Systolic Blood Pressure Control Research Articles

Abstract 4138494: Remote Blood Pressure Monitoring and Intervention as a better and cost-effective method of Hypertension control compared to Usual care: A Systematic Review

Introduction/Background: Hypertension is a leading cause of morbidity and mortality. Despite treatment recommendations and encouragement of lifestyle changes, the actual rate of blood pressure control is still not at par. Remote intervention methods have been shown to achieve better rates of blood pressure control utilising lesser resources and lower healthcare costs. We conducted a systematic review by qualitatively evaluating the potential impact of remote monitoring and interventions compared to usual care in controlling Hypertension. Research Question: Are remote monitoring techniques and interventions better than usual in-person blood pressure checks for hypertension control? Methods: We did a comprehensive literature search of Pubmed/MEDLINE, Google scholar, Cochrane central Library, PLOS ONE, ScienceDirect and Clinicaltrials.gov to identify eligible randomised control trials and clinical trials published between July 2013 and May 2025. A Risk of Bias assessment was conducted using Cochrane Risk of Bias tools such as ROB-2 for randomised control trials and ROBINS-1 for cohort studies. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 5,185 records analysed, 10 randomised control trials, 1 cohort study and 1 implementation study satisfied our inclusion criteria. Compared to usual care, remote monitoring methods showed significant difference in systolic blood pressure control at 6-12 months in 9 out of 12 studies, while 3 studies did not show any significant difference. Quality of life, physical health, mental health and drug compliance have also shown a significant positive difference in patients. Remote self monitoring interventions were found to be more cost-effective than usual care. They also reduced the load of patients seeking appointments for hypertension control thereby improving the quality of patient care. Conclusion: The management of clinical hypertension is a challenging entity. Conventional methods of regular in-office blood pressure checks are both tedious and resource consuming. Using remote monitoring methods have shown to significantly improve blood pressure control compared to routine methods. It also eliminates white-coat hypertension during follow-up blood pressure checks which leads to more appropriate interventions. Remote monitoring and intervention for hypertension control is time-effective, cost-effective and improves quality of life.

Time in target range for systolic blood pressure and glucose with cardiovascular disease and all-cause mortality risks.

Evidence on the combined effect of time in the target range (TTR) for systolic blood pressure (SBP) and fasting blood glucose (FBG) in real-world settings was scarce. We aimed to evaluate the separate and combined effects of SBP TTR and FBG TTR on cardiovascular disease (CVD) and all-cause mortality risks among participants with comorbidity of hypertension and diabetes. The data was derived from the Kailuan study. The target ranges for SBP and FBG were set as 110-140 mmHg and 3.9-7.0 mmol/L, and linear interpolation to calculate TTR. Cox proportional hazard regression models were used to estimate the separate and combined effects of SBP TTR and FBG TTR on CVD and all-cause mortality risks. We included 11,899 participants with hypertension and diabetes comorbidity whose mean age was 54.52 ± 10.36 years, and 9,873 (83.00%) were male. After a follow-up of 6.67 years, 1,381 cases of CVD and 2,148 cases of all-cause mortality were documented. In the fully adjusted model, compared with the participants with both SBP TTR and FBG TTR lower than 25%, participants with both greater SBP TTR and FBG TTR had the lowest risks of CVD (HR: 0.53; 95%CI: 0.57-0.78) and mortality (HR: 0.59; 95%CI: 0.47-0.74). Per 1 SD increase in SBP TTR was associated with a 14% reduction in CVD risk (HR, 0.86; 95% CI, 0.80-0.92) and a 10% reduction in mortality risk (HR, 0.90; 95% CI, 0.85-0.95), all significant results were maintained in the FBG TTR analyses. Both higher SBP TTR and FBG TTR were associated with lower risks of CVD and all-cause mortality in participants with comorbidity of hypertension and diabetes. Simultaneous control of SBP and FBG within the target ranges is a beneficial strategy for CVD prevention.

