Self-measured Blood Research Articles

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

THE GREAT PRETENDER: COULD A PHEOCHROMOCYTOMA MANIFEST ITSELF AS A SEIZURE?

Objective: Seizures are defined as transient occurrence of signs or symptoms due to the abnormally excessive or synchronous neuronal activity in the cerebral cortex. Pheochromocytomas and paragangliomas (PPGL) are chromaffin cell tumors arising from the adrenal medulla in 80–85% of patients and from extra-adrenal sympathetic tissue in 10–20% of patients. PPGL has been referred to as ‘‘the great mimic’’ disease. We present a patient with pheochromocytoma possibly disguised as seizures. Design and method: A 44 years old woman was referred to University Clinic of Endocrinology by radiologist. Two years earlier she had syncopal crises . She complained of headache, heart palpitation and malaise, heart palpitations and fatigue during exertion and sense of panic. The maximal self-measured blood pressure was 160/100 mmHg, the pulse is 90-100 beats per min. Abdominal US: a hyperechoic change, 76x65mm was seen, then described in the right lobe of the liver. The following year she had two commotional crises of consciousness and spasms of the extremities . She had a non-specific slowing of FC on EEG on the right for 1-2 seconds. MSCT abdomenal : in the right adrenal gland, a mass 144 x 90mm, with clear borders, pressing into the liver and pushing the right kidney,. The 24h urine was collected, which confirmed a norepinephrine secreting pheochromocytoma. We administered long acting alpha blocking agent preoperatively. The complete surgical excision of the right adrenal mass was done, pathohistological diagnosis: Pheochromocytoma. The last EEG after sleep deprivation performed 2 months postoperatively was described as normal. The patient had no headache or seizure. Results: PPGLs have a notable ability of boosting NE levels systemically and hypertension, the most common sign of PPGL could facilitate the permeability of blood brain barrier to NE. Studies showed NE could play its anticonvulsant property at an appropriate concentration but has a proconvulsant effect in either too high or too low concentrations . Conclusions: The definite pathogenetic mechanisms explaining how PPGL can cause seizures are far from being clearly understood, though “the great pretender” should be considered as a possible etiological factor of seizures.

Self-Measured Blood Pressure Telemonitoring Programs: A Pragmatic How-to Guide.

Self-measured blood pressure (SMBP) telemonitoring is the process of securely storing and tele-transmitting reliably measured, patient self-performed blood pressure (BP) measurements to healthcare teams, while ensuring that these data are viewable and clinically actionable for the purposes of improving hypertension diagnosis and management. SMBP telemonitoring is a vital component of an overall hypertension control strategy. Herein, we present a pragmatic guide for implementing SMBP in clinical practice and provide a comprehensive list of resources to assist with implementation. Initial steps include defining program goals and scope, selecting the target population, staffing, choosing appropriate (clinically validated) BP devices with proper cuff sizes, and selecting a telemonitoring platform. Adherence to recommended data transmission, security, and data privacy requirements is essential. Clinical workflow implementation involves patient enrollment and training, review of telemonitored data, and initiating or titrating medications in a protocolized fashion based upon this information. Utilizing a team-based care structure is preferred and calculation of average BP for hypertension diagnosis and management is important to align with clinical best practice recommendations. Many stakeholders in the United States are engaged in overcoming challenges to SMBP program adoption. Major barriers include affordability, clinician and program reimbursement, availability of technological elements, challenges with interoperability, and time/workload constraints. Nevertheless, it is anticipated that uptake of SMBP telemonitoring, still at a nascent stage in many parts of the world, will continue to grow, propagated by increased clinician familiarity, broader platform availability, improvements in interoperability, and reductions in costs that occur with scale, competition, and technological innovation.

IGlarLixi provides a higher derived time-in-range versus insulin glargine 100 U/mL or lixisenatide in Asian Pacific people with type 2 diabetes: A post hoc analysis.

