Screening For Hypertension Research Articles

Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study.

The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 "Non-invasive Sphygmomanometers-Part 2: Clinical investigation of automated measurement type." This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension.

Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment

BackgroundOlder adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico.MethodsData came from five waves (2001–2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used.ResultsFor all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03–1.23) but lower risk of outpatient services (RR = 0.95, 0.93–0.97), cholesterol screening (RR = 0.93, 0.91–0.96), and diabetes screening (RR = 0.95, 0.92–0.97).No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment.ConclusionsWe identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.

Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa

BackgroundThe burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions.MethodsUsing a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.ResultsData from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic’s logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients’ knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.ConclusionsThe convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.

Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey.

Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India's National Family Health Survey Fifth Round (2019-2021). The prevalence of hypertension among 204,054 older adolescents (15-19 years) was 5.08% (95% CI: 4.94-5.23%) wherein 42.26% (95% CI: 40.69-43.64%) were aware of their condition, 43.70% (95% CI: 41.73-45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83-87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.

Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States.

Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99m Tc carbon particles, 97.1% 81m Kr gas, 58.7% 99m Tc-DTPA, and 19.4% 133 Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.

Comparability analysis of the HNT-1P Huvitz non contact tonometer for the measurement of intraocular pressure.

To evaluate the diagnostic validity of the HNT-1P non-contact tonometer (Huvitz) as a tool for accurately measuring intraocular pressure (IOP) in patients with healthy eyes, compared to the Goldmann applanation tonometer (GAT), which is the Gold Standard method for measurement of IOP. Observational, descriptive, transversal study using 148 eyes of 74 healthy patients without a diagnosis of glaucoma or other ophthalmological diseases. Three measurements of IOP were taken in each eye, using three tonometers: HNT-1P, ICR100, and GAT. The median IOP (quartiles) and mean IOP (SD) its statistical significance were calculated, and comparisons were made between the mean and median IOP values found in three groups: GAT-HNT, GAT-ICR, and HNT-ICR. The difference in mean and median IOP was analyzed in each of the three study groups, and its statistical significance and concordance correlation coefficient (CCC) were calculated. The median IOP with HNT-1P was statistically significantly lower than the median IOP with GAT, (1.1 mmHg, p < 0.001). The median IOP with HNT-1P was also lower than the median IOP with ICR100. As an additional result, the median IOP with GAT was lower than the median IOP with ICR. The CCC was moderate for HNT-ICR (0.72) and low for GAT-HNT and GAT-ICR (0.43 and 0.38, respectively). HNT-1P (Huvitz) provides statistically significantly lower IOP values than those obtained with GAT. HNT-1P could be used for screening of ocular hypertension in postoperative patients. The IOP measurement obtained with HNT-1P should be confirmed with GAT. HNT-1P yields lower IOP values than those obtained with ICR.

“Lansia Berdaya” Program Penguatan Posyandu Lansia Dusun 2 Desa Karangwuni Sebagai Upaya Peningkatan Pengetahuan dan Pencegahan Hipertensi

Hypertension, a non-communicable disease, exhibits significant death and suffering rates worldwide, including in Indonesia. Hypertension ranks as the third leading cause of mortality in Indonesia, following strokes and tuberculosis, primarily impacting the older population. Dusun 2 Karangwuni is a region that experiences a high mortality rate due to hypertension. The hypertension screening findings revealed that out of the 49 elderly visitors to Posyandu, 41 of them were found to have hypertension. The team's objective is to implement the dedication of Lansia Berdaya's activities in managing hypertension in Dusun Two village, Karangwuni, Weru district. The Lansia activities occur in Dukuh Ngampas, Dusun 2, Village KarangWuni, district Weru, Sukoharjo. Activities encompass kader upgrading training, hypertension assessment, rehabilitation, and elderly gymnastics. The sequence of events will occur in February 2023. The intended recipients are 17 healthcare professionals, whereas the intended recipients are 47 individuals. Activities are evaluated by examining the level of knowledge, which is determined using pre-test and post-test values. Heath cadre training was conducted with 17 audiences. Hypertension screening, senior gymnastics, and health education activities were conducted and attended by 47 seniors. The hypertension exercise video has been distributed to the health cadre. The video is anticipated to serve as a comprehensive manual for gymnastics exercises at Posyandu Lansia to establish a long-lasting and sustainable devotion program.

