Reduction In Diastolic Blood Pressure Research Articles

Does Collaboration between General Practitioners and Pharmacists Improve Risk Factors for Cardiovascular Disease and Diabetes? A Systematic Review and Meta-Analysis.

To assess whether inter-professional, bidirectional collaboration between general practitioners (GPs) and pharmacists has an impact on improving cardiovascular risk outcomes among patients in the primary care setting. It also aimed to understand the different types of collaborative care models used. Systematic review and Hartung-Knapp-Sidik-Jonkman random effects meta-analyses of randomised control trials (RCTs) in inter-professional bidirectional collaboration between GP and pharmacists assessing a change of patient cardiovascular risk in the primary care setting. MEDLINE, EMBASE, Cochrane, CINAHL and International Pharmaceutical Abstracts, scanned reference lists of relevant studies, hand searched key journals and key papers until August 2021. Twenty-eight RCTs were identified. Collaboration was associated with significant reductions in systolic and diastolic blood pressure (23 studies, 5,620 participants) of -6.42 mmHg (95% confidence interval (95%CI) -7.99 to -4.84) and -2.33 mmHg (95%CI -3.76 to -0.91), respectively. Changes in other cardiovascular risk factors included total cholesterol (6 studies, 1,917 participants) -0.26 mmol/L (95%CI -0.49 to -0.03); low-density lipoprotein (8 studies, 1,817 participants) -0.16 mmol/L (95%CI -0.63 to 0.32); high-density lipoprotein (7 studies, 1,525 participants) 0.02 mmol/L (95%CI -0.02 to 0.07). Reduction in haemoglobin A1c (HbA1C) (10 studies, 2,025 participants), body mass index (8 studies, 1,708 participants) and smoking cessation (1 study, 132 participants) was observed with GP-pharmacist collaboration. Meta-analysis was not conducted for these changes. Various models of collaborative care included verbal communication (via phone calls or face to face), and written communication (emails, letters). We found that co-location was associated with positive changes in cardiovascular risk factors. Although it is clear that collaborative care is ideal compared to usual care, greater details in the description of the collaborative model of care in studies is required for a core comprehensive evaluation of the different models of collaboration.

Effects of a Combination of Phytoestrogens on Risk Factors for Cardiovascular Diseases in Climacteric Women: A Randomized, Placebocontrolled Trial

Background & Aims: The incidence of cardiovascular disease in the climacteric has increased, becoming the main cause of death in mature women. The use of phytoestrogens, isoflavone,s and lignans, derived from soy and flaxseed can be natural alternative treatments for this phase of life. This study investigates the utility of isoflavones and lignans derived from soy and flaxseed as natural alternatives to pharmaceuticals to alleviate the symptoms of menopause. Methods: A clinical, prospective, randomized, blind, placebo-controlled trial was performed. Forty-eight women aged 40 to 65 years were divided into two groups, Phytoestrogen (PHY), which received a cereal bar containing isoflavones and lignans for 90 days, and Placebo (PLA), which received expanded rice flake bar. The sociodemographic, clinical, anthropometric data, blood pressure (BP) measurements, biochemical and hormonal tests were performed. Results: Forty-three women were studied (PHY=21 and PLA=22). There was a significant reduction of diastolic BP in the PHY group after the intervention (p <0.001). The frequency of BP fluctuations in the PHY group significantly decreased to 23.8% after the intervention period (p=0.027), with no significant differences for the other indicators studied. Conclusion: The combination of phytoestrogens showed a trend to reduce the blood pressure of climacteric women, however, no significant changes in cardiovascular risk factors were observed. The study was registered under essaclinicos.gov.br, Brazilian Clinical Trials, number 6z8qqy.

Upper Airway Stimulation Therapy Effect on Blood Pressure.