To evaluate the efficacy of iGlarLixi in Asian Pacific (AP) population with type 2 diabetes (T2D) using derived time-in-ranges calculated from seven-point self-measured blood glucose. Two phase III trials were analyzed. LixiLan-O-AP was performed in insulin-naive T2D patients (n=878) randomized to iGlarLixi, glargine 100 units/mL (iGlar), or lixisenatide (Lixi). LixiLan-L-CN was performed in insulin-treated T2D patients (n=426) randomized to iGlarLixi or iGlar. Changes in derived time-in-ranges from baseline to end-of-treatment (EOT) and estimated treatment differences (ETDs) were analyzed. The proportions of patients achieving ≥70% derived time-in-range (dTIR), ≥5% dTIR improvement, and the composite triple target (≥70% dTIR, <4% derived time-below-the-range [dTBR], and <25% derived time-above-the-range [dTAR]) were calculated. The changes from baseline to EOT in dTIR with iGlarLixi were greater versus iGlar (ETD1 : 11.45% [95% CI, 7.66 to 15.24]) or Lixi (ETD2 : 20.54% [95% CI, 15.74 to 25.33]) in LixiLan-O-AP, and versus iGlar (ETD: 16.59% [95% CI, 12.09 to 21.08]) in LixiLan-L-CN. In LixiLan-O-AP, the proportions of patients achieving ≥70% dTIR or ≥5% dTIR improvement at EOT with iGlarLixi were 77.5% and 77.8%, respectively, higher than with iGlar (61.1% and 75.3%) or Lixi (47.0% and 53.0%). In LixiLan-L-CN, the proportions of patients achieving ≥70% dTIR or ≥5% dTIR improvement at EOT were 71.4% and 59.8% with iGlarLixi, greater than with iGlar (45.4% and 39.5%). More patients achieved the triple target with iGlarLixi compared with iGlar or Lixi. iGlarLixi achieved greater improvements in dTIR parameters vs. iGlar or Lixi in insulin-naïve and insulin-experienced AP people with T2D. This article is protected by copyright. All rights reserved.

MHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study.

Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the greater cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.

Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study.

Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging-based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city. As the benefits of Reach Out are predicated on participants' engagement with the intervention, we sought to understand participants' determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback). We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (≥80% response to SMBP prompts), low engagers (≤20% response to BP prompts), and early enders (participants who withdrew from the trial). We conducted interviews with 13 participants, of whom 7 (54%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs. Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants' unmet health-related social needs, as well as strategies to cultivate social norms.

Hypertension management before and under the COVID-19 pandemic: lessons and future directions.

Hypertension is a significant risk factor for cardiovascular diseases. The prevalence of hypertension and its complications is increasing yearly, yet it remains inadequately controlled worldwide. It has already been recognized that self-management, including self-measured blood pressure monitoring at home, is more important than office blood pressure monitoring. The practical application of telemedicine using digital technology was already underway. COVID-19 has promoted the popularization of these management systems in primary care, although the COVID-19 pandemic disrupted lifestyle and healthcare access. At the beginning of the pandemic, we were at the mercy of information on whether certain antihypertensive drugs, for example, might pose a risk of infection in the face of unknown infectious diseases. Over the past three years, however, much knowledge has been accumulated. It has been scientifically proven that there is no serious problem in managing hypertension in the same way as before the pandemic. That is to control blood pressure mainly through home blood pressure monitoring and continuing conventional drug therapy while modifying lifestyle. On the other hand, in the New Normal era, it is necessary to accelerate digital hypertension management and the establishment of new social networks and medical systems to prepare for the re-emergence of future pandemics while continuing to protect against infection. This review will summarize the lessons and future directions we learned from the impact of the COVID-19 pandemic on hypertension management. The COVID-19 pandemic has disrupted our daily life, restricted access to healthcare, and altered some of the conventional management of hypertension.