May Measurement Month 2021: an analysis of blood pressure screening results from Hungary.

Elevated blood pressure (BP) is the most important risk factor for cardiovascular diseases (CVDs), which are still the leading cause of mortality in Hungary. Therefore, screening programmes identifying subjects with hypertension have an important role in CVD prevention. In 2017, the International Society of Hypertension initiated May Measurement Month (MMM) aimed at raising awareness of elevated BP. Hungary joined the MMM campaigns in 2017, 2019, and 2021, and a summary of the results from 2021 is presented here. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in September 2021. Measurement of BP, the definition of hypertension, and statistical analysis followed the standard MMM protocol. In Hungary, 30 sites were set up in primary and secondary care facilities, in pharmacies, and in malls. Both cities and villages were involved in all regions. A total of 1414 individuals were screened, and 558 subjects (39.5%) had hypertension. Out of 1065 participants not on antihypertensive medication, 209 (19.6%) had elevated BP. Among treated individuals (n = 349), 206 (59.0%) had controlled BP (<140/90 mmHg). Almost 40% of the participants had hypertension. Among untreated participants, one in five had elevated BP, while among patients on antihypertensive medication, 41% had uncontrolled BP. These results confirm the importance of screening of hypertension in untreated individuals and that efforts are required to adequately control BP in treated hypertensive patients.

May Measurement Month 2021: an analysis of blood pressure screening results from Nepal.

Despite the well-recognized importance of prevention and early treatment of hypertension, the majority of adults in Nepal are not aware of their high blood pressure (BP) and are left untreated. In this paper, we report the result of the May Measure Month 2021 campaign in Nepal: a nationwide community-based hypertension screening campaign. An opportunistic cross-sectional survey was conducted in 15 districts between September 2021 and December 2021. An individual was included if aged 18 years or more and provided informed consent. Structured questionnaires were administered, and BP was measured three times in a sitting position by trained volunteers. A total of 5172 participants were included. The median age (interquartile range) was 37 (25-51), and 49.9% were female. The mean (SD) of the systolic and diastolic BP was 123.9 (14.9) and 80.2 (9.3) mmHg, respectively. A total of 1066 participants (20.6%) were identified as hypertensive (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or on antihypertensive medication), of whom 399 (39.5%) and 298 (29.5%) were aware of their BP status and treated with at least one antihypertensive medicine, respectively. Blood pressure control (<140/90 mmHg) was achieved in 15.6% of all hypertensives and in 56.0% of treated individuals. Multivariate logistic regression showed an association between hypertension and the following variables: every 1-year increase of age [odds ratio (OR) = 1.13 (1.11-1.15) if age < 40 and OR = 1.05 (1.04-1.06) if age ≥ 40], male [OR = 1.57 (1.33-1.89)], regular alcohol use [OR = 1.59 (1.30-1.93)], and diabetes [OR = 2.63 (1.93-3.58)]. Hypertension awareness, treatment, and control were suboptimal in Nepal. This study supports a strong need to scale up community-based hypertension programmes in Nepal and raises the possibility of task sharing with community health workers.

May Measurement Month 2021: an analysis of blood pressure screening results from Albania.

This article describes the May Measurement Month (MMM) 2021 campaign, which was the fourth time this annual hypertension screening campaign was conducted in Albania, a Mediterranean country in southeastern Europe. The MMM21 was conducted during the period of 28 September-30 November 2021, in 32 sites across several districts of Albania. Overall, 11 788 participants aged ≥18 years were included (63% women), with a mean age of 49.7 ± 14.9 years. Blood pressure (BP) was measured three times with Omron sphygmomanometers (model M3, Omron Healthcare, Kyoto, Japan), which are automatic upper arm BP monitors. Hypertension was defined as SBP ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg (based on the mean of the second and third recordings for SBP and DBP, respectively) or on antihypertensive medication. Self-reported data included pre-existing conditions, physical activity, smoking, alcohol consumption, COVID-19 testing, and use of contraception in women. Overall, 47.3% of screened participants had hypertension. Of those with hypertension, 70.1% were aware of their condition and 67.0% were on antihypertensive medication. About half (49.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). On average, BP was higher in those on antihypertensive medication and with increasing alcohol intake but lower in those with a history of stroke and those with higher levels of physical activity, previous positive COVID-19 test, and contraception use in women. In Albania, the MMM campaign continues to contribute to the early detection of hypertension among adults. Hence, it constitutes a valuable opportunistic screening instrument among other routine tools applied in the general Albanian population.

