Rates Of Uncontrolled Hypertension Research Articles

Abstract P325: Perceptions of Primary Care Quality and Hypertension Control in the Eastern Caribbean

Introduction: The Caribbean region has high rates of uncontrolled hypertension, a condition that is predominantly managed in primary care. Though evidence shows patient perceptions of quality of care are associated with health outcomes, there is a paucity of research in the Caribbean. This study aimed to fill evidence gaps on the relationship between perceived quality of care and hypertension management in the Caribbean. Objective: To understand the role of quality-of-care perceptions in hypertension control in the Eastern Caribbean. Hypothesis: We assessed the hypothesis that individuals with higher perceived quality of primary care are more likely to achieve blood pressure control. Methods: We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECHORN) (N=2961). ECHORN is an ongoing longitudinal study of adults conducted across four island sites. Participants completed a self-reported health survey, clinical examination, and laboratory testing. Participants who were aware of their hypertension status and reported a clinic visit within the past year were included in this study. The main exposure, perceived quality of care (QOC), was measured by asking participants to rate the quality of their healthcare. Likert responses were used and categorized as poor/fair, good, and very good in analyses. The outcome, hypertension control, was defined by JNC-7 guidelines and used as a binary variable. Pearson and Mantel-Haenszel Chi-Square tests were used for analysis. Results: The final analysis included 470 participants. Forty-six percent of participants had controlled hypertension, and 54% did not. Younger persons and those with higher educational attainment were more likely to have controlled hypertension. Twenty-four percent ranked QOC as poor/fair, 47% as good, and 29% as very good. Forty-one percent of those who rated QOC as poor/fair, 44 percent of those who rated QOC as good, and 53 percent of those who rated QOC as very good had their hypertension controlled. Mantel-Haenszel Chi-Square results showed a statistically significant positive linear trend in the relationship between QOC and hypertension control. Conclusion: This study demonstrated a positive relationship between higher perceived QOC and hypertension control in the Eastern Caribbean. Due to the burden of hypertension and the lack of region-specific literature on quality of care, further research is warranted to explore dimensions of QOC that most influence hypertension control.

Uncontrolled Hypertension, Treatment, and Predictors among Hypertensive Out-Patients Attending Primary Health Facilities in Johannesburg, South Africa.

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.

Effectiveness of mHealth interventions for improving hypertension control in uncontrolled hypertensive patients: A meta‐analysis of randomized controlled trials

AbstractThe benefits of mHealth interventions in uncontrolled hypertension are unclear. To determine whether mHealth effectively improves the control rate of uncontrolled hypertension. PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were searched for randomized controlled trials (RCTs) from January 2007 to September 2022. The intervention group consisted of mHealth intervention, and the control group was usual care. Random‐effects meta‐analysis models were used to assess pooled mHealth intervention effects and CIs. The primary outcome was the blood pressure (BP) control rate of uncontrolled hypertension. The secondary outcome was the change of BP. Thirteen RCTs were included in this meta‐analysis, of which eight reported the successful BP control rate, 13 reported the change of systolic blood pressure (SBP), and 11 reported the change in diastolic blood pressure (DBP). The mean age of trial participants ranged from 47.7 to 66.9 years old, with a female composition ratio of 40.0%–66.1%. The duration of follow‐up ranged from 3 to 18 months. This study showed a more robust effect size for improving BP control rate by mHealth interventions than usual care (57.5% vs. 40.8% of successful control rate; odds ratio [OR], 2.19 [95% CI, 1.32—3.62]). Furthermore, mHealth significantly reduced SBP by 4.45 mm Hg and DBP by 2.47 mm Hg, and subgroup analysis did not observe the major source of heterogeneity. This meta‐analysis found that mHealth could significantly improve the uncontrolled hypertension control rate and might be a feasible, acceptable, and effective tool for uncontrolled hypertension management.