Upper airway stimulation (UAS) therapy has become increasingly utilized to treat obstructive sleep apnea, which is an independent risk factor for the development of hypertension. This study examines the impact of this therapy on blood pressure (BP). Retrospective cross-sectional cohort study. Tertiary center, Military Health System. Patients who underwent UAS implantation at Brooke Army Medical Center between July 2015 and July 2020 were included if they used their device for at least 25 h/wk. Pre- and postoperative systolic BP, diastolic blood pressure (DBP), calculated mean arterial pressure (MAP), and the apnea-hypopnea index (AHI) were compared using paired ttest or Wilcoxon's signed-rank test. Thirty patients met the inclusion criteria. The median age was 60, and the median body mass index was 29.9 kg/m2 . The mean time between pre- and postoperative BP measurements was 11.6 months. AHI decreased from 35.1to 16.5 events/h(p < .001). DBP decreased from 78.5 (73.8, 85.0) to 74.5 mm Hg (68.8, 81.3), with a mean difference of -3.7 mm Hg (p = .002). MAP decreased from 94.8 (89.6, 100.6) to 90.2 mm Hg (84.3, 100.0), with a mean difference of -3.7 mm Hg (p = .004). UAS therapy was associated with a significant reduction in DBP, MAP, and AHI. These reductions in BP could potentially lead to favorable decreases in cardiovascular morbidity.

Association between improved metabolic risk factors and perceived fatigue during dietary intervention trial in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES trial.

Preliminary dietary intervention trials with the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls) diets have shown favorable effects on fatigue among people with multiple sclerosis (MS); however, their impact on metabolic health is unknown. To evaluate the impact of the Swank and Wahls diets on markers of metabolic health and to determine the association and mediation effect between changes in metabolic health and perceived fatigue among people with relapsing-remitting MS (RRMS). As part of a randomized parallel-arm trial, vital signs, blood metabolic biomarkers, and the fatigue scale for motor and cognitive functions (FSMC) were collected from participants with relapsing-remitting MS (n = 77) at four study visits spaced 12 weeks apart: (1) run-in, (2) baseline, (3) 12-weeks, and (4) 24-weeks. Participants followed their usual diet at run-in, then were randomized at baseline to either the Swank or Wahls diets and followed for 24 weeks. Both groups had significant reductions in weight, body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) at 12- and 24-weeks compared to respective baseline values (p ≤ 0.04 for all). The Swank group also had a significant reduction in high-density lipoprotein (HDL) at 12- and 24-weeks (p = 0.0001 and p = 0.02, respectively), while the Wahls group had significant reductions in diastolic blood pressure (DBP). In addition, both groups had significant reductions in FSMC total perceived fatigue and the motor and cognitive fatigue subscales at 12- and 24-weeks (p ≤ 0.01 for all); however, change in the cognitive subscale was not significant at 12-weeks in the Swank group (p = 0.06). Furthermore, the favorable effects, of both diets, on markers of metabolic health were not associated with and did not mediate the effect of the diets on perceived fatigue (p > 0.05 for all). Both diets lead to significant reductions in perceived fatigue, weight, BMI, total cholesterol, and LDL, but the significant reductions in perceived fatigue were independent of changes in markers of metabolic health.

BLOOD PRESSURE VARIATIONS ASSOCIATED WITH AGEING IN SUB-SAHARAN AFRICA

Elderly persons who live in communities and appear to be in good health frequently experience postural hypotension, which is frequently asymptomatic. Uncertainty exists regarding the relationship between postural changes in blood pressure and numerical factors including age, gender, and body mass index. The goal of the current study is to identify the orthostatic blood pressure (OBP) changing patterns, symptoms, and related factors in various age groups. In this study, sixty participants ranging in age from 20 to 75 years old were used. To check for orthostatic hypotension in these groups, various blood pressure readings are taken in the lying and standing positions at intervals of one minute and three minutes. The findings demonstrated that in the elderly groups, symptoms of headache, blurred vision, dizziness, and lightheadedness were unrelated to orthostatic hypotension. These subjects' Body Mass Indexes were calculated based on their nutritional condition, and they were found to be 60% well-nourished, 6% under-nourished, and 34% overweight. The elderly person had systolic hypotension (P&amp;lt;0.01) more frequently than diastolic hypotension (P&amp;gt;0.05). In the senior group, standing hypotension was equally common in both sexes. BMI declines with aging in males as well, n=60. In all four groups, heart rate readings in the standing position were greater than the supine measurement. In the older population of Ndola which was the subject group of the study, 16.7% had OH. Age and the decline in diastolic blood pressure after three minutes of standing were positively correlated in all males. In all females, a positive link was seen between body mass index and a reduction in diastolic blood pressure after three minutes of standing. After 3 minutes of standing, all males showed a positive link between body mass index and a decrease in systolic blood pressure. Therefore, there is a link between body mass index and a drop in blood pressure readings when standing. On the basis of the current study, we draw the conclusion that orthostatic hypotension rises with age and that symptoms are unrelated to physical measurements.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0202/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Mobile APP-assisted family physician program for improving blood pressure outcome in hypertensive patients