The Critical Role of Community Pharmacists in Blood Pressure Monitoring.

Arterial hypertension is the most important modifiable risk factor for cardiovascular morbidity and mortality. In some countries, pharmacists' patient-centered approach has become a common practice, and their role in supporting the management of cardiovascular disease has been successfully developed for years. In particular, recent findings have confirmed benefits of pharmacist-provided hypertension care. Current guidelines emphasize the need for regular BP measurements in subjects age 40 years and older, who are at increased risk of hypertension. A panel of experts in cardiology, hypertensiology, family medicine, and pharmacy presented a narrative review of implementing community pharmacy blood pressure (CPBP) measurements into Polish pharmacy practice to assist pharmacists in CPBP readings. The paper focuses on basic aspects of management of untreated patients with elevated blood pressure levels, as well as management of individuals diagnosed with hypertension, who should follow their primary care physicians' recommendations for anti-hypertensive therapy. The article also includes a few important aspects related to CPBP measurement, such as equipment and techniques. Development of ready-made schemes of procedures for patients with different results of blood pressure measurement could ensure a uniform standard of services provided by pharmacists. This gives an opportunity to provide such patients with medical care and initiate treatment, and facilitates effective maintenance of BP in hypertensive subjects. This article reviews the role of pharmacists in Poland in screening for hypertension by taking blood pressure measurements.

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

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

Epigenetic Alteration of Smooth Muscle Cells Regulates Endothelin-Dependent Blood Pressure and Hypertensive Arterial Remodeling.

Long-standing hypertension (HTN) affects multiple organ systems and leads to pathologic arterial remodeling, which is driven largely by smooth muscle cell (SMC) plasticity. Although genome wide association studies (GWAS) have identified numerous variants associated with changes in blood pressure in humans, only a small percentage of these variants actually cause HTN. In order to identify relevant genes important in SMC function in HTN, we screened three separate human GWAS and Mendelian randomization studies to identify SNPs located within non-coding gene regions, focusing on genes encoding epigenetic enzymes, as these have been recently identified to control SMC fate in cardiovascular disease. We identified SNPs rs62059712 and rs74480102 in the promoter of the human JMJD3 gene and show that the minor C allele increases JMJD3 transcription in SMCs via increased SP1 binding to the JMJD3 promoter. Using our novel SMC-specific Jmjd3-deficient murine model ( Jmjd3 flox/flox Myh11 CreERT ), we show that loss of Jmjd3 in SMCs results in HTN, mechanistically, due to decreased EDNRB expression and a compensatory increase in EDNRA expression. As a translational corollary, through single cell RNA-sequencing (scRNA-seq) of human arteries, we found strong correlation between JMJD3 and EDNRB expression in SMCs. Further, we identified that JMJD3 is required for SMC-specific gene expression, and loss of JMJD3 in SMCs in the setting of HTN results in increased arterial remodeling by promoting the SMC synthetic phenotype. Our findings link a HTN-associated human DNA variant with regulation of SMC plasticity, revealing therapeutic targets that may be used in the screening and/or personalized treatment of HTN.

Effectiveness of the Hypertension Screening Corner in Enhancing the Cascade of Care at Primary Healthcare Center Level: Evidence from Zambezia, Mozambique.

Hypertension is the leading cause of cardiovascular disease, whose death burden is dramatically increasing in sub-Saharan Africa. To curb its effects, early diagnosis and effective follow-up are essential. Therefore, this study aims to evaluate the impact of a hypertension screening corner on the hypertension care cascade at the primary healthcare level. A prospective cohort study was conducted between October 2022 and March 2023 in two PHCCs in Zambezia (Mozambique). The study involved a demographic and socioeconomic status (SES) questionnaire for those screened. Patients with blood pressure (BP) > 140/90 mmHg were given a follow-up questionnaire regarding the care cascade. The four cascade steps were: medical visit, diagnosis confirmation, follow-up visit, and recalling the follow-up appointment. The odds ratio (OR) of reaching each step of the cascade was assessed by binomial logistic regression. Patients with BP > 140/90 mmHg were 454, and 370 (86.0%) completed both study phases. Individuals attending the medical visit were 225 (60.8%). Those with low SES had a higher probability of visit attendance than those with middle (OR = 0.46, 0.95CI[0.23-0.88] p = 0.020) and high (OR = 0.21 0.95CI[0.10-0.42], p < 0.001). Hypertension diagnosis was confirmed in 181 (80.4%), with higher probability in the low SES group compared to the middle (OR = 0.24 IC95[0.08-0.66], p = 0.007) and high (OR = 0.23, IC95[0.07-0.74], p = 0.016) groups. The OR to complete step 1 and step 2 were higher for older age groups. A follow-up appointment was received and recalled by 166 (91.7%) and 162 (97.6%) patients, respectively. The hypertension corner proved to be a useful tool for effective screening of hypertension with satisfactory retention in care, especially for people with lower socio-economic status.