A socio-ecological framework examination of drivers of blood pressure control among patients with comorbidities and on treatment in two Nairobi slums; a qualitative study.

Despite the known and effective treatments to control blood pressure, there is limited information on why there are high uncontrolled hypertension rates in urban slum settings. The aim of this paper is to explore the views of treated people with uncontrolled hypertension and other key stakeholders on the facilitators and barriers to blood pressure control among people with comorbid conditions in two Nairobi slums. The study was conducted in two Nairobi slums namely, Korogocho and Viwandani. This study used a qualitative methodology using interviews and focus group discussions. Barriers and facilitators to blood pressure control were explored using the Social Ecological Model (SEM) framework. A total of 57 participants were interviewed for this study. There were 31 in-depth interviews and two focus group discussions among participants with uncontrolled hypertension and with comorbidities. Additionally, 16 key informant interviews were conducted with healthcare providers and decision/policymakers. All interviews were audio-recorded, transcribed verbatim and analysed thematically. This study identified barriers and facilitators to blood pressure control among patients with uncontrolled hypertension at the patient/individual level, family and community level, health system level and at the policy level. High cost of hypertension medicines, the constant unavailability of medicines at the health facilities, unsupportive family and environment, poor medicines supply chain management, availability and use of guidelines were among the barriers reported. The results show that uncontrolled hypertension is a major public health issue in slums of Nairobi and they highlight barriers to blood pressure control at different levels of the socio-ecological model. These findings can be used to design holistic interventions to improve blood pressure control by addressing factors operating at multiple levels of the socio-ecological framework.

Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice.

This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations. Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender. There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18-29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group. Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.

Novel Therapies on the Horizon of Hypertension Management.

The rates of uncontrolled hypertension, along with downstream cardiovascular outcomes, has been worsening in this country. Despite the plethora of antihypertensive medications on the market, the prevalence of resistant hypertension (RH) is estimated to be 13.7%. Therefore in addition to increased clinical education and focus on lifestyle management of hypertension and medication compliance, new therapies are needed to address this rise in hypertension. A systematic review of the available medical literature was performed to identify emerging treatment options for RH. Six different pharmacologic classes and 2 procedural interventions were identified as being appropriate for review in this paper. The pharmacologic classes to be explored are non-steroidal mineralocorticoid receptor antagonists, aminopeptidase A inhibitors, dual endothelin antagonists, aldosterone synthetase inhibitors, atrial natriuretic peptide inhibitors, and attenuators of hepatic angiotensinogen. Discussion of procedural interventions to lower blood pressure will focus on renal denervation and devices that increase carotid baroreceptor activity. Promising medication and procedural interventions are being developed and studied to expand our treatment arsenal for patients with uncontrolled essential hypertension and RH.

Chlorthalidone and Advanced Chronic Kidney Disease.

Chlorthalidone and Advanced Chronic Kidney Disease.

Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study

BackgroundApproximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension.MethodsIn this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data.ResultsBlack and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure.ConclusionThis study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.

Abstract 9844: Virtual Outreach Facilitates Blood Pressure Self-Monitoring Among Black Men at a Federally Qualified Health Center