BackgroundThis study was aimed to examine the effectiveness of App-assisted self-care in a Beijing community based on intelligent family physician-optimised collaborative model (IFOCM) program. MethodsWe conducted a survey of 12,050 hypertensive patients between Jan 2014 and Dec 2021. Generalized linear model was used to analyze the covariates that associated with blood pressure (BP) control. Decision tree and random forest algorithm was used to extract the important factors of BP outcome.ResultsThe study included 5937 patients, mean age 66.2 ± 10.8, with hypertension in the baseline; 3108(52.4) were female. The community management resulted in mean systolic BP and diastolic BP reductions of 4.6 mmHg and 3.8 mmHg at follow-up. There were 3661 (61.6%) hypertension patients with BP control, increasing from 55.0% in 2014 to 75.0% in 2021. After adjusted for covariates, antihypertensive medication adherence, diabetes, and APP-assisted self-care were common predictors associated with BP control in GLM model and machine learning algorithm.ConclusionCommunity management based on IFOCM program significantly improved BP control in hypertensive patients. APP-assisted self-care would be beneficial for the management of chronic disease.

Daily profiles of blood pressure in patients with arterial hypertension of various psychotypes

Аim: to assess the influence of the patient's psychotype on the degree of nighttime reduction in blood pressure (BP) to determine predictors of an unfavorable daily BP profile.Materials and methods. The study involved 80 patients with newly diagnosed or untreated arterial hypertension (AH), with various stages, severity, risk of developing cardiovascular complications, in the absence of concomitant severe somatic pathology, who independently consulted a local therapist. All patients underwent 24-hour blood pressure monitoring in the absence of antihypertensive therapy and the psychological profile was assessed using the SMOL questionnaire.Results. The psychopathological profile of the examined AH patients corresponded to the social and psychological adaptation. Our analysis of the indices of the averaged profile of the SMOL test, depending on the degree of reduction in nocturnal systolic blood pressure (between dipper and non-dipper profiles) and diastolic blood pressure (between dipper, non-dipper and extreme dipper patterns profiles) did not reveal statistically significant differences (p &gt; 0,05). Patients with a riser daily blood pressure profile, due to the small size of the group, were not included in the comparative analysis. The average profile of SMOL of the examined patients was noted by an increase in indicators on the scales 1 – hypochondria and 3 – emotional lability.Conclusion. The variant of the daily blood pressure profile does not depend on the psychotype of the patient; it is likely that functional and structural changes that occur during the formation of hypertension affect the type of the degree of nighttime decrease in blood pressure.

Serum Vitamin D Levels in Children and Adolescents with Vasovagal Syncope, Syncope Due to Orthostatic Hypotension, and Cardiac Syncope.