Healthcare system barriers and facilitators to hypertension management in Ghana.

Background: Hypertension continues to pose a significant burden on the health systems in Sub-Saharan Africa (SSA). Multiple challenges at the health systems level could impact patients' blood pressure outcomes. There is a need to understand the gaps in health systems to improve their readiness to manage the rising burden of hypertension Objective: To explore health system barriers and opportunities for improved management of hypertension in Ghana, West Africa. Methods: We conducted 5 focus group discussions involving 9 health facility leaders and 24 clinicians involved in hypertension treatment at 15 primary-level health facilities in Kumasi, Ghana. We held discussions remotely over Zoom and used thematic analysis methods. Results: Four themes emerged from the focus group discussions: (1) financial and geographic inaccessibility of hypertension services; (2) facilities' struggle to maintain the supply of antihypertensive medications and providers' perceptions of suboptimal quality of insured medications; (3) shortage of healthcare providers, especially physicians; and (4) patients' negative self-management practices. Facilitators identified included presence of wellness and hypertension clinics for screening and management of hypertension at some health facilities, nurses' request for additional roles in hypertension management, and the rising positive practice of patient home blood pressure monitoring. Conclusion: Our findings highlight critical barriers to hypertension service delivery and providers' abilities to provide quality services. Health facilities should build on ongoing innovations in hypertension screening, task-shifting strategies, and patient self-management to improve hypertension control. In Ghana and other countries, policies to equip healthcare systems with the resources needed for hypertension management could lead to a high improvement in hypertension outcomes among patients.

Smoking and the Risk of Type 2 Diabetes: A Cross-sectional Analytical Study.

India is undergoing epidemiological transitions with the increase in noncommunicable disease (NCD) burden. Targeting the modifiable risk factors through lifestyle changes in the early years of life remains the most effective strategy for decreasing the prevalence of type 2 diabetes mellitus (T2DM). To determine the association between cigarette smoking and T2DM. An analytical cross-sectional study was conducted among the patients attending the outpatient department of a tertiary care teaching hospital in Kolkata, West Bengal, India. Patients aged more than 35 years were enrolled, and details regarding sociodemography, clinical status, and NCD risk factors were collected using pretested semistructured questionnaires after obtaining IEC approval. Data collected were entered in MS Excel and analyzed using SPSS software. Simple logistic regression and multivariable logistic regression analysis were used to calculate the crude and adjusted odds ratio with 95% confidence interval. Out of 434 participants, 37.3% had diabetes mellitus, 51.6% were males, and 28.6% had alcohol consumption. Univariate logistic regression analysis revealed age, BMI, systolic BP, diastolic BP, and cigarette smoking were significantly associated with increased risk of T2DM. Multivariable logistic regression analysis revealed cigarette smoking, systolic BP, age, and female gender were significant risk factors for T2DM. Our study reported cigarette smoking and systolic BP are modifiable risk factors associated with T2DM. Early identification of smoking through screening and appropriate control of hypertension in T2DM patients will decrease the morbidities and mortalities in T2DM cases.

Improving Pediatric Hypertension Screening in an Academic Primary Care Setting.

Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.