Abstract P355: Examining Sexual Identity Differences in Self-Measured Blood Pressure Monitoring Among Adults in the Behavioral Risk Factor Surveillance System

Background: Hypertension is a leading risk factor for cardiovascular disease. Self-measured blood pressure (SMBP) monitoring has been identified as an effective strategy to achieve BP control among adults with hypertension. Although there is growing evidence that sexual minority (e.g., gay/lesbian, bisexual) adults are at higher risk of hypertension than heterosexual adults, there is no data on hypertension self-management among sexual minority people with hypertension. Methods: We used data from the 2019 Behavioral Risk Factor Surveillance System to examine differences in SMBP monitoring between sexual minority and heterosexual participants with hypertension. Participants were asked questions regarding SMBP monitoring at home, including whether they were advised by a healthcare professional to check their BP at home, regularly checked their BP at home, and if they shared their home BP readings with a healthcare professional. We ran sex-stratified logistic regression models, adjusted for demographic factors and healthcare utilization, to estimate differences in SMBP monitoring between sexual minority and heterosexual participants. Results: The sample included 25,461 participants with a mean age of 54.1 ( ± 16.8) of which 95.1% were heterosexual, 1.7% were gay/lesbian, and 2.2% were bisexual. Although there were no differences in the odds of being advised by a healthcare professional to check their BP at home, lesbian women were more likely than heterosexual women to report taking their BP at home (AOR 1.23, 95% CI = 1.03-4.85) and sharing their home BP readings with a healthcare professional (AOR 2.31, 95% CI = 1.04-5.17). In contrast, bisexual women were less likely than heterosexual women to report taking their BP at home (AOR 0.59, 95% CI = 0.43-0.81) and sharing their home BP readings with a healthcare professional (AOR 0.56, 95% CI = 0.40-0.78). No differences in SMBP monitoring were found between sexual minority and heterosexual men. Conclusions: As the first examination of sexual identity differences in SMBP monitoring among adults with hypertension, this study addresses important knowledge gaps within cardiovascular and sexual minority health research. Lesbian women with hypertension exhibited more favorable self-management behaviors compared to heterosexual women. However, bisexual women with hypertension were less likely than heterosexual women to engage in SMBP monitoring. Findings suggest there is a need for clinical interventions to improve hypertension self-management among bisexual women.

Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pressure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in individuals with untreated hyper-tension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) us-ing ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Resi-dential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Systolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dismissed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

TEXT MY BP MEDS NOLA: A pilot study of text-messaging and social support to increase hypertension medication adherence

Study objectiveNon-Hispanic Black (NHB) adults have high hypertension (HTN) and cardiovascular disease (CVD) burden. Medication nonadherence limits control and self-measured blood pressure (SMBP) improves diagnosis and adherence. This predominantly NHB cohort pilot, via community-clinical linkages, with uncontrolled HTN and low adherence, utilized bidirectional electronic messaging (BEM) with team-care, to assess medication adherence, quality of life, and BP. SettingAcademic clinic and community sources. DesignRecruitment included: uncontrolled HTN (BP ≥130/80 mm Hg), low adherence (Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) ≥1 score), and smartphone access. Participants and interventionsParticipants (N = 36) received validated Bluetooth-enabled BP devices, synced to smartphones, via a secured cloud-based application. Main outcome measuresDemographics, adherence scores, Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQOL-14), BP, body mass index (BMI), 8 weeks daily BEM, SMBP and text reminders were obtained. ResultsAge was 58.7 ± 12.8 years; BMI 34.8 ± 7.9; 63.9 % female; 88.9 % self-identified NHB adults; 72.2 % with obesity; 74.3 % with diabetes. K-Wood-MAS-4 adherence composite score improved: 2.19 to 1.58 (median −0.5, p = 0.0001). Systolic BP decreased by 10.5 ± 20.0 mm Hg (median −11.0, p = 0.0027). QOL did not significantly change. Mean 7-day average SBP/DBP differences were −4.94 ± 16.82 (median −3.5, p = 0.0285) and −0.17 ± 7.42 (median 0, p = 0.7001), respectively. Social support with taking BP medication was: “yes” (n = 19); 143.8 mm Hg to 131.5 mm Hg (median −12.5, p = 0.0198) and “no” (n = 14); 142.32 mm Hg to 130.25 mm Hg (median −4.0, p = 0.0771). ConclusionsCommunity-clinical linkages and SMBP with BEM significantly improved medication adherence and SBP without modifying pharmacotherapy.