The study aimed to compare vitamin D levels between children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, cardiac syncope, and healthy individuals and to investigate the correlations of 25(OH)D with main clinical parameters of syncope. This study involved 83 children aged 8-17 years with syncope: 40 with vasovagal syncope, 24 with syncope due to orthostatic hypotension, and 19 with cardiac syncope. There were 24 healthy volunteers in the control group. Data concerning active standing test, electrocardiography, echocardiography, electroencephalography, and 24-hour Holter monitoring findings were collected. Serum vitamin D was evaluated by an enzyme-linked immunoassay technique test. The mean levels of serum 25(OH)D were decreased in children with vasovagal syncope (18.8 ± 5.9 ng/mL), syncope due to orthostatic hypotension (19.9 ± 6.7 ng/mL), and cardiac syncope (20.6 ± 7.3 ng/mL) in comparing with the control group (30.9 ± 5.9 ng/mL; P < .001). In patients with syncope due to orthostatic hypotension, vitamin D deficiency was associated with a reduction in systolic blood pressure (r = 0.43) and diastolic blood pressure (r = 0.38) within the first minute, lower systolic blood pressure (r = 0.44) within the third minute of active orthostasis (P < .05). There were significant correlations of vitamin D deficiency with parameters of cardiac autonomic activity pNN50 (r = 0.49), total power (r = 0.39), and low frequency index (r = 0.35) in children with cardiac syncope (P < .05), while heart rate variability was not affected in patients with vasovagal syncope and syncope due to orthostatic hypotension (P > .05). Children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, as well as cardiac syncope had higher frequency of vitamin D deficiency than healthy pediatric controls. This provides a new approach to syncope management in pediatric population, requiring further studies.

EVALUATION OF THE ANTIHYPERTENSIVE EFFECT OF THE THYME AMONG PATIENTS SUFFERING FROM HYPERTENSION IN IRAQ.

The aim: of research is to test effectiveness of thyme on patients with high blood pressure and comparing between blood pressure of patients who took thyme and patients who did not among different ages. Materials and methods: This study concerning patients with high blood pressure, (3/2022 to 3/2023). Collecting data was depend on interviewed patients directly to get information. A questionnaire paper includes several questions. Interview included convincing patients to take thyme for 15 days to know how could thyme effect on their blood pressure and over different patients. Results: A significant difference in distribution between male and female within control and treated groups. A significant difference between all age groups when compared control and treated group, and decrease in systolic blood pressure when patients taking own drug plus thyme compared with patients taking own drug alone, but non-significant decrease in systolic blood pressure when compared with control group, a non-significant decrease in systolic blood pressure in patients taking own drug when compared with control group. A significant decrease in diastolic blood pressure when patients taking own drug plus thyme in comparison with patients taking own drug alone, but non-significant reduction in diastolic blood pressure when compared with group which considered control, non-significant decrease in diastolic blood pressure in patients taking own drug when compared with control group. Conclusions: Thyme herbs induce normalization hypertension and keeps blood pressure in usual range. The available clinical trial data provide evidence for the safe utilization of herbal preparations containing Thyme in the treatment of hypertension.

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

ObjectivesTo evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).DesignA population-based observational...

PS-C35-3: EFFECT OF BMI REDUCTION ON BLOOD PRESSURE CHANGES IN OVERWEIGHT PATIENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) in overweight patient, a systematic review and meta-analysis of randomised trials was performed. Design and method: A systematic literature search was conducted to identify relevant studies in the PubMed, Embase and Scopus databases up to April 2022. Only studies with English language were included. Studies were considered for inclusion if they met the following criteria: (1) included comparison clinical BP between weight loss; (2) the mean values and standard deviations (SD) of clinical BP and BMI were reported respectively; (3)all patients have a BMI ≧ 25 kg/m2. The certainty of evidence was used the GRADE approach. All statistical analyses were performed using Revman 5. Results: Twenty-four studies, for a total of 2614 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 7.04 mmHg (95% CI, 5.04–9.03) and 4.40 mmHg (95% CI, 3.17–5.62) after a mean body mass index (BMI) reduction of 2.42 Kg/m2. The BP reductions were much larger in patients with a BMI decrease ≧ 3 kg/m2 than in patient with less BMI decrease, both for SBP [10.32 mmHg (95% CI, 6.15–14.49)] vs. [5.79 mmHg (95% CI, 3.19–8.39)] and DBP [7.48 mmHg (95% CI, 4.50–10.47)] vs [3.93 mmHg (95% CI, 2.15–5.70)]. The BP reductions were also much larger in patients with a baseline BMI ≧ 30 kg/m2 than in patients with a lower BMI, both for SBP [8.90 mmHg (95% CI, 5.97–11.83) vs. 5.25 mmHg (95% CI, 2.19–8.31)] and DBP [6.02 mmHg (95% CI, 3.89–8.14) vs. 3.82 mmHg (95% CI, 1.78–5.86)]. Furthermore, the SBP and DBP reductions in patients with medical interventions (ie drugs and surgeries) were 9.22 mmHg (95% CI, 6.36–12.08) and 6.11 mmHg (95% CI, 3.29–8.92) respectively, which were larger than patients with lifestyle interventions both for SBP [4.69 mmHg (95% CI, 2.81–6.57)] and DBP [3.82 mmHg (95% CI, 2.22–5.43)]. Conclusions: The significant reduction of clinic BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.