Introduction: Rates of uncontrolled hypertension are higher in Black men than in the general population. Prior studies have shown that home self-monitoring of blood pressure (SMBP), in addition to clinical support and education, helps patients lower their blood pressure (BP). This study evaluated a SMBP program for Black men with hypertension at a Federally Qualified Health Center (FQHC). Hypothesis: We hypothesized that virtual outreach would increase SMBP adoption and lower BP among Black Men at a FQHC. Methods: Black men >18 years old with severe hypertension (>160 mmHg systolic or > 100 mmHg diastolic) were contacted by student volunteers and offered a free BP cuff with program enrollment. Students attempted > 4 calls with each participant over the course of 2 plan-do-study-act (PDSA) cycles. Students provided BP education and asked participants to report SMBP readings. Univariate analyses were performed to explore the effect of our SMBP program on clinic BPs. Results: Of 258 eligible, 137 (53.1%) were successfully contacted and 82 (31.8%) received a BP cuff. By the end of PDSA cycle 2, 52 men (20.2%) had reported a BP reading to their student caller. For those who had an updated BP documented in the medical record after cycle 1, subsequent office systolic BP changed by an average of -24.9 (95% CI: -30.8, -19.0) mmHg for the 37 men who used their BP cuff (p<0.001) and by -21.4 (95% CI: -25.1, -16.8) mmHg for the 108 men who did not (p<0.001). The reduction in BP was larger for the group that used BP cuffs (difference -3.5 [95% CI: -12.1, 5.1] mmHg, p=0.35), but this change was not statistically significant. Conclusions: Creating partnerships via virtual communication between university students and community members led to adoption of SMBP among Black men. BP reduction trended greater in the group that began self-monitoring, but difficulty in follow-up and a small sample size limited statistical power.

Risk factors and outcomes of hospitalized stroke patients in Lusaka, Zambia

BackgroundLimited data exists about stroke risk factors and outcomes in sub-Saharan African countries, including Zambia. We aim to fill this gap by describing features of hospitalized stroke patients at University Teaching Hospital (UTH), the national referral hospital in Lusaka, Zambia. MethodsWe conducted a retrospective study of consecutive adults with stroke admitted to UTH's inpatient neurology service from October 2018 to March 2019. Strokes were classified as ischemic or hemorrhagic based on CT scan results and unknown if CT scan was not obtained. Chi-square analyses and t-tests were used to compare characteristics between cohorts with differing stroke subtypes. ResultsAdults with stroke constituted 43% (n = 324) of all neurological admissions, had an average age of 60 ± 18 years, and 62% of the cohort was female. Stroke subtypes were 58% ischemic, 28% hemorrhagic, and 14% unknown. Hypertension was present in 80% of all strokes and was significantly associated with hemorrhagic stroke (p = 0.03). HIV was present in 18% of all strokes and did not significantly differ by stroke subtype. Diabetes (16%), heart disease (34%), atrial fibrillation (9%), and past medical history of stroke (22%) were all significantly more common in patients with ischemic stroke (p < 0.05). In-hospital mortality was 24% overall and highest among individuals with hemorrhagic strokes (33%, p = 0.005). ConclusionsThis Zambian stroke cohort is notable for its young age, significant HIV burden, high in-hospital mortality, and high rates of uncontrolled hypertension. Our results demonstrate Zambia's substantial stroke burden, significant contribution of HIV to stroke, and the need to improve primary stroke prevention.

Characterizing Patients with Uncontrolled Blood Pressure at an Urban Hospital in Hanoi, Vietnam.

Great efforts to advance the diagnosis and treatment of hypertension for controlling hypertension have been made; however, the rates of uncontrolled blood pressure are still high. This study explored the rate of uncontrolled hypertension in patients with hypertension managed in an urban hospital of Vietnam and identified associated factors. A cross-sectional survey was performed from August to October 2019 among hypertensive patients at an urban hospital in Hanoi, Vietnam. Blood pressure was evaluated at the time of medical examination. Demographic, clinical, and behavioral characteristics were also collected. Multivariate logistic regression was used to identify the factors related to uncontrolled hypertension. Among 220 patients, the rate of uncontrolled hypertension was 40.5%. Females had a lower likelihood of having uncontrolled hypertension compared to males (adjusted OR = 0.33; 95% CI = 0.11–0.98). Higher duration of diseases (adjusted OR = 1.07; 95% CI = 1.01–1.14) and higher body mass index (adjusted OR = 1.23; 95% CI = 1.05–1.45) were positively associated with uncontrolled hypertension. Patients who carried supplies needed for self-care, cut down on stress, exercised regularly, and stopped/cut down on smoking were also less likely to develop uncontrolled hypertension. This study reveals that uncontrolled hypertension was common among hypertensive patients in Vietnam. Improving self-care capacity and encouraging healthy behaviors are critically important to control blood pressure, particularly among patients who were males and had high disease duration and body mass index.