Pharmacist care for hypertension management among patients with diabetes: a systematic review

Abstract Background Improving blood pressure (BP) control is of major importance among patients with diabetes, due to their high risk of micro- and macrovascular complications. Community-based models of care with the involvement of pharmacists and other nonphysician healthcare providers can help manage hypertension. We aimed to estimate the effectiveness of pharmacist interventions, alone or in collaboration, on BP among outpatients with diabetes and hypertension. Methods We conducted systematic searches of randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients with hypertension and diabetes compared to usual care. The outcome was the systolic and diastolic BP change or BP control. We performed a meta-analysis with random effects models and results are presented by mean difference along with relative 95% CI.We will perform subgroup analyses for the types and intensity (duration, frequeny) of pharmacist interventions, patients’ characteristics, and healthcare settings. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal. Results Out of 2048 study records identified by electronic database searching, we included 9 studies, with 5067 participants, published between 2008 and 2022. These studies were conducted mainly in North America (n = 5; other regions: n = 4). The intervention was led by the pharmacist in 78% of the studies and in collaboration with other healthcare providers in 22%. Pharmacist intervention included patient education in 67%, healthcare providers education in 11% of studies and feedback to healthcare providers in 44% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.6 mmHg (95% CI: -10.6 to -0.6) and -4.1 mmHg (95% CI: -7.1 to -1.2) respectively. Additional analyses will be presented at the congress. Conclusions Pharmacist interventions improve blood pressure control in hypertensive diabetic outpatients. Key messages • Recent hypertension guidelines recommend pharmacist involvement in hypertension care management. • This systematic review provide updated evidence on the effect of pharmacist interventions on hypertension management of patients with diabetes.

Association of different timepoint and threshold of time-in-target-range and MACEs: insight from the SPRINT study

Abstract Objective To evaluate the prognostic value of different timepoint and threshold of systolic blood pressure (SBP) Time in Target Rang (TTR) in Major Adverse Cardiovascular Events (MACEs). Method This is a post-hoc analysis of the SPIRNT (Systolic Blood Pressure Intervention Trial). Participants with complete record of BP values and no adverse events occurred in the initial 2-years follow-up were enrolled. Different SBP TTR indexes was calculated by different timepoint (3 month,12 month,24 month) and threshold (110-130mmHg;110-140mmHg;110-130mmHg for intensive treatment group and 120-140mmHg for standard treatment group) (Fig 1). The primary outcome was major adverse cardiovascular events (MACEs) occurred 2 years later, defined as the composite of myocardial infarction, stroke, heart failure and cardiovascular death. Results A total of 7134 participants in SPIRNT were enrolled in this study. Those SBP TTR indicators with independent predictive value of MACEs were selected by a multivariable COX model adjusted for traditional cardiovascular risk factors (Fig 2). SBP TTR calculated with 110-140mmHg window in 3 months (3month SBP TTR110-140) was considered to be the best predictor of MACEs occurred 2 years later among selected SBP TTR indexes according to c statistics and relative informativeness (Table1). The restricted cubic spline plot was used to evaluate the nonlinear trend of the TTR indicator. In addition, we obtain the cut-off value by looking for the point in the RCS curve with the largest slope change. 0.65 was considered to be the best truncation for 3month SBP TTR110-140(Fig 3). Patients with 3month TTR110-140 greater than 0.65 had 23.9% lower incidence of MACEs than patients with TTR less than or equal to 0.65 (HR 0.761[0.592-0978], P=0.033).(Table 2) In addition, for patients with early SBP control (3month SBP TTR110-140 >0.65), there was no significant difference in mean SBP between 110-130 mmHg and 130-140 mmHg (Fig4 Group1 Vs Group2). Lasso regression also suggests that TTR110-140 has more informatics advantages than TTR110-130 in cox model at different timepoints (Fig5). Conclusions 3month SBP TTR110-140 was considered to be the best predictor of MACEs occurred 2 years later in different SBP TTR indexes, which indicated the importance of early SBP control. This study also proposed 0.65 as the critical value of 3-month SBP TTR110-140 for prevention of the incident of MACEs. In the future, more cohort studies are needed to expend these findings.