S-28-3: COMPARATIVE EFFECTIVENESS AND IMPLEMENTATION OF DIGITAL HEALTH INTERVENTIONS FOR PEOPLE WITH HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Background: Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes is lacking. This study aimed to compare the effectiveness of short message service (SMS), smartphone application and website interventions on improving blood pressure in people with hypertension, and to report on their reach, uptake and feasibility. Methods: CINAHL, Cochrane Central, Embase, Medline and PsychInfo were searched on 25th May 2022 for randomised controlled trials (RCTs) published in English from 1st January 2009 that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Risk of Bias was assessed using Cochrane Risk of Bias 2 (RoB 2). Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. The level of evidence was evaluated using GRADE. Results: Of 3,235 records identified, 29 RCTs from 12 countries (n = 7,592 participants) were included. Eleven studies used SMS as the primary mode of delivery of the digital health intervention, 13 employed smartphone applications, and five implemented the interventions via websites. Overall, digital health intervention group participants achieved a -3.62 [-5.22, -2.02] mm Hg greater reduction in systolic blood pressure compared to control group participants. All three different modes of delivery of the intervention resulted in statistically significant reductions in systolic blood pressure compared to the control group, with no statistically significant differences between the three different modes of delivery (p = 0.73). Due to considerable heterogeneity between included studies and the high risk of bias overall, the level of evidence was assigned a low overall score. SMS intervention studies reported higher reach compared to smartphone application and website-based intervention studies, but smartphone application studies reported higher uptake compared to the other two. Conclusion: Digital health interventions were associated with improved blood pressure control, compared to usual care, regardless of the mode of delivery. Considering that at least 92% of the global population has access to a digital telecommunication medium and that numerous digital health tools are available for hypertension management, clinicians should familiarise themselves with this modality of program delivery and encourage people with hypertension to use evidence-based digital health tools for improving their self-management of hypertension. Digital health interventions now have the option of several modes of delivery and choice should be made based on context, feasibility, economics, and patients preference, emphasising the importance of study co-design.

Effect of Music Therapy versus Aromatherapy with Aerobic Exercise on Stage 2 Hypertension: A Randomized Controlled Trial

Context: High blood pressure (BP) is a worldwide public health problem that is becoming more common by the day. Music therapy and aromatherapy are two novel complementary therapies, that when used in conjunction with aerobic exercise, can help lower BP. The outcome is measured using a mercury sphygmomanometer and the Perceived Stress Scale (PSS). Aim: The aim of this study was to determine the effect of music therapy versus aromatherapy in combination with aerobic exercise in stage 2 hypertensive patients. Settings and Design: The present randomized controlled trial was conducted in Tertiary Care Centre, Belagavi. Subjects and Methods: A total of 78 people with stage 2 hypertension were included in the study. For 2 weeks, the patients were randomly assigned to receive either music therapy or aromatherapy in combination with aerobic exercise or merely aerobic exercise. The PSS was given to the participants before and after the intervention, and their BP was monitored with a mercury sphygmomanometer before and after the intervention. Statistical Analysis: Various statistical measures such as test of significance, SD, and mean were used to analyze the data. Results: The results were statistically significant (P = 0.0001). The percentage of change seen in systolic BP (SBP) scores in Group A was 1.60, Group B was 3.44, and Group C was 1.57. The percentage of change seen in the diastolic BP (DBP) scores in Group A was 1.17, Group B was 2.81, and Group C was 1.48. The percentage of change seen in the PSS scores in Group A was 14.51, Group B was 22.17, and Group C was 16.47. Conclusion: The present study concluded that combining music therapy and aerobic exercise showed a maximum reduction in SBP, DBP, and stress levels. Thus, music therapy with aerobic exercise can be used as an alternative treatment with medications to reduce BP in hypertensive patients.