Factors associated to uncontrolled hypertension in Brazilian adults: National Health Survey

Abstract Background Hypertension is the main risk factor for cardiovascular diseases, contributing significantly to the increase in the number of deaths and disabilities worldwide. Moreover, hypertension control is a major action for NCDs prevention. Although pharmacological treatment has been shown effective, high rates of uncontrolled hypertension remain. The objective is to estimate the prevalence of uncontrolled arterial hypertension and the factors associated to this outcome in a representative adult Brazilian population under a pharmacological treatment. Methods This is a cross-sectional study conducted with 10,016 Brazilian adults over 18 years old who participated in the National Health Survey in Brazil carried-out in 2013. The sample comprised of residents from all Federative Units, Poisson multivariate regression was used to calculate the prevalence ratio (PR) and 95% confidence interval. Results 45% (95% CI: 44; 48) of hypertensive adults under drug treatment have uncontrolled blood pressure levels. Female gender [PR = 0.92; CI: 0.85; 0.99] and not having previous hospitalizations due to complications from hypertension or other causes [PR = 0.86; CI: 0.78; 0.94] were associated to low the prevalence of uncontrolled blood pressure. Participants aged 60 years old or more [PR = 1.31; CI:1.04; 1.64], who self-declared as black [PR = 1.19; CI: 1.04; 1.36], without health insurance [PR = 1.15; CI: 1.05; 1.27] and not attending the health service because of arterial hypertension [PR = 1.10; CI:1.01; 1.20)] presented higher prevalence of uncontrolled blood pressure. Conclusions The prevalence of uncontrolled hypertension among Brazilian adults was high among the male gender, black people, elderly, without previous hospitalizations, without health insurance and not regularly attending the health service. These results may alert the need for a reassessment of the assistance provided, in addition to raising awareness of a possible change in public policies in these groups. Key messages Evidence the magnitude of people who are at risk of hypertension even under pharmacological treatment. Highlight inequities related to the uncontrol of hypertension.

Value of Mapping Techniques for Planning and Quality Improvement Around the Prevention, Identification, and Management of Hypertension

Clinical care practices can be optimized to better prevent, identify, and manage hypertension, especially in safety‐net clinics which primarily serve patients at higher risk for related complications. Nearly 30% of American adults have pre‐hypertension. Another 32% of adults have hypertension; 17% of them are undiagnosed, while 46% are uncontrolled. Although recommended best practices exist for the prevention, identification, and management of hypertension, safety‐net clinics often have limited resources and staff with which to implement them; consequently, it is important to target and prioritize efforts. The Los Angeles County (LAC) Department of Public Health (DPH) seeks to improve care practices to better prevent pre‐hypertension, identify undiagnosed hypertension, and manage uncontrolled hypertension. Understanding the relative prevalence of these conditions using clinical data from across LAC and overlaid with community‐level hypertension data can help identify “hot spot” areas to focus efforts that benefit patients in both the clinical and community setting.DPH conducted descriptive and geospatial analysis using two distinct datasets: (1) retrospective clinic data (pre‐, undiagnosed, and uncontrolled hypertension) of patients at 18 sites of one large federally qualified health center (FQHC) system in LAC and (2) health district‐level hypertension prevalence data from the 2015 Los Angeles County Health Survey. This mapping was used to answer two questions: (1) To what extent do clinic levels of pre‐, undiagnosed, or uncontrolled hypertension correspond to levels of hypertension in surrounding communities? and (2) How can layering/mapping data in this way help identify concrete policy and practice opportunities to optimize care practices and outreach by safety‐net clinics?Patients at 18 sites of one large FQHC system in LAC, overlaid with hypertension prevalence for all residents of Los Angeles County.Site‐level pre‐hypertension rates ranged from 11.0% to 37.5%, undiagnosed hypertension rates were between 0.5% and 4.8%, and uncontrolled hypertension rates spanned from 2.0% to 33.9%. Community‐level hypertension rates ranged from 13.0% to 29.8%. Site‐level rates had varying alignment with the community‐level hypertension prevalence. Sites with higher rates of either undiagnosed and uncontrolled hypertension tended to be in communities with higher hypertension prevalence, while site‐level pre‐hypertension rates had no consistent relationship with community‐level hypertension prevalence.Using these mapping techniques helped identify concrete opportunities for targeted learning and quality improvement efforts around care practices in the region. For instance, several clinic sites were located in areas with high community hypertension, but with low undiagnosed or uncontrolled hypertension rates among patients. These sites could serve as models for successful care practices for clinics that experience worse outcomes.FQHC systems can establish protocol to routinely query medical records for patients that meet criteria for pre‐, undiagnosed, or uncontrolled hypertension, and engage these patients in a prevention or treatment plan. FQHC systems can use mapping to examine rates of these conditions in the context of surrounding community‐level hypertension prevalence and to identify sites to prioritize for quality improvement around hypertension care guidelines and community outreach to address this health problem.Centers for Disease Control and Prevention.

