Seventh Joint National Committee Research Articles

Sex hormone-binding globulin levels and development of hypertension in middle-aged men and women.

To investigate the association between sex hormone-binding globulin (SHBG) levels, change in blood pressure and development of hypertension. In a community-based study, we examined 2816 middle-aged participants with focus on cardiometabolic risk factors in 2002-2005. A representative sample of 1954 men and women was invited to follow-up in 2012-2014 and 1327 were included in a second study visit. Mean follow-up time was 9.7 years. Blood pressure was measured according to the guidelines from the seventh Joint National Committee of Hypertension, and new cases of hypertension were recorded. SHBG was measured at baseline. The association between SHBG, blood pressure and new cases of hypertension was investigated using linear regression analyses and logistic regression analyses after excluding individuals treated with blood pressure-lowering drugs. Mean SBP and DBP at follow-up was 123 and 72 mmHg, respectively, and mean increase from baseline was 5.8 and 2.9 mmHg. During the follow-up time, 167 new cases of hypertension (16.1%) were identified. One standard deviation (SD) increase in SHBG at baseline was inversely associated with the risk to develop hypertension at follow-up (OR = 0.74, 95% CI 0.58-0.95) in the fully adjusted model. Moreover, one SD increase in SHBG was associated with a decrease in mean SBP (delta = -1.5 mmHg, 95% CI - 2.2 to -0.8) and DBP (delta = - 1.0 mmHg, 95% CI - 1.5 to -0.4), after adjusting for covariates. SHBG levels are inversely associated with development of hypertension and change in blood pressure levels independent of major risk factors.

Systolic Blood Pressure Is Associated with Increased Brain Amyloid Load in Mild Cognitively Impaired Participants: Alzheimer’s Disease Neuroimaging Initiatives Study

Background: Cardiovascular disease (CVD), including elevated blood pressure (BP), is known to promote Alzheimer’s disease (AD) risk. Although brain amyloid load is a recognized hallmark of pre-symptomatic AD, its relationship to increased BP is less known. The objective of this study was to examine the relationship of BP to brain estimates of amyloid-β (Aβ) and standard uptake ratio (SUVr). We hypothesized that increased BP is associated with increased SUVr. Methods: Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), we stratified BP according to the Seventh Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Classification (JNC VII). Florbetapir (AV-45) SUVr was derived from the averaged frontal, anterior cingulate, precuneus, and parietal cortex relative to the cerebellum. A linear mixed-effects model enabled the elucidation of amyloid SUVr relationships to BP. The model discounted the effects of demographics, biologics, and diagnosis at baseline within APOE genotype groups. The least squares means procedure was used to estimate the fixed-effect means. All analyses were performed using the Statistical Analysis System (SAS). Results: In non-ɛ4 carrier MCI subjects, escalating JNC categories of BP was associated with increasing mean SUVr using JNC-4 as a reference point (low-normal (JNC1) p = 0.018; normal (JNC-1) p = 0.039; JNC-2 p = 0.018 and JNC-3 p = 0.04). A significantly higher brain SUVr was associated with increasing BP despite adjustment for demographics and biological variables in non-ɛ4 carriers but not in ɛ4-carriers. This observation supports the view that CVD risk may promote increased brain amyloid load, and potentially, amyloid-mediated cognitive decline. Conclusion: Increasing levels of JNC classification of BP is dynamically associated with significant changes in brain amyloid burden in non-ɛ4 carriers but not in ɛ4-carrier MCI subjects. Though not statistically significant, amyloid burden tended to decrease with increasing BP in ɛ4 homozygote, perhaps motivated by increased vascular resistance and the need for higher brain perfusion pressure.

Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura

Introduction: Prehypertension is defined as an independent category of blood pressure (BP) by the seventh joint national committee on prevention, detection, evaluation, and treatments of BP. Systolic BP (SBP) between 120 and 139 mm Hg or diastolic BP between 80 and 89 mm Hg are considered to have prehypertension. BP ≥140/90 mm Hg is considered hypertension. It is to assess the prevalence of prehypertension and hypertension among urban school-going children. Materials and Methods: A cross-sectional study was conducted among 1011 school-going children of both sexes within 12–17 years of age group and each participant was selected using a simple random sampling technique. Pretested predesigned questionnaire was used for data collection. Results: Prevalence of normotensive, prehypertensive, and hypertensive were 73.6%, 19.4%, and 7%, respectively, when both systolic and diastolic components have been taken into account. Conclusion: This study has showed that more than 19% prehypertensive and 7% hypertensive among the school-going children aged between 12 and 17 years when both systolic and diastolic components have been taken into account.