Impact of appendicular skeletal muscle mass on effect of intensive blood pressure control

Abstract Background Appendicular skeletal muscle mass (ASM) is associated with cardiovascular diseases (CVDs) and chronic kidney diseases (CKDs). However, whether low ASM affects the efficacy of intensive systolic blood pressure control is currently uncertain. Purpose To examine the impact of low ASM on the effects of intensive SBP control on cardiovascular and kidney outcomes. Methods Data from the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trials was used. The primary outcome was a composite of myocardial infarction, acute coronary syndrome without myocardial infarction, stroke, heart failure, and cardiovascular death. The prespecified incident CKD was defined as a >30% decrease in estimated glomerular filtration rate to a value <60 mL/min/1.73 m2. Results A total of 14,017 patients were included in this study, 2203 (15.7%) of whom had low ASM. Over a median follow-up of 3.26 years, 1,032 primary outcomes and 460 incident CKD were observed. Patients with low ASM had a significantly higher risk of primary outcome and CKD. Intensive SBP control effects on cardiovascular outcomes were not significantly different on a relative scale or absolute scale. But low ASM significantly amplified the increased risk of CKD associated with intensive SBP control, on an absolute scale (P for interaction = 0.04). Conclusions Low ASM is one of the markers of increased risk of CVD and CKD, and it did not affect the cardiovascular benefits of intensive treatment, but significantly amplified the increased risk of CKD associated with intensive SBP control.

The effect of digital therapeutics intervention on improving hypertension management in adults: a meta-analysis of randomized controlled trial.

Digital therapeutics (DTx) intervention is an emerging therapy for the treatment and long-term management of hypertension. We aim to systematically evaluate the overall effect of DTx intervention on improving hypertension management. The systematic review and meta-analysis of RCTs was conducted and the PubMed, EMBASE, Web of Science, and Cochrane Library were searched to identify eligible RCTs published between Jan 1, 1982 and Sep 10, 2023. Random-effect models were utilized to pool estimates of net changes in systolic blood pressure (BP), diastolic BP, BP control rate, body mass index, weight, waist circumference, and physical activity between the DTx group and control group. 15 RCTs were included with a total of 3789 participants. Compared with the control group, DTx intervention was associated with significant changes in systolic BP, diastolic BP, and BP control rate of -3.75 mmHg(95% CI -5.74 to 1.77), -1.79 mmHg (95% CI -2.81 to -0.77) and 1.47% (95% CI 1.10 to 1.95), respectively. In addition, DTx intervention was statistically significant for improving other risk factors such as lower BMI (-0.5 kg/m2, 95% CI -0.86 to -0.15), increased physical activity (66.73 min/week, 95%CI 49.64 to 83.81), and reduced waist circumference (-2.91 cm, 95% CI -5.15 to -0.66). No difference between groups was demonstrated in weight (P = 0.30). Subgroup analyses revealed consistent effects of the change in SBP and DBP across study duration, age, sample size, patient baseline status, and intervention scenario settings(P > 0.05). DTx intervention may be useful for lowering BP and long-term management of hypertension. More large-size trials providing evidence on the same product are needed.

Hypertension Control Is Associated with Telomere Length in Older Adults.

Hypertension is the leading risk for cardiovascular disease and worldwide mortality. Uncontrolled blood pressure worsens with age and its control is part of public health strategies especially for older adults. Telomere length (TL) has been associated with hypertension, with age and sex as relevant confounding factors, but it is not clear whether hypertension control in older adults impacts on TL and if this relationship is consistently age and sex dependent. TL was assessed in leukocytes of 369 hypertensive patients. Individuals were >60 years male (169) and female (200) and have been diagnosed and treated for hypertension for at least four years. TL was measured by RT-PCR using a commercial probe. Regression models were developed considering systolic and diastolic blood pressure control as dependent variables and age, sex, glucose, and lipid levels as confounding factors. TL showed a mean of 7.5 ± 5.1 Kb, and no difference between males and females was observed. We identified a significant association between systolic blood pressure control and TL (p value = 0.039) and a trend for diastolic blood pressure (p value = 0.061). These observations confirm and expand previous reports showing that hypertension control can have an impact on TL and consequently on other factors of healthy aging.

Development of a risk predication model for critical care needs in patients with intracerebral hemorrhage: a retrospective cohort.