Effect of lard plus soybean oil on blood pressure and other cardiometabolic risk factors in healthy subjects: a randomized controlled-feeding trial.

Lard has been consumed by humans for thousands of years, but its consumption has declined substantially in the last few decades, because of negative publicity about the consumption of animal-derived saturated fats. Emerging evidence highlights that lard plus soybean oil (blend oil) could be more beneficial for body weight and liver function than the individual use of the two oils. This study aimed to evaluate the effects of blend oil on cardiometabolic risk factors in healthy subjects. This was a parallel, three-arm, randomized controlled-feeding trial. 334 healthy subjects (mean age: 33.1 years, 60% women) were randomized into three isoenergetic diet groups with three different edible oils (30 g day-1) (soybean oil, lard, and blend oil [50% lard and 50% soybean oil]) for 12 weeks. 245 (73.4%) participants completed the study. After the 12-week intervention, reductions in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were greater in the blend oil group than in the other two groups (P = 0.023 and 0.008 for the interaction between the diet group and time, respectively). Reductions of SBP and DBP in the blend oil group were more significant than those in the soybean oil group with P = 0.008 and P = 0.026 and the lard group with P < 0.001 and P < 0.001. Changes in SBP/DBP at 12 weeks were -6.0 (95% CI: -8.6 to -3.4)/0.8 (95% CI: -1.7 to 3.2) mmHg in the blend oil group, -3.3 (95% CI: -5.7 to -0.9)/1.5 (95% CI: -1.0 to 4.0) mmHg in the soybean oil group and -1.2 (95% CI: -3.7 to 1.4)/3.3 (95% CI: 0.9 to 5.8) mmHg in the lard group. Subgroup analyses showed that blend oil significantly decreased SBP and DBP compared with the other two groups in participants with BP ≥ 130/80 mmHg and body mass index ≥25. There were no significant differences in the changes in body weight, waist circumference, serum lipids, or glucose between groups. In conclusion, our findings suggest that blend oil (lard plus soybean oil) reduces BP compared with soybean oil and lard in healthy subjects.

A Community Trial in Coastal Karnataka using Life Style Modifications to Assess its Impact on Hypertension and Diabetes.

In the management of hypertension and diabetes mellitus, a systematic response like modifications in lifestyles is needed along with the medication. The study was conducted to determine the impact of comprehensive lifestyle modifications on hypertension and diabetes and to compare it with that of physical activity alone as a health education intervention. A risk factor-based community intervention trial was conducted for one year in 3 villages in coastal Karnataka. The sample of 305 was calculated depending on the expected change in blood pressure and an equal sample size was drawn from each of the villages using a systematic random sampling method. Baseline data on blood pressure level, random blood sugar, and HbA1c levels were recorded. After 1 year of intervention, all the parameters were further recorded along with the adherence to medication for these non-communicable diseases. The mean difference between the groups suggested that participants with physical activity intervention reported a statistically significant reduction in systolic blood pressure. In the comprehensive lifestyle modification group, there was a significant reduction in both diastolic blood pressure and glycated hemoglobin levels (21 mmHg and 2.1%; p < 0.001). The study indicates that in the management of hypertension and diabetes mellitus, the impact of comprehensive lifestyle modifications was more significant compared to physical activity alone.