Plasma Adiponectin and Blood Pressure Progression in African Americans: The Jackson Heart Study.

Little is known on the association of plasma adiponectin with blood pressure (BP) changes in African Americans (AAs). We evaluated the associations between plasma adiponectin and BP progression among AAs. We analyzed data from 1,184 participants without hypertension at baseline (2000-2004) with ≥1 follow-up visits in the Jackson Heart Study. We used robust Poisson regression to generate risk ratios (RRs) for BP progression (an increase by ≥1 BP stage) and incident hypertension. Over a median of 7 years, 71% progressed to higher BP stage and 65% developed hypertension. We found evidence of interaction by sex (P-interaction = 0.088). Compared with those in the lowest quartile (Q1), male participants in the highest adiponectin quartile (Q4) had reduced risks of BP progression (RR 0.76 [95% confidence interval, CI, 0.60-0.96]) and incident hypertension (RR 0.74 [95% CI 0.56-0.97]). After accounting for body mass index, this relation persisted among obese men (RR for the highest [vs. lowest] adiponectin quartile: 0.59 [95% CI 0.36-0.97] for incident hypertension, and 0.69 [95% CI 0.45-1.06] for BP progression). Among women, adiponectin was not associated with BP outcomes (RR [95% CI] for Q4 vs. Q1: 1.03 [0.86-1.23] and 1.01 [0.83-1.23] for BP progression and incident hypertension, respectively). Our findings were consistent across both the American College of Cardiology (ACC)/American Heart Association (AHA) and Seventh Joint National Committee (JNC-7) BP categories. In a large, community-based sample of AAs, higher adiponectin concentrations were associated with lower risks of BP progression and incident hypertension in men, but no significant association was observed in women.

Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study.

High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90mmHg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80mmHg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.

The Association of Obstructive Sleep Apnea and Hypertension.

Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. Hypertension (HTN) is defined by the presence of a chronic elevation of systemic arterial pressure above a certain threshold value (≥140 mm Hg systolic or ≥90 mm Hg diastolic). On the surface, OSA and HTN appear very different from one another. Despite this, they share several common risk factors including obesity, male gender, and advancing age. In 2003, the Seventh Joint National Committee (JNC VII) recognized OSA as a secondary cause of HTN. As physicians, our goal is to understand the OSA-HTN association better through academic study regarding its epidemiology, its pathophysiology, and its treatment.

Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals.

The Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in US adults with hypertension by 2022. We used the validated Blood Pressure Control Model to quantify changes in clinic-based hypertension management processes needed to attain ≥80% blood pressure control. The Blood Pressure Control Model simulates patient blood pressures weekly using 3 key modifiable hypertension management processes: office visit frequency, clinician treatment intensification given uncontrolled blood pressure, and continued antihypertensive medication use (medication adherence rate). We compared blood pressure control rates (using the Seventh Joint National Committee on hypertension targets) achieved over 4 years between usual care and the best-observed values for management processes identified from the literature (1-week return visit interval, 20%-44% intensification rate, and 76% adherence rate). We determined the management process values needed to achieve ≥80% blood pressure control in US adults. In adults with uncontrolled blood pressure, usual care achieved 45.6% control (95% uncertainty interval, 39.6%-52.5%) and literature-based best-observed values achieved 79.7% control (95% uncertainty interval, 79.3%-80.1%) over 4 years. Increasing treatment intensification rates to 62% of office visits with an uncontrolled blood pressure resulted in ≥80% blood pressure control, even when the return visit interval and adherence remained at usual care values. Improving to best-observed values for all 3 management processes would achieve 78.1% blood pressure control in the overall US population with hypertension, approaching the ≥80% Million Hearts 2022 goal. Achieving the Million Hearts blood pressure control goal by 2022 will require simultaneously increasing visit frequency, overcoming therapeutic inertia, and improving patient medication adherence. As the relative importance of each of these 3 processes will depend on local characteristics, simulation models like the Blood Pressure Control Model can help local healthcare systems tailor strategies to reach local and national benchmarks.

National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007\u20132011)

BackgroundThe current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran.MethodsThis study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15–19 years, data collected in four repeated cross-sectional surveys (2007–2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed.ResultsUsing the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68–2.79 and 1.92, 95% CI 1.57–2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65–3.51 and 1.82, 95% CI 1.36–2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01–1.75).ConclusionThe current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.