May Measurement Month 2018: an analysis of blood pressure screening results from Brazil.

Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2018 (MMM18) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 12 413 individuals, 59.1% were white, 51.3% were women. The average age was 54. ± 16.0 years. Diabetes was present in 11.6%, previous myocardial infarction in 5.9%, and previous stroke in 2.7%. Current smokers were 9.3% and 12.4% were regular drinkers. The average body mass index was 27.3 ± 4.5 kg/m2. After multiple imputations, 67.9% were hypertensive (>140/90 mmHg). Of the individuals who were not taking antihypertensive medication, 27.9% were hypertensive and of those taking antihypertensive medication, 40.3% were uncontrolled. Systolic BP increased with age. The MMM18 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil, unfortunately in keeping with 2017 findings.

Abstract P313: Self-reported Sleep Disturbance is Associated With Poor Hypertension Self-management in Latinos

Background: Antihypertensive medication adherence is an important determinant of hypertension control. Although Latinos have high rates of uncontrolled hypertension, factors associated with anti-hypertensive medication adherence in this population are poorly understood. Self-reported sleep disturbance is associated with impaired chronic disease self-management in the general population. To date, no study has examined the association of sleep disturbance with hypertension self-management among Latinos. Hypothesis: Sleep disturbances will be associated with poor anti-hypertensive medication adherence and higher rates of uncontrolled hypertension in Latinos. Methods: We used cross-sectional data from the Washington Heights/Inwood Comparative Effectiveness Research (WICER) Project to assess the link between sleep disturbance with anti-hypertensive medication adherence and uncontrolled hypertension among Latinos with hypertension. The 8-item Morisky Medication Adherence Scale (MMAS) was used to assess medication adherence (alpha 0.75; range 0-8). The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance measure was used (alpha 0.75; range 4-20). Uncontrolled hypertension was defined as a systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg. Multiple logistic regression models were used to examine the associations of self-reported sleep disturbance with low medication adherence (MMAS &lt;6). In addition, we examined whether sleep disturbance was associated with uncontrolled hypertension. Models were adjusted for age, sex, education, preferred language, insurance status, comorbid conditions, and anxiety. Results: The final sample consisted of 1,116 Latino participants with hypertension (mean age 63.2, 76.8% were female, and 69.5% had completed less than a high school education). The mean MMAS and PROMIS sleep disturbance scores were 1.9 and 10.1, respectively. A total of 341 (30.4%) participants were classified as having low medication adherence. Participants with low medication adherence were more likely to be younger (p &lt;0.001), single (p &lt;0.001), and have lower educational attainment (p &lt;0.01). After covariate adjustment, a one-point increase in sleep disturbance was associated with higher odds of low medication adherence (AOR 1.05, 95% CI [1.01-1.09]). Sleep disturbance was also associated with higher odds of uncontrolled hypertension (AOR 1.04, 95% CI [1.01-1.07]). Conclusions: Reducing sleep disturbance in Latinos may be an important target for improving hypertension self-management. It remains unclear whether sleep disturbances are a cause of poor hypertension self-management in these patients. Additional research that incorporates longitudinal designs is needed to examine associations between sleep disturbance and hypertension self-management among Latinos.