It is very important to provide the correct nursing care for patients with intracerebral hemorrhage (ICH), but the level of critical care needs in patients with intracerebral hemorrhage is not clear. The purpose of this study is to establish a risk model based on the epidemiological and clinical characteristics of ICH patients, to help identify the critical care needs of ICH patients. The clinical data of ICH patients from January 2018 to September 2023 were analyzed retrospectively. The full cohort was used to derive the clinical prediction model and the model was internally validated with bootstrapping. Discrimination and calibration were assessed using the area under curve (AUC) and the Hosmer-Lemeshow tests, respectively. 611 patients with ICH were included for model development. 61.21% (374/611) ICH patients had received critical care interventions. The influencing factors included in the model were Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, past blood pressure control, systolic blood pressure on admission and bleeding volume. The model's goodness-of-fit was evaluated, which yielded a high area under the curve (AUC) value of 0.943, indicating a good fit. For the purpose of model validation, a cohort of 260 patients with ICH was utilized. The model demonstrated a Youden's index of 0.750, with a sensitivity of 90.56% and a specificity of 78.22%. GCS, systolic blood pressure, intraventricular hemorrhage, bleeding volume and past blood pressure control are the main factors affecting the critical care needs of patients with ICH. This study has deduced a clinical predictive model with good discrimination and calibration to provide scoring criteria for clinical health care providers to accurately evaluate and identify the critical care needs of ICH patients, to improve the rational integration and allocation of medical resources.

In-hospital systolic blood pressure lowering patterns and risk of rehospitalization for angina in patients with hypertension and coronary artery disease.

This study aimed to examine the association between in-hospital systolic blood pressure (SBP) lowering patterns and rehospitalization for angina in patients with hypertension and coronary artery disease (HT-CAD). This prospective cohort study was conducted in Chinese PLA General Hospital, Beijing, China. We included 730 patients with HT-CAD, who were hospitalized between August 2020 and September 2022. The in-hospital SBP lowering patterns were identified according to SBP level at admission, SBP level at discharge, and the difference between them: normal-stable SBP, more-intensive SBP reduction, less-intensive SBP reduction, and non-reduced SBP. We used Cox proportional hazards regression to estimate the risk of rehospitalization for angina according to SBP lowering patterns. We identified 121 cases of rehospitalization for angina in a median follow-up of 28.2 months. Patients with more-intensive SBP reduction had the lowest incidence rate of rehospitalization for angina, followed by those with normal-stable SBP, less-intensive SBP reduction, and non-reduced SBP. After adjusting for potential confounders, we found that compared with patients with more-intensive SBP reduction, the hazard ratios and 95% confidence intervals of rehospitalization for angina were 1.35 (0.78-2.35) for patients with normal-stable SBP, 2.17 (1.14-4.14) for patients with less-intensive SBP reduction, and 2.99 (1.57-5.68) for patients with non-reduced SBP. This association was more pronounced in patients with multi-vessel stenosis than in patients with single-vessel stenosis. In conclusion, in-hospital SBP lowering patterns were associated with risk of rehospitalization for angina. These results highlighted the importance of intensive in-hospital SBP control in patients with HT-CAD.