The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh.

We analyzed the Bangladesh Demographic and Health Survey 2011 data to examine absolute differences in hypertension prevalence according to the hypertension definition of the "2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" and "Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7)" 2003 guidelines. Among 7839 participants ≥35 years, the JNC7 and 2017 ACC/AHA classified 25.7% (95% confidence interval (CI): 24.5-27.0%) and 48.0% (95% CI: 46.4-49.7%) people hypertensive, respectively. The JNC7 prevalence was 19.4% (95% CI: 18.0-21.0%) among males and 31.9% (95% CI: 30.1-33.6%) among females. The prevalence was 41.4% (95% CI: 39.4-43.5%) among males and 54.5% (95% CI: 52.4-56.4%) among females as per the 2017ACC/AHA guideline. From JNC7 to 2017 ACC/AHA, the overalldifference in prevalence was 22.3% (95% CI: 19.8-24.8%). Males and females had similar differences, 22.0% (95% CI: 18.3-25.7%) and 22.6% (95% CI: 19.4-26.0%), respectively. As per the 2017 ACC/AHA guideline, >50% prevalence was observed among people with body mass index ≥25 kg/m2, college-level education, co-morbid diabetes, richest wealth quintile, females, age ≥55 years, urban residence, or living in Khulna, Rangpur or Dhaka divisions; the absolute difference was >20% in most categories. We found a substantial increase in the prevalence of hypertension due to change in blood pressure thresholds as per the 2017 ACC/AHA guideline. We recommend conducting more comprehensive population-based studies to estimate the recent burden of hypertension in Bangladesh. Future studies should estimate similar prevalence in other countries.

Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study

Background: The monitoring of hypertension treatment can provide insight into the rational drug use pattern. The objective of this study was to examine the antihypertensive medication use among South Indian adults with hypertension in compliance with the hypertension treatment guidelines (Seventh Joint National Committee [JNC 7] and JNC 8). Methods and Results: A total of 550 hypertensive people aged >25 years were included in this retrospective cross-sectional study. The order of drugs prescribed in the year 2012 was beta blockers (BB) > calcium channel blockers (CCB) > CCB + BB > angiotensin receptor blockers (ARB) > angiotensin-converting enzyme inhibitors (ACEI) > thiazide diuretics, whereas in the year 2014, the order has changed drastically, namely, ACEI > CCB > ARB > BB > thiazide diuretics (P < .001). Most notably, there was a large increase in the use of monotherapy (from 56.9% to 82.5%, P < .001). The usage of BB has simply moved from the first position to the last position in concordance with JNC 8 guidelines, whereas use of thiazide diuretics was found to be the least preferred drug in the 2012 prescriptions, thus deviating from JNC 7 guidelines. The use of generic names (28.3% vs 11.3%) and National List of Essential Medicines (NLEM) compliance (79.3% vs 60.9%) were significantly more in the calendar year 2012 than in the calendar year 2014 (P < .001). Conclusions: Antihypertensive medication use has gone through wide variations among south Indian adults with hypertension. Combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals.

Blood pressure goal for the elderly Chinese: the findings from the Northern Shanghai Study

ABSTRACTBackground: The Eighth Joint National Committee Panel (JNC8) recommended a novel blood pressure (BP) goal for individuals with hypertension, which was less stringent than the Seventh Joint National Committee (JNC7) guideline and is still under debate. In our study, we aimed at finding a better BP goal for the elderly Chinese. Methods: About 1599 community-based elderly participants were recruited in the northern Shanghai and were classified by chronic kidney disease or diabetes mellitus to investigate their BP control conditions based on both the JNC7 and JNC8. Then, participants were categorized into four groups: normotensive individuals (Group 1), individuals at BP goal by JNC7 (Group 2), individuals at BP goal by JNC8 but not by JNC7 (Group 3), and individuals not at-goal by both guidelines (Group 4). Patients’ hypertensive target organ damages as left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), pulse wave velocity (PWV), etc. were evaluated. Results: According to the JNC8, 19.0% of the population were reclassified as at-goal. Group 4 had significantly greater LVMI than Group 2 (96.5 vs 91.5 g/m2, p < 0.05) and also had significantly greater E/Ea (10.3 vs 9.7 and 10.3 vs 9.7, p < 0.05) and PWV (10.3 vs 9.3 m/s and 10.3 vs 9.7 m/s, p < 0.05) than both Group 2 and Group 3; however, there were no significant differences of these variables between Group 2 and Group 3. Conclusion: In the community-based elderly Chinese, the JNC8 hypertension guideline may set a better BP goal than the JNC7 in identifying patients’ left ventricular diastolic dysfunction and arterial stiffening.