S-42-7: TELEMEDICINE FOR POST-COVID-19 MANAGEMENT OF HYPERTENSION

The pandemic has led to changes in regulations and reimbursement rules to generally favor telehealth, as well as increased public awareness and acceptance of virtual visits. In Japan, the adoption of virtual video visits has been slow, largely due to regulations and reimbursement policies. For the whole country, much less than 1% of total outpatient visits has used virtual video visits. Compared to traditional care, hypertension management using online digital solutions has a potential to improve care access and reduce untreated hypertension population. Notably, hypertension is one of the best fit conditions to be managed by virtual care among various acute and chronic illnesses because the primary index of treatment is self-measured home blood pressure and effective medications with minimal side effects are available. However, currently implemented hypertension telemedicine includes different styles of care delivery that needs to be taken into account when discussing remote hypertension management. According to a report, telephone visits and video visits had lower proportion of visits with recorded blood pressure compared to in-person visits (Ye, JMIR Formative Research, 2022). An ideal ICT-assisted management likely involves home blood pressure monitoring, team care with interactive lifestyle modification guidance, and audio-video visits. Post-COVID-19 management of Hypertension can be enriched by combining remote blood pressure monitoring and virtual visits with digital therapeutics and mHealth services promoting lifestyle modifications. The remaining challenge includes cost considerations and disparities that may arise from economic status, internet availability, and digital service familiarity. Especially for a patient population whose primary or sole health condition needing medical attention is hypertension, total care with online visits may have advantage over other forms of care, offering convenience, care effectiveness using accurate BP assessment, and good cost profile. In addition, online hypertension care employing properly-planned data structure can help generate a high-quality real-world dataset which may be used to evaluate the advances in quality of care using technologies.

Investigating the effect of an mHealth coaching intervention on health beliefs, adherence and blood pressure of patients with hypertension: A longitudinal single group pilot study.

Mobile health technologies have shown promise as delivery platforms for digital health coaching for chronic conditions. However, the impacts of such strategies on users' health beliefs, intentions and ultimately clinical outcomes are understudied. This study sought (1) to evaluate the effects of a digital health coaching intervention on participants' belief constructs; and (2) to assess relationships between these belief constructs and intentions to utilize the technological intervention, actual adherence metrics and clinical outcomes related to hypertension. Thirty-four participants with hypertension were recruited from a university community from January to May 2021. They self-measured weight and blood pressure (BP) for 30 days followed by digital coaching delivered via a mobile application for 30 days. Surveys assessed constructs from the Health Belief Model and Technology Acceptance Model, compared to intention, health belief, BP self-monitoring adherence and BP outcomes. A path analysis model was used to assess the relationships between constructs and intention, adherence metrics and clinical outcomes. A Kruskal-Wallis test was used to identify changes in beliefs. Participant health beliefs significantly improved after coaching, including self-efficacy (H(1) = 15.12, p < 0.001), cues to action (H(1) = 5.33, p = 0.02), attitude (H(1) = 10.35, p = 0.002), perceived usefulness (H(1) = 15.02, p < 0.001) and decreased resistance to change (H(1) = 4.05, p = 0.04). Adherence to BP measurements positively correlated with perceived health threat (β = .033, p = 0.007) and perceived ease of use (β = .0277, p < 0.001). Self-efficacy (β = -2.92, p = 0.02) and perceived usefulness (β = -3.75, p = 0.01) were linked with a decrease in diastolic BP. A mobile health coaching intervention may help participants improve beliefs regarding hypertension self-management.