6957 5-Year Follow-Up of Acute, micro, and Macrovascular Complications of Patients With Type 2 Diabetes Managed by a Multi-Disciplinary Team In A Hospital in Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales Rodríguez: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. A. González-Cantú: None. Type 2 Diabetes Mellitus (T2DM) is a condition associated with various acute and chronic complications, which constitute the leading cause of disability, morbidity and mortality globally. During the SARS-CoV-2 pandemic, vulnerable individuals such as those with T2DM faced a restriction in access to primary healthcare services. Therefore, we decided to compare the presence of micro and macrovascular complications before and during the SARS-CoV-2 pandemic, as well as the incidence of acute complications. A retrospective observational cohort study from 2018 to 2022 was conducted in a hospital in northeastern Mexico on patients with T2DM who were treated by a multidisciplinary team composed of an internist or geriatrician based on the patient's age, endocrinologist, nutritionist, and other diabetes-related specialties. Levels of HbA1C, fasting serum glucose (FSG), low-density lipoprotein cholesterol (LDLc), blood pressure (BP), and microalbuminuria were analyzed. Consequently, presence of micro and macrovascular complications and incidence of acute complications was described. A total of 999 subjects were analyzed, 516 (51.7%) males, with an average age (SD) of 60.1 (12.7) years. There was an increase in the proportion of patients with adequate glycemic control based on HbA1C of 15.2% between 2018 and 2022 (p<0.001) and a 42.3% increase in FSG control during the same period (p<0.001). LDLc showed a decrease in the control proportion of 5.1% between 2018 and 2022 (p<0.001). Systolic BP control in 2018 was 82.7% and 80.1% in 2022 (p<0.001). Diastolic BP control in 2018 was 89.6%, with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria control increased from 80.5% in 2018 to 89% in 2022 (p=0.002). There were 78 (7.8%) cases of microvascular complications, with diabetic neuropathy being the most prevalent (n=35, 3.6%), and a higher incidence in 2021 with 15 (1.6%) cases. A total of 15 (1.5%) patients presented a macrovascular complication, with ischemic heart disease being the most frequent with 11 (1.1%) subjects, and a higher incidence of cases in 2021 (n=4, 0.4%). Hypoglycemia was found to be the most frequent acute complication with 14 (1.4%) cases, with a higher incidence in 2020 (n=5, 0.5%). The low incidence of complications in our population, emphasizes the importance of coordinating patient’s care between a multidisciplinary team to maintain an overall disease control, optimize T2DM treatment and enhance patient’s quality of life. Presentation: 6/1/2024

6954 Effect Of The SARS-CoV-2 Pandemic on Metabolic Control In Patients With Type 2 Diabetes: A 5-year Cohort Follow-Up

Abstract Disclosure: D.P. Morales Rodríguez: None. M. Romero Ibarguengoitia: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernandez-Chau: None. A. Cepeda Medina: None. A. Gonzalez-Cantú: None. The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and a suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2DM). Thus, we compared the metabolic control of patients with T2DM before and throughout 3 years of the SARS-CoV-2 pandemic, described the type of consultations and trends in attendance in various specialties, and compared the number of medications prescribed to patients before and during the pandemic. We conducted a retrospective observational cohort study on steelworkers with T2DM from a hospital in northeastern Mexico, who were treated by a multidisciplinary team from 2018 to 2022. We analyzed HbA1C levels, fasting serum glucose (FGS), low-density lipoprotein cholesterol (LDLc), blood pressure (BP) values, microalbuminuria, attendance at consultations across different specialties, and the trend in medication usage. We analyzed 999 subjects, 516 (51.7%) males, with a mean age (SD) of 60.1 (12.7) years. A significant difference was found in the proportion of controlled patients based on HbA1C with 55.5% in 2018 and 70.7% in 2022 (p<0.001). There was an increase of FGS control from 13.8% in 2018 to 56.1% in 2022 (p<0.001). LDL cholesterol control exhibited a decrease from 62.1% in 2018 to 57% in 2022 (p<0.001). Proportion of patients with systolic BP control decreased from 82.7% in 2018 to 80.1% in 2022 (p<0.001). Diastolic BP control was 89.6% in 2018 with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria based control, increased from 80.5% in 2018 to 89% in 2022 (p=0.002). Telephone consultations were introduced in 2020, with 899 (90%) patients using this modality at least once, leading to a 35.8% decrease of in-person consultations (n=541,54.2%) and reaching its lowest point in 2021 (n=2, 0.2%). Throughout the follow-up period, all patients had at least one annual consultation with an internist or geriatrician based on their age group. There was an increase of endocrinology consultations from 8.5% in 2018 to 12.1% in 2022 and in cardiology from 6.9% in 2018 to 10.3% in 2022 (<0.05). There was a rise in the prescription of oral hypoglycemic agents raging from 4.9% to 14.2% between 2018 and 2020, with SGLT2 inhibitors being the highest prescribed and a 2.5% decrease in the prescription of sulfonylureas between 2018 and 2020. Similarly, there was an increase in the prescription of long-acting insulin by 5.9% between 2018 and 2020. There was a higher proportion of patients with controlled glycemic and diastolic blood pressure targets during the SARS-CoV-2 pandemic, this can be attributed to patient’s access to telemedicine and a multidisciplinary team capable of providing an appropriate medication prescription for an optimized management and improvement in patient’s quality of life. Presentation: 6/1/2024