OP.2C.06] OPTIMAL BLOOD PRESSURE GOAL FOR THE ELDERLY CHINESE

Objective: The Eighth Joint National Committee Panel recommended novel blood pressure (BP) goals for individuals with hypertension, which is still under debate. We therefore assessed patients’ target organ damages in controlled hypertensives defined by the Seventh or Eighth Joint National Committee thresholds (JNC7 and JNC8) in a community-based elderly Chinese population, in order to find the optimal BP goal for the elderly Chinese. Design and method: 1599 community-based elderly participants (age >65 years old) were recruited in the northern Shanghai. Participants were classified by chronic kidney disease (CKD) or diabetes mellitus (DM) to investigate the conditions of their BP control based on both the JNC7 and JNC8. Then participants were categorized into 4 groups: normotensive individuals (Group1), individuals at BP goal by JNC7 (Group2), individuals at BP goal by JNC8 but not by JNC7 (Group3), and individuals not at goal by both guidelines (Group4). Patients’ hypertensive target organ damages as left ventricular mass index (LVMI), peak transmitral pulsed Doppler velocity / early diastolic tissue Doppler velocity (E/Ea), pulse wave velocity (PWV), carotid intima-medium thickness (CIMT), urinary albumine-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were evaluated. Results: According to the JNC7, 48.5% of the entire population were at BP goal, while 67.5% were at-goal by the JNC8, including 19.0% reclassified as at-goal. Group4 had significantly greater LVMI than the group2 (96.5 vs 91.5 g/m2, p < 0.05), and also had significantly greater E/Ea (10.3 vs 9.7 and 10.3 vs 9.7, p < 0.05) and PWV (10.3 vs 9.3 m/s and 10.3 vs 9.7 m/s, p < 0.05) than both the group2 and group3, however, there were no significantly differences of these variables between group2 and group3. Conclusions: In the community-based elderly Chinese, 32.5% of the entire population remained uncontrolled BP by JNC8, but 19% were reclassified as at-goal. The reclassified group did not have more target organ damages than the original at-goal group, so BP criteria by JNC8, but not by JNC7, would be more beneficial for the elderly Chinese.

A study on the prevalence and awareness of hypertension among women in the reproductive age group and the factors contributing to it in a rural area of Jorhat district, Assam

Background: Hypertension has been identified as one of the major causes of morbidity and mortality in both developed and developing nations. Prevalence is seen to be increasing in the rural areas, especially among the females in the reproductive age group. The prevalence of hypertension is found to be high in Assam, while the awareness is quite low thus necessitating a study in this regard.Methods: A total of 400 women in the reproductive age group were selected from Bagchung block, Jorhat by Simple Random Sampling. They were interviewed and their blood pressure was measured along with some anthropometric variables. Classification of hypertension was done as per the US Seventh Joint National Committee (JNC 7) report on the prevention, evaluation and treatment of high BP.Results: A total of 23.5% prevalence of hypertension was found among the study subjects. 44.5% of the total was in the pre hypertensive stage. 77% of them had heard of hypertension while only 20% were aware of its side effects. Extra salt intake, family history and underlying medical conditions were the major risk factors.Conclusions: Knowledge, awareness on hypertension in women in this part of the district is poor and the prevalence is high and their life style practices are grossly contributing to it. Therefore, efforts should be geared towards improving the levels of awareness of the women regarding hypertension and the risk factors.

The Elusive Search for Optimal Blood Pressure Targets.