S-44-6: ASSESSING THE EFFECT OF SIMPLE CARBOHYDRATE RESTRICTED DIET ON BLOOD PRESSURE LEVELS OF HYPERTENSIVE

Objective: In the recent past, various functional foods have been proposed to be effective tools for alleviating hypertension. There is a paucity of evidence on the efficacy of restricted sugar intake in an Indian setting and most evidence comes from non-validated studies. Studies have proposed that sugar acts by decreasing nitric oxide, increasing low-grade inflammation, increasing insulin resistance and promoting obesity. The objective of the study is to assess the efficacy of restriction of simple carbohydrate intake on change in body weight, blood pressure and anthropometry [waist circumference (WC), waist to hip ratio(WHR) and body mass index (BMI)] after 30 days in males with pre-dominant hypertension. Design and Methods: A Case-Control Study with a sample size of 200 urban patients with clinical blood pressure &gt; 140/90 were selected and divided into 2 groups. A 1800kcal/day diet restricted in simple carbohydrates was given and Blood pressure, body weight, anthropometry (height, WC, HC, BMI, WHR, BSL (F, PP) were measured after 30 days. The participants had been following a structured 1800 kcal/day 3 months prior to the carbohydrate-restricted intervention. Complex carbohydrates were allowed. No change in physical activity was initiated. Results: A significant reduction was observed in the intervention group consuming a restricted carbohydrate diet along with a structured diet. Diet recall was taken using food frequency questionnaires and daily pictures of the plate that the participants consumed. Conclusion: A restricted simple carbohydrate diet was found to be effective in weight loss and reduction of systolic and diastolic blood pressure in patients with hypertension. The intervention group has a higher odds ratio and is positively associated with SBP, Weight loss and WC as compared to the control group. The source of simple carbohydrates in the majority of the participants was noted as bakery products, sauces and other hidden sources of carbohydrates. Participants were regularly counselled towards healthy eating and dietary sources of various nutrients.

S-21-3: EFFECTIVENESS AND ACCEPTABILITY OF MOBILE PHONE TEXT MESSAGING INTERVENTION TO IMPROVE BLOOD PRESSURE CONTROL (TEXT4BP) AMONG HYPERTENSIVE PATIENTS IN NEPAL

Objectives: In LMICs, the rapid uptake and availability of mobile phones provide excellent opportunities for host of an intervention. However, research on the effectiveness and acceptability of mHealth in these settings remains limited. The main objective of this feasibility study was to assess the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve blood pressure control and treatment adherence among hypertensive patients in Nepal. Design and Methods: The TEXT4BP study was a two-arm, parallel-group, unblinded, randomized controlled pilot trial that recruited 200 clinically diagnosed hypertensive patients aged 18–69 years visiting at a tertiary referral hospital in Kathmandu, Nepal. We co-designed the contextual text messages informed by the formative qualitative studies that used COM-B (capability, opportunity, motivation, and behavior) model and Technology Acceptance Model (TAM) model. Patients in the intervention arm (n = 100) received text messages containing information on hypertension, diet, medication, and physical activity three times per week for three months. The control arm (n = 100) received standard care. Primary outcomes were changes in blood pressure and medication adherence at three months. Secondary outcomes included blood pressure control, medication adherence self-efficacy, and hypertension knowledge. Feasibility measures, such as attrition rate, was calculated. A nested qualitative study assessed the acceptability of the intervention. Results: Over the 12 weeks of follow-up, the retention rate was 77%. The intervention group had a greater reduction in systolic and diastolic BP vs usual care [-7.09/-5.86 (p = 0.003) vs -0.77/-1.35 (p = 0.28) mmHg] [adjusted difference: systolic B = -6.50 (95% CI, -12.6; -0.33) and diastolic BP B = -4.60 (95% CI, -8.16; -1.04)] (fig 1), coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006) at three months. The intervention arm showed an improvement in compliance to antihypertensive therapy (p &lt; 0.001), medication adherence (p &lt; 0.001), medication adherence self-efficacy (p = 0.023), and knowledge on hypertension and its treatment (p = 0.013). In addition, intervention participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention in the future too. Conclusion: The TEXT4BP study has generated promising evidence that text messaging intervention is feasible, acceptable, and effective in improving blood pressure control in low-resource settings like Nepal. The findings will inform further large-scale mHealth research and contribute to clinical practice with evidence-based hypertension guidelines in Nepal. Trial reg: ACTRN12619001213134