Racial and Socioeconomic Disparities in the Presence of Acute Type A Aortic Dissections

Nonadherence to hypertensive medications is the most common predisposing factor associated with acute aortic dissections. Acute dissections are more likely to occur in African Americans due to higher rates of uncontrolled hypertension. Through a patient case study, the effects of racial and socioeconomic disparities will be illustrated. Through discussing the case of a 39-year-old African American man who presented with hypertensive crisis and nonadherence to hypertension treatment resulting in the diagnosis of an acute aortic dissection. His case exemplifies the effect of health disparities on postoperative outcomes, morbidity, and mortality in the African American population diagnosed with aortic dissections.

Association Between a Temporary Reduction in Access to Health Care and Long-term Changes in Hypertension Control Among Veterans After a Natural Disaster

Temporary disruptions in health care access are common, but their associations with chronic disease control remain unknown. To evaluate whether long-term changes in chronic disease control were associated with a temporary 6-month decrease in access to health care services. This cohort study examined the long-term changes in chronic disease control associated with the 6-month closure of the Manhattan facility of the Veterans Affairs (VA) New York Harbor Healthcare System after superstorm Sandy, which caused a significant disruption in health care access for veterans in the region. Electronic health records from the VA Healthcare System between October 29, 2010, and October 29, 2014, were used to identify a total of 81 544 veterans who were and were not exposed to the 6-month closure of the VA Manhattan Medical Center after superstorm Sandy. Of those, 19 207 veterans were included in the exposed cohort and 62 337 were included in the nonexposed control cohort, which included veterans who were equally exposed to the storm but who retained regular access to health care from 3 VA medical centers (Brooklyn and the Bronx in New York and New Haven in Connecticut) during and after the storm. A difference-in-differences analysis was used to assess within-patient changes in chronic disease control over time between a cohort that was exposed to decreased health care access compared with a similar cohort that was not exposed to decreased access. All analyses adjusted for individual demographic and socioeconomic characteristics, between-zip code differences, and common time trends. Data analyses were conducted between February 1, 2016, and September 30, 2019. The 6-month closure of the VA Manhattan Medical Center after superstorm Sandy on October 29, 2012. The outcomes measured were uncontrolled blood pressure (defined as mean blood pressure per patient per quarter >140/90 mm Hg), uncontrolled diabetes (defined as mean hemoglobin A1c per patient per quarter >8%), uncontrolled cholesterol (defined as mean low density lipoprotein per patient per quarter >140 mg/dL), and patient weight. Among the 81 544 veterans included in the study, the mean (SD) age was 62.1 (17.6) years, and 93.6% were men, 62.7% were white, and 31.8% were black. At the 3-month midpoint of the 6-month facility closure of the VA Manhattan Medical Center, an absolute decrease of 24.8% (95% CI, -26.5% to -23.0%; P < .001) was observed in the percentage of veterans who had any VA primary care visit per quarter compared with a baseline of 47.8% before the closure (relative decrease, 51.9%; 95% CI, -55.4% to -48.1%; P < .001). One year after the facility reopened, no differential change was observed in the percentage of patients with a primary care visit between the exposed vs nonexposed cohorts (absolute decrease, -0.1%; 95% CI, -1.5% to 1.4%; P = .94); however, patients in the exposed cohort were 25.9% more likely to have uncontrolled blood pressure than patients in the nonexposed cohort (unadjusted increase, 5.5% in the exposed cohort vs 1.3% in the nonexposed cohort; adjusted absolute increase, 5.0%; 95% CI, 3.5%-6.0%; P < .001). Two years after superstorm Sandy, patients in the exposed cohort were 10.9% more likely to experience uncontrolled blood pressure than those in the nonexposed cohort (unadjusted increase, 5.2% in the exposed cohort vs 3.5% in the nonexposed cohort; adjusted absolute increase, 2.1%; 95% CI, 0.5%-3.6%; P < .001). Compared with the nonexposed cohort, the exposed cohort also experienced a decrease in filled medication prescriptions per patient per quarter of 6.9% during the facility closure (absolute decrease, -0.7 prescriptions filled per patient per quarter; 95% CI, -0.9 to -0.5; P < .001) and of 2.2% a year after the facility reopened (absolute decrease, -0.2 prescriptions filled per patient per quarter; 95% CI, -0.4 to -0.1; P = .04). No differential changes were observed in uncontrolled diabetes, uncontrolled cholesterol, or patient weight. In this study, a temporary period of decreased access to health care services was associated with increased rates of uncontrolled hypertension, but not with increased rates of uncontrolled diabetes or hyperlipidemia, more than 1 year after the Manhattan VA facility reopened. Temporary gaps in access to health care may be associated with long-term increases in uncontrolled blood pressure among patients with hypertension.