BP treatment thresholds/targets determine when to initiate treatment and to what level BP should be reduced. The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80mmHg for patients with diabetes or chronic kidney disease. Subsequently, meta-analyses, retrospective studies relating on-treatment BP to clinical outcomes and two large, randomized clinical trials (RCTs) have re-evaluated BP targets. In Action to Control Cardiovascular Risk in Diabetes (ACCORD), a systolic blood pressure (SBP) <120mmHg was found not to be superior to SBP <140mmHg in diabetics. In SPRINT (Systolic Blood Pressure Intervention Trial) which studied a different population, the lower target resulted in a 25% cardiovascular event reduction. Despite unresolved issues, certain recommendations can be made with confidence. SBP >160mmHg should, with rare exceptions, be treated. The historical threshold/target of 140/90mmHg remains reasonable in most patients in identifying "treatable" risk, i.e., risk high enough to justify treatment and for which available treatment is effective enough to result in significant endpoint reduction. Above 140/90mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD. The advisability of initiating or intensifying treatment with BPs in the 130s remains equivocal. The next steps in the search for more precise BP targets should include (1) standardization of BP measurement techniques and (2) well-designed RCTs evaluating a treatment target of SBP <130 in carefully categorized patient populations.

Switching of antihypertensive drugs at Tertiary Care Government Hospital, Hyderabad, India: A cross-sectional retrospective investigation.

OBJECTIVE:Switching of antihypertensive drugs is attributed to uncontrolled blood pressure (BP) which imposes a great burden on health economics. But again, switching leads to accomplishment of the goal BP, thereby improving the health status. Such studies are well documented in developed nations but rarely reported in developing countries, especially in India. Therefore, the aim of this study was to evaluate various factors associated with switching of antihypertensive drugs.METHODS:A cross-sectional retrospective investigation was performed using a standardized schedule adapting the World Health Organization indicators for drug utilization in a tertiary care government hospital, Hyderabad, India. A total of 429 prescriptions were monitored for a switchover to a different antihypertensive drug in 180 days.RESULTS:The results revealed that the duration of hypertension (HTN) >5–10 years (adjusted odds ratio [aOR] = 3.73, P < 0.05), two or more symptoms of HTN (aOR = 3.42, P < 0.05), 2014 prescriptions (aOR = 4.54, P < 0.001), polytherapy (aOR = 2.85, P < 0.001), noncompliance to National List of Essential Medicine (NLEM) (aOR = 1.631, P < 0.05), and systolic BP (SBP) (aOR = 1.77, P < 0.05) were the predictors, which were highly likely to switch (38.5%) the antihypertensive drugs. Diuretics (0.7%) were poorly prescribed, the first line of therapy suggested by Seventh Joint National Committee (JNC VII). Stepwise logistic regression analysis revealed, the calendar year 2014 (odds ratio [OR] = 3.23, P < 0.001), polytherapy (OR = 2.5, P < 0.001), and the level of SBP ≥140 mmHg (OR = 1.82, P < 0.01) as the three major predictors which showed a likelihood of switching medication.CONCLUSIONS:Findings of the study reveals predictors of the switchover like uncontrolled SBP, duration of HTN, compliance with the list of NLEM drugs, polytherapy, enabling the clinicians to critically analyze the patients' profile, and hence, reach target BP soon, i.e., decreased cardiovascular risk.

Non Compliance Pattern of Anti Hypertensive Treatment

A cross-sectional type of observational study was conducted on hypertensive patients attending at medicine department (OPD and admitted) of Z. H. Sikder Women’s Medical College Hospital, Dhaka, from January to June 2014, to see the patient compliance of anti-hypertensive drugs. The sample size was 185. Patients with evidence of hypertension as per Seventh Joint National Committee Criteria’ (defined as systolic blood pressure &gt;140 mm oh Hg or diastolic blood pressure &gt;90 mm of Hg or use any anti-hypertensive medication, regardless of blood pressure. Time from initiation of antihypertensive treatment was at least 3 months and patients between 18-70 years were included in this study. A pre-tested questionnaire was used to gather sociodemographical and relevant epidemiological data. Standard blood pressure measurement was recorded as the average of 2 measurements to detect anti-hypertension. Patients were asked for their reasons of noncompliance, knowledge regarding importance of compliance, side effects of drugs and family support. Mean age of the patients was 47.40(±5.09) years. 75.9% of the non adherent population is in the 41-50 years age group. 85% percent of the patients were found non-adherent to treatment. Out of 158 non adherent population, 54.43% were male and 45.57% were female. 38.6% of the non-adherent people have no education or a primary education, only 7.6% were graduate and above. 42.41% of the non-adherent people were poor and earning &lt; 5000 taka/month. Majority duration of disease ranged from 1 to 15 years which was 50%, with an average of 3.99(±3.47) years. The most commonly prescribed antihypertensive medicine was beta blockers. 49.4% of the non-adherent population was advised to take relatively costly antihypertensive drug (Calcium channel blocker, ACEI, ARB). The main reason for not taking the medication was forgetfulness (48.1%) and the economic reason for non-compliance was only 7.59%. About 63% patients felt hypertension is not a curable disease, 42% 0f the study subjects were not sure about the signs and symptoms of HTN and another 30.6% said that HTN had no definite sign symptom.77.4% of the respondent said that preservation of previous prescription is important to understand HTN status. The overall Knowledge on complication of uncontrolled hypertension of the adherent people was relatively higher than that of nonadherent people. 96.4% of the adherent people knew that uncontrolled hypertension can cause brain stroke, whereas only 81.65% of the non-adherent people knew that. Most of the respondent of the both adherent and non-adherent group informed that hypotension, severe weakness, anorexia, nausea and impotency were the important side effect of antihypertensive drugs. Most of the (87.5%) participant went for follow up when they felt hypertensive, 35% change medicine for expenses and 27% stop taking drug when BP is under control. 78% did not know whether only regular anti-hypertensive can prevent complication or not, 62% of the respondent did not think that to buy drug is wastage of money. One-third of the respondent said that they were never asked to take medicines or visit physician by their family members. And half of the respondents had to depend on monetary support of the family member for treatment. 99.36% of non-adherent missed their follow up.J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 108-116