Policy Evaluation Of Minimum Service Standards For Hypertension Health Services At Mabelopura Health Center

Hypertension is a chronic medical condition in which arterial blood pressure increases, causing the heart to work harder. At Puskesmas Mabelopura, hypertension has not yet reached the Minimum Service Standard (MSS) target with an achievement of only 68.61% of the 95% target. This study evaluated the SPM policy on hypertension services at the Mabelopura Health Center using a descriptive qualitative method with informants from Key Informants and Triangulated Informants. The results showed that the implementation of SPM Hypertension only reached 68.61% of the 95% target, indicating that the target has not been achieved. Health services are in accordance with SPM standards but not optimal, due to differences in central target data with Puskesmas data and limited human resources. The low number of community visits for hypertension screening, due to the community's lack of perceived importance of routine control, was also a major factor. This study concluded that to achieve SPM targets, intensive efforts are needed from Puskesmas Mabelopura and the Health Office of Palu City to establish better communication with Pusdasten and increase community awareness of the importance of routine check-ups. Thus, it is expected that Puskesmas Mabelopura can be more effective in achieving SPM targets and improving the quality of life of people with hypertension in the area.

Study on the relationship between body mass index and blood pressure indices in children aged 7-17 during COVID-19.

To explore the relationship between body mass index (BMI), age, sex, and blood pressure (systolic blood pressure, SBP; diastolic blood pressure, DBP) in children during COVID-19, providing reference for the prevention and screening of hypertension in children. This study adopted a large-scale cross-sectional design to investigate the association between BMI and blood pressure in 7-17-year-old students in City N, China, during COVID-19. Thirty-six primary and secondary schools in City N were sampled using a stratified cluster sampling method. A total of 11,433 students aged 7-17 years in City N, China, were selected for blood pressure (Diastolic blood pressure, DBP, Systolic blood pressure, SBP), height, and weight, Resting heart rate (RHR), chest circumference, measurements, and the study was written using the STROBE checklist. Data analysis was conducted using SPSS 26.0, calculating the mean and standard deviation of BMI and blood pressure for male and female students in different age groups. Regression analysis was employed to explore the impact of BMI, age, and sex on SBP and DBP, and predictive models were established. The model fit was evaluated using the model R2. The study included 11,287 primary and secondary school students, comprising 5,649 boys and 5,638 girls. It was found that with increasing age, BMI and blood pressure of boys and girls generally increased. There were significant differences in blood pressure levels between boys and girls in different age groups. In regression models, LC, Age, BMI, and chest circumference show significant positive linear relationships with SBP and DBP in adolescents, while RHR exhibits a negative linear relationship with SBP. These factors were individually incorporated into a stratified regression model, significantly enhancing the model's explanatory power. After including factors such as Age, Gender, and BMI, the adjusted R2 value showed a significant improvement, with Age and BMI identified as key predictive factors for SBP and DBP. The robustness and predictive accuracy of the model were further examined through K-fold cross-validation and independent sample validation methods. The validation results indicate that the model has a high accuracy and explanatory power in predicting blood pressure in children of different weight levels, especially among obese children, where the prediction accuracy is highest. During COVID-19, age, sex, and BMI significantly influence blood pressure in children aged 7-17 years, and predictive models for SBP and DBP were established. This model helps predict blood pressure in children and reduce the risk of cardiovascular diseases. Confirmation of factors such as sex, age, and BMI provide a basis for personalized health plans for children, especially during large-scale infectious diseases, providing guidance for addressing health challenges and promoting the health and well-being of children.

Kegiatan Skrinning Tekanan Darah Dan Penyakit Hipertensi Pada Populasi Usia Produktif Di Sekolah SMA Kalam Kudus II, Kelurahan Duri Kosambi, Jakarta

Hypertension is a condition where a person's blood pressure exceeds normal limits. In order to detect hypertension and provide health education, this community service activity evaluates the basic characteristics and blood pressure of men and women of productive age at Kalam Kudus II High School, Duri Kosambi Village, Jakarta. A total of 68 respondents participated, consisting of 26 men (38.2%) and 42 women (61.8%), with the majority being in the 18-35 year age group (52.9%). The results showed that 77.9% of respondents had normal systolic blood pressure and 82.4% had normal diastolic blood pressure. However, 22.1% of respondents experienced systolic hypertension and 17.6% experienced diastolic hypertension, with the highest prevalence in the 51-64 year age group. These findings emphasize the importance of early detection and health education about hypertension to prevent serious complications such as stroke and heart disease. Prevention can be done by changing lifestyle, such as exercising, avoiding smoking and alcohol, and consuming foods high in fiber and low in salt. Collaboration with schools and health units is very important for regular monitoring and comprehensive education. This community service activity aims to increase awareness and quality of life for individuals of productive age through prevention and early screening for hypertension.