P2648Uncontrolled hypertension is common among patients with implanted pacemaker

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

May Measurement Month 2017: Brazilian results-Americas.

Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2017 (MMM17) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 7260 individuals, 40% were white, 56.4% were women. The average age was 52 years. Diabetes was present in 11.9%, previous myocardial infarction in 4.0% and stroke in 2.7%. About 8.4% were smokers and 26.2% were users of alcoholic drinks. The average BMI was 26.9 kg/m2. Considering the means of the last two measures of BP 47.0% were hypertensive (>140/90 mmHg). Of the individuals who did not use medication, 19.5% were hypertensive and of those who used anti-hypertensive medication 40.0% were uncontrolled. Systolic BP increased with age. The use of alcohol was related to higher BP levels, as well as diabetes and obesity. The MMM17 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil.

Pensions and Low Sodium Salt: A Qualitative Evaluation of a New Strategy for Managing Hypertension in Rural South Africa.

This paper describes a pilot study to assess the feasibility of a novel intervention to improve the management of hypertension among older people in rural South Africa. Older South Africans have the highest rates of uncontrolled hypertension recorded for any country. Notably, South Africa has a widely-available old age grant (pension), which is delivered on a monthly basis to citizens living in rural villages. We assessed the feasibility of engaging with older people at the point of pension delivery in the Agincourt sub-district of Mpumalanga Province. This included providing information about hypertension, measuring blood pressure, referral to primary care services, and providing a monthly supply of low sodium salt. We recruited 20 people aged 60 and over to participate in the pilot intervention, which was conducted over three months in two villages. Towards the end of the intervention, we conducted focus groups with study participants and held a meeting with local stakeholders, including the district health office and the state social security agency. The pilot study demonstrated (i) Sustained engagement with the original 20 participants. Of these, 19 continued to participate in the intervention during subsequent monthly pension days. (ii) A high level of acceptance of the low sodium salt product reflected in repeat usage and comments made in the focus groups. (iii) Strong support for the intervention and a willingness to collaborate with local stakeholders. (iv) A perception among participants that symptoms they associated with hypertension had abated. This is supported by blood pressure readings made over the three months of follow-up. Though limited in scope, this pilot study provided evidence of the feasibility of the intervention and justification for it to be tested on a larger and more robust basis.