OS 18-08 OPTIMAL BLOOD PRESSURE GOAL FOR THE ELDERLY CHINESE

Objective:The Eighth Joint National Committee Panel recommended novel blood pressure (BP) goals for individuals with hypertension, which is still under debate. We therefore assessed patients’ target organ damages in controlled hypertensives defined by the Seventh or Eighth Joint National Committee t

Data-Driven Markov Decision Process Approximations for Personalized Hypertension Treatment Planning.

Background: Markov decision process (MDP) models are powerful tools. They enable the derivation of optimal treatment policies but may incur long computational times and generate decision rules that are challenging to interpret by physicians. Methods: In an effort to improve usability and interpretability, we examined whether Poisson regression can approximate optimal hypertension treatment policies derived by an MDP for maximizing a patient’s expected discounted quality-adjusted life years. Results: We found that our Poisson approximation to the optimal treatment policy matched the optimal policy in 99% of cases. This high accuracy translates to nearly identical health outcomes for patients. Furthermore, the Poisson approximation results in 104 additional quality-adjusted life years per 1000 patients compared to the Seventh Joint National Committee’s treatment guidelines for hypertension. The comparative health performance of the Poisson approximation was robust to the cardiovascular disease risk calculator used and calculator calibration error. Limitations: Our results are based on Markov chain modeling. Conclusions: Poisson model approximation for blood pressure treatment planning has high fidelity to optimal MDP treatment policies, which can improve usability and enhance transparency of more personalized treatment policies.

Blood Pressure-Related Outcomes in a Diabetic Population.

See related article, pp 71–77 There has been significant controversy during the past decade about what is appropriate blood pressure control to optimally reduce cardiovascular disease– (CVD) and kidney disease–related events in patients with diabetes mellitus. The recent discussion on blood pressure targets in diabetes mellitus sets the stage for a thought-provoking contribution by Wu et al1 who reported that individuals with diabetes mellitus with persistently low pressures <120/80 mm Hg or pressures that drop below 120/80 mm Hg have an increase in CVD events and mortality over time. On the basis of data derived from larger clinical trials in those with diabetes mellitus, the seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure advised a 130/80 mm Hg target.2 However, achieved systolic blood pressures in those trials were rarely below 130/80 mm Hg and limited to only a few studies.3,4 The Action of Control Cardiovascular Risk in Diabetes (ACCORD) trial was then designed to investigate whether targeting pressures in patients with diabetes down to 120/80 mm Hg would improve CVD outcomes to a greater extent than a goal of <140/90 mm Hg. At end of trial, the overall CVD results were null, but stroke was reduced in those with achieved pressures of <120/80 mm Hg.5 Another recent trial, the Systolic Blood Pressure Intervention Trial (SPRINT), was designed to investigate whether pressures <120/80 mm Hg would improve outcomes in patients with kidney disease compared with 140/90 mm Hg. The SPRINT investigators reported an improvement in fatal and nonfatal major CVD events in the intensive arm <120/80 mm Hg.6 Although …

Antihypertensive Drugs and Male Sexual Dysfunction

Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends. Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner. Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations. Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.