with a history of hypertension—can negatively impact the safety of the procedure, resulting in suprachoroidal haemorrhage or retinal haemorrhage. Diazepam has a sedative effect and can relieve tension during surgery. This study aims to evaluate the efficacy and safety of diazepam for intraoperative BP stabilisation in hypertensive patients under retrobulbar anaesthesia during surgery.MethodsThis single-centre, double-blind, randomised controlled and parallel clinical trial will include 180 hypertensive patients who will undergo vitrectomy with nerve block anaesthesia. Study participants will be randomly allocated in a 1:1 ratio to intervention (patients receiving oral diazepam before the operation) and control (patients receiving oral placebo before the operation) groups. The primary outcome is the effective rate of intraoperative BP control (systolic BP during operation maintained at <160mmHg at all timepoints). The secondary outcomes are the proportion of patients with SBP ≥180 mmHg at any timepoint from operation to 1 h post-operation, the change of mean systolic blood pressure and mean heart rate during operation from baseline, as well as the number of patients with intraoperative and post-operative adverse reactions within 12 weeks of surgery. The logistic regression model will be performed to compare the outcomes.DiscussionThis study will evaluate the efficacy and safety of diazepam for intraoperative BP stabilisation in hypertensive patients under nerve block anaesthesia during surgery. The results of this trial will reveal whether diazepam has a significant effect on intraoperative BP stability in patients with a history of hypertension who require vitrectomy. If the results of this trial are significant, a large-scale multi-centre clinical trial can be designed.Trial registrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2100041772. Registered on 5 January 2021.

Abstract P215: Evidence Of Terminal Digit Preference In Veterans Affairs Midwest Region Primary Care Clinics

Objective: This study examined terminal digit preference (TDP) and its association with BP control in Veterans Affairs Midwest region clinics. Methods: TDP was examined in 517,668 BP values from 202,781 Veterans age 18 to 85 years during primary care visits from January 1, 2019 to March 1, 2020 across eight Midwest region sites. Presence of TDP was examined using a goodness of fit test with 10 bins. BP control (&lt;140/90 mmHg or &lt;130/80 mmHg) was assessed in 98,433 Veterans with diagnosed hypertension based on last clinic visit vital signs. Spearman correlation coefficients examined the association of TDP with BP control. Results: Mean age was 65.9 (standard deviation [SD]15.7) years, 93.9% (188, 586/202,781) were male; race was White in 78.1% (153,372/202,781), Black or African American in 16.3% (33, 053/202,781), and Asian in 0.5% (1,014/202, 781). For SBP measurements, significant TDP (P&lt;0.001) for digit 8 was noted in all 8 sites ranging from 12.6% (6,839/54,279) to 21.2% (18,124/85,493). For DBP measurements, significant TDP was noted (P&lt;0.001) for digit 0 ranging from 13.5% (7,327/54,276) to 32.7% (27,956/85,493). Among the 8 sites, BP control rates (&lt;140/90 mmHg) ranged from 72.2% (5,947/8,237) to 81.0% (15,405/19,019) while BP &lt; 130/80 mmHg among Veterans with high CVD risk (n=179, 074) ranged from 33.6% (4,960/14,762) to 45.5% (8,204/18,233). Both SBP TDP for digit 8 (r=0.80; P&lt;0.05) and DBP TDP for digit 0 (r=0.73; p &lt; 0.05) were significantly and positively correlated with BP control. Conclusion: Our data show presence of BP TDP in the Midwest region VA sites. The correlation of TDP with BP control rates raises concerns about ability to accurately assess BP control in these sites.