S-04-1: CURRENT EVIDENCE AND ISSUES ON AOBP FROM JAPAN

The potential ability of unattended office blood pressure (AOBP) has been acknowledged worldwide, including Japan, although much resource consumption makes it less feasible to use AOBP in clinical practice. We reported that the three consecutive AOBP measurement values in each patient were almost identical, with high correlations (r ≥ 0.90), and the AOBP and conventional attended office blood pressure were moderate to highly correlated. We therefore interpret that AOBP can be an alternative that is more stable than the conventional attended blood pressure value despite with the average shifted to some extent, e.g., 10.4/4.2 mmHg based on the same study. In contrast, there is a fundamental discrepancy between the similarity in average values and the poor agreement in individuals when we compare AOBP versus self-measured home blood pressure, as the systolic blood pressure difference was 0.9 mmHg with a 95% agreement limit was -34.0 to + 35.8 mmHg. The vast wide range of difference indicates that we cannot estimate home as well as ambulatory blood pressure values by AOBP measurements in each patient, and vice versa. AOBP has another advantage regarding the elimination of white-coat effect by the presence of medical staff. Nevertheless, because AOBP measurement is performed at a clinic or in a screening setting where participants cannot be relaxed like at their own home, such a clinic effect still affects AOBP readings. In this session, the current evidence on AOBP based on our Japanese studies and others will be summarized and issues which remain to be investigated for the assessment of a variety of blood pressure conditions, unattended and attended office, and out-of-office blood pressures will be discussed.

Influence of Environment and Measurement Conditions on Blood Pressure During Self-Measurement Blood Pressure

Background: Effective blood pressure (BP) monitoring outside medical office requires that each patient havevalidated sphygmomanometer. Due to their relatively high expense, these sphygmomanometers remain littleor not accessible in our working context. When self-monitoring of blood pressure (SMBP) is prescribed in theoffice, most patients go to private pharmacies where BP measurements are influenced by environment andmeasurement conditions.Aim: To determine influence of environment and measurement conditions on BP during SMBP in healthysedentary people in order to describe reality of practice of this method in our working context.Method: Prospective experimental transversal study including 174 volunteers (47 women), aged 18 to 25years. Systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were measured by home SMBP according tointernational guidelines and by private “pharmacies SMBP”. Information on environment and conditions of BPmeasurement was collected on form by each subject. Means and standard deviations of SBP, DBP, and HR werecalculated and compared from the measurements obtained.Results : The mean age of study population was 21.1±2 years (Table 1). Only 9.7% of pharmacy measurementswere taken in quiet environment (Figure 1). In study population, SBP, DBP, and HR measured by homeSMBP were significantly (p=0.00) higher than those measured by “pharmacies SMBP” (Table 2). However, nosignificant difference (p&gt;0.5) was found between measurements obtained by home SMBP and those obtained by“ pharmacies SMBP “ in quiet environment (Table 3). All of the equipment used in pharmacies were validatedelectronic sphygmomanometers (Figure 2).Conclusion: The environment significantly influenced measurements performed in pharmacies. Compared tohome SMBP, “private pharmacies SMBP” in our working context does not follow international guidelines and istherefore influenced by environment and measurement conditions.

S-15-2: COMMUNITY-BASED APPROACHES TO PREVENTION AND MANAGEMENT OF HYPERTENSION

There are multiple level factors that contribute to hypertension prevalence and control across various racial/ethnic populations. Hypertension rates in non-Hispanic Black (African American) adults in the USA are among the highest globally, impacted by the social determinants of health. Clinical approaches include team-based care, encouraging self-measured blood pressure, and strengthening community-clinical linkages. Prevention of new-onset hypertension and complications has been clearly demonstrated with community-level NaCl substitution in China and Peru. In the USA, Black population treatment approaches as community interventions include early initiatives from the Association of Black Cardiologists and the Healthy Heart Community Prevention Project (HHCPP) in New Orleans. The HHCPP was one of the early adopters of using barbers and hair stylists as hypertension control centers, working with faith-based institutions, and doing community education and outreach. Evidence-based approaches, now proven to be effective, include the faith-based treatment program for hypertension in New York, NY and a very successful in cluster-randomized trial demonstrating hypertension control in Black barbershops in Los Angeles, CA. The positive components of the Los Angeles barbershop intervention include trusted site of blood pressure intervention, physician-pharmacist collaboration, and effective anti-hypertensive medication including initial two drug protocol with amlodipine and a long-acting RAS blocker, and the appropriate use of aldosterone antagonists. Ongoing research include a small pilot study, simple text messaging and social support in New Orleans for medication adherence which will be reported at the AHA 2022 scientific sessions, and a large church-based health intervention study addressing primary prevention, including hypertension in New Orleans among 42 selected African American churches using community health workers in a combination of exercise weight-loss programs, self-monitoring blood pressure, glucose, and physical activity, and group education centers. In the USA, the American Heart Association in conjunction with the US Department of Health and Human services have initiated a national hypertension control initiative. Overarching strategies include patient and public education, community outreach and integration, and healthcare organization including provider and clinician training, as well as management evaluation of the project. This national program will engage community partners with federal health centers. In conclusion, hypertension can be controlled with evidence-based medicines, not only in clinical settings, but also with interventions in the community environment. Therapeutic lifestyle and evidence-based pharmacotherapy along with self-monitored blood pressure can lead to blood pressure control, especially in racial/ethnic populations.