S-21-5: COMPARISON OF THIRD-DOSE TRIPLE VERSUS THIRD-DOSE DUAL ANTIHYPERTENSIVE COMBINATION THERAPIES IN PATIENTS WITH ESSENTIAL HYPERTENSION DURING 8-WEEK FOLLOW-UP

Objective: We compared efficacy and safety of low-dose triple versus low-dose dual antihypertensive combination therapies in patients with essential hypertension. Design and method: This trial was a multicenter, randomized, double-blind, parallel, phase II study. After a 4-week placebo run-in period, 243 patients were randomized to the third -dose triple combination (ALC group, amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg), third-dose dual combination (AL group, amlodipine 1.67 mg + losartan potassium 16.67 mg), (LC group, losartan potassium 16.67 mg + chlorthalidone 4.17 mg), or (AC group, amlodipine 1.67 mg + chlorthalidone 4.17 mg) for 8 weeks. The primary outcome was to compare the mean changes in systolic blood pressure (SBP) from baseline to week 8. Results: Baseline patient characteristics and blood pressure did not show significant differences among 4 groups. The mean SBP reductions of ALC group, AL group, LC group and AC group were -18.30 ± 13.23, -13.03 ± 13.30, -16.29 ± 12.36, and -13.80 ± 13.21 mmHg at week 8 from baseline, respectively. The ALC group showed significant SBP reductions in comparison to the AL and AC groups at week 4 (p = 0.0097 and p = 0.0179, respectively) and week 8 (p = 0.0170 and p = 0.0357, respectively). The mean diastolic blood pressure (DBP) reduction from baseline was significantly greater in the ALC group when compared to the AL group (-7.93 ± 7.05 and -4.95 ± 7.96 mmHg, respectively, p = 0.0307). The proportion of responders for SBP was significantly greater in the ALC group (42.6%) compared to the AL (22.0%), LC (23.3%) and AC (27.1%) groups (p = 0.0126, 0.0210 and 0.0445, respectively) at week 4. Furthermore, the proportion of responders for SBP and DBP was significantly greater in the ALC group (59.7%) compared to the AL (39.3%) and AC (42.4%) groups (p = 0.0222 and 0.0491, respectively) at Week 8. Study drug-related adverse reactions were rare and did not show significant differences among 4 study groups. Conclusions: Low-dose triple antihypertensive combination therapy when compared to the low-dose dual combination therapies demonstrated early effective BP control without increasing adverse drug reactions in patients with essential hypertension during 8-week follow-up.

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Adjunctive Therapeutic Effects of Forest Bathing Trips on Geriatric Hypertension: Results from an On-Site Experiment in the Cinnamomum camphora Forest Environment in Four Seasons

Forest bathing is receiving increased attention due to its health benefits for humans. However, knowledge is scarce about the adjunctive therapeutic effects of forest bathing in different seasons on geriatric hypertension. The aim of the current study was to evaluate the antihypertensive effects of forest bathing in a Cinnamomum camphora (C. camphora) forest environment in four seasons. One group of participants with geriatric hypertension was sent to a C. camphora forest to experience a 3 day trip, while, as a control, another group was sent to the urban center. The participants’ blood pressure, blood routine, and blood biochemistry were assessed. The profile of the mood states (POMS) of the participants was assessed before and after the experiment. The air quality, atmospheric environment, and content of volatile organic compounds (VOCs) at the two experimental sites were monitored during the experiment. This experiment was repeated across four seasons. The advantages of the urban forest groups over the control groups were mainly represented by reductions in diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR), as well as increased oxygen saturation (SpO2). The antihypertensive effects of forest bathing in the C. camphora forest environment changed with the seasons. Compared with the baseline level, SBP and DBP declined after forest bathing across the whole year, except during winter, whereas SpO2 increased. The effect of forest bathing on lowering blood pressure was particularly pronounced during summer and autumn. The antihypertensive effects of forest bathing in the four seasons were highly consistent with the seasonal dynamics of VOCs and negative air ions (NAIs), which implies that the effect of forest bathing may be attributed to alterations of the atmospheric environment. The antihypertensive effects of C. camphora forest were confirmed in our study, and the results can provide a reference for scheduling bathing trips.