The metabolic control and laboratory evaluation in patients with type 2 diabetes during the COVID-19 pandemic and the impact of telemedicine: a single-center experience

Abstract Objective: The study aimed to evaluate the metabolic control during the COVID-19 pandemic in subjects with type 2 diabetes mellitus (T2DM) and whether care through telemedicine significantly impacted it. Material and methods: This was a retrospective study for which three time-periods were prespecified: the COVID-19 pandemic period, pre-COVID-19 period, and before pre-COVID-19. The following information were collected: anthropometric and laboratory parameters (glycated hemoglobin (HbA1c), blood glucose, lipid profile, creatinine, eGFR, etc.), self-measured blood glucose (SMBG), blood pressure (BP), diabetes therapy, number of on-site and of telemedicine consultations. The mean values of all available measurements for HbA1c, SMBG, BP, weight, and body mass index (BMI) were calculated. Results: During the COVID-19 pandemic, the HbA1c values increased (6.78±0.77% to 6.96±0.87%, p&lt;0.0001; + 0.18±0.67%), despite treatment intensification (p&lt;0.01), while BMI and total cholesterol values slightly decreased (32.01±5.5 kg/m2 to 31.7±5.4 kg/m2, p&lt;0.0001, and 178.1±40.8 mg/dl to 170.5±38.4 mg/dl, p&lt;0.05). The deterioration of glycemic control (to HbA1c &gt;7%) were rather seen in males (to 7.01±0.92%, p&lt;0.0001), patients from rural areas (to 7.08±0.96%, p&lt;0.001) and younger than 65 y.o. (to 7.05±0.82%, p&lt;0.001). More male patients had a mean HbA1c increase of &gt;0.5% during the COVID-19 pandemic (32.3% vs 21.5%, p&lt;0.05). Patients who received more diabetes care visits through telemedicine had a more attenuated increase in HbA1c (6.79±0.80% to 6.90±0.83%, p&lt;0.05 vs 6.76±0.72% to 7.08±0.92%, p&lt;0.0001). Conclusions: The glycemic control slightly deteriorated during the COVID-19 pandemic (but with overall HbA1c within target), with certain patient categories being more affected. Diabetes care though telemedicine allowed the maintenance of the metabolic control.

Conventional office blood pressure measurements and unattended automated office blood pressure compared with home self-measurement and 24-h ambulatory blood pressure monitoring.

To assess whether automated office blood pressure (BP) (AOBP) measurement is a better method for measuring BP in the office than conventional techniques and an alternative to out-of-office BP measurements: home-self BP (HSBP) or ambulatory BP monitoring (ABPM). We conducted a cross-sectional study of 74 patients and compared AOBP with the conventional technique using a mercury sphygmomanometer and with both out-to-office BP measurements: HSBP of 7 days (three measurements in the morning, afternoon, and night) and daytime ABPM. In addition, we compared BP values obtained using HSBP and ABPM to determine their level of agreement. We used ANOVA to compare means, Bland-Altman, and intraclass correlation coefficients (ICC) for concordance. BP values obtained by the two office methods were similar: conventional 147.2/85.0 mmHg and AOBP 146.0/85.5 mmHg ( P > 0.05) with good agreement (ICC 0.85). The mean SBP differences between AOBP and HSBP ( P < 0.001) and between AOBP and ABPM ( P < 0.001) were 8.6/13.0 mmHg with limits of agreement of -21.2 to 38.5 and -18.4 to 44.3 mmHg, respectively. The average SBP values obtained by HSBP were 4.3 mmHg higher than those obtained by ABPM ( P < 0.01). Our study showed good agreement and concordance between the two office methods as well between the two out-to-office methods, although there was a significant difference in the mean SBP between the HSBP and ABPM. Moreover, AOBP was not comparable to either HSBP or ABPM; therefore, the estimation of out-to-office BP using AOBP is not supported.

Device-guided slow breathing with direct biofeedback of pulse wave velocity - acute effects on pulse arrival time and self-measured blood pressure.

There isevidence that device-guided slow breathing using biofeedback acutely reduces blood pressure (BP) and pulse wave velocity [i.e. increased pulse arrival time (PAT)]. The objectives of the study presented here were to test whether the results of changes observed in PAT in earlier studies are reproducible over 1 week and how changes in pulse wave velocity/PAT translate into absolute self-measured BP changes. Patients with a systolic BP 130-160 mmHg or treated essential hypertension (21 females/23 males) were trained to perform unattended device-guided slow breathing exercises for 10 min daily over 5 days. Furthermore, they were skilled to perform self-measurement of BP before and after the breathing exercise using a validated upper-arm device. Office BP at screening [median (1, 3. Q)] was 137 (132, 142)/83 (79, 87) mmHg. We observed a significant ( P < 0.05) increase in PAT of 5 ms (SD 12.5 ms) on average after 10 min of guided breathing and an additional 1 ms ( P < 0.05, SD 8 ms) during the following 5 min of spontaneous breathing compared to baseline. PAT before the exercise remained constant over 5 days paralleled by constant self-measured BP before the exercise. Device-guided breathing was associated with a significant reduction of self-measured SBP of 5 mmHg ( P < 0.01, SD 8 mmHg). Data furthermore demonstrated that these changes were highly reproducible over 1 week. Device-guided slow breathing and biofeedback lead to reproducible and favorable changes (increase) in PAT and SBP (decrease).

Implementing DASH-Aligned Meals and Self-Measured Blood Pressure to Reduce Hypertension at Senior Centers: A RE-AIM Analysis.

Low-income, minority seniors face high rates of hypertension that increase cardiovascular risk. Senior centers offer services, including congregate meals, that can be a valuable platform to reach older adults in underserved communities. We implemented two evidence-based interventions not previously tested in this setting: DASH-aligned congregate meals and Self-Measured Blood Pressure (SMBP), to lower blood pressure (BP) at two senior centers serving low-income, racially diverse communities. The study enrolled congregate meal program participants, provided training and support for SMPB, and nutrition and BP education. DASH-aligned meals delivered 40% (lunch) or 70% (breakfast and lunch) of DASH requirements/day. Primary outcomes were change in BP, and BP control, at Month 1. Implementation data collected included client characteristics, menu fidelity, meal attendance, SMBP adherence, meal satisfaction, input from partner organizations and stakeholders, effort, and food costs. We used the RE-AIM framework to analyze implementation. Study Reach included 94 older, racially diverse participants reflecting neighborhood characteristics. Effectiveness: change in systolic BP at Month 1 trended towards significance (-4 mmHg, p = 0.07); change in SMBP reached significance at Month 6 (-6.9 mmHg, p = 0.004). We leveraged existing community-academic partnerships, leading to Adoption at both target sites. The COVID pandemic interrupted Implementation and Maintenance and may have attenuated BP effectiveness. DASH meals served were largely aligned with planned menus. Meal attendance remained consistent; meal satisfaction was high. Food costs increased by 10%. This RE-AIM analysis highlights the acceptability, feasibility, and fidelity of this DASH/SMBP health intervention to lower BP at senior centers. It encourages future research and offers important lessons for organizations delivering services to older adults and addressing cardiovascular risk among vulnerable populations.