Telemedical strategies for improving systolic blood pressure control in secondary prevention of cerebrovascular events-a systematic review and meta-analysis

BackgroundStroke remains the second leading cause of death worldwide, with a 20 % risk of recurrence within 5 years. Preventing secondary stroke events is crucial for patient management. Kraft et al. highlighted the potential of telemedicine in secondary prevention, but noted the need for further research. Our study incorporates recent trials to provide an updated analysis of telemedical strategies in stroke prevention. MethodsWe reviewed and analyzed RCTs and observational studies from PubMed, Cochrane, Google Scholar, and Clinicaltrials.gov (May 19, 2016 - March 20, 2024) comparing telephone-based follow-up to standard care in stroke patients. The meta-analysis focused on SBP changes within 12 months. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, sourced from PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov (May 19, 2016 – March 20, 2024). We compared telephone-based follow-up to standard care in stroke patients, and the primary outcome was systolic blood pressure (SBP) changes within 12 months. ResultsOur systematic review included data from 21,904 patients. The meta-analysis focused on studies with comparable systolic blood pressure (SBP) data. It involved 3,501 individuals in the control group and 3,485 in the experimental group. The analysis revealed a significant reduction in SBP with telemedicine strategies for secondary stroke prevention, with a p-value of 0.003. Additionally, a systemic review of the included studies demonstrated that these strategies improved medication adherence, lifestyle habits, and physical performance, positively correlating with better health outcomes and reduced mortality risk. ConclusionWith the inclusion of recent clinical trials, our updated systematic review and meta-analysis concludes that telemedicine supports secondary prevention in cerebrovascular diseases, particularly blood pressure control. While telemedicine may have a role in reducing recurrent stroke risk, we believe further studies with longer follow-up periods are needed to validate the role of telemedical strategies in reducing recurrence rates.

Hypertension control and risk of age-associated dementia in people with hiv infection.

Hypertension is a major risk factor for dementia, but sustained blood pressure control is difficult to achieve. We evaluated whether inadequately controlled hypertension may contribute to excess dementia risk among people with HIV. Retrospective cohort study. We studied demographically matched people with and without HIV between 7/1/2013 and 12/31/2021 who were ≥50 years old and had a hypertension diagnosis but no dementia diagnosis. Hypertension control was calculated using a disease management index (DMI) which captured degree and duration above the hypertension treatment goals of systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg. DMI values ranged from 0% to 100% (perfect control); hypertension was considered "inadequately controlled" if DMI<80% (i.e., in control for <80% of the time). Annual, time-updated DMI was calculated for SBP and DBP. Associations of SPB and DPB control with incident dementia were evaluated using extended Cox regression models. The study included 3,099 hypertensive people with HIV (mean age: 58.3 years, 90.2% men) and 66,016 people without HIV. Each year of inadequate SBP control was associated with greater dementia risk in both people with HIV (adjusted hazard ratio [aHR] = 1.26, 0.92-1.64) and people without HIV (aHR = 1.27 (1.21-1.33); p-interaction = 0.85). Similarly, inadequate DBP control was associated with greater dementia risk in both people with HIV (aHR = 1.43, 0.90-1.95) and people without HIV (aHR = 1.71, 1.50-1.93; p-interaction = 0.57). Findings suggest the association of inadequate hypertension control with greater dementia risk is similar by HIV status. Stronger associations of DBP control with dementia merits further investigation.

Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension.

Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence. Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.

P210 ASSOCIATION BETWEEN FOLLOW-UP BLOOD PRESSURE AND BLOOD PRESSURE CONTROL: A META-REGRESSION ANALYSIS

Background: Blood pressure (BP) control is typically defined as BP values under certain thresholds, most commonly &lt;140/90 mmHg – but there is widespread uncertainty about how mean BP is related to BP control, and what mean BP is required to achieve BP control in 80% of patients. Objective: To assess the association between follow-up mean systolic BP (SBP) and BP control from randomised clinical trials (RCTs). Methods: We systematically searched multiple databases for relevant RCTs. We included double-blind individual RCTs (iRCTs) of adults with hypertension, randomised to BP-lowering drugs from five major antihypertensive classes for ≥2 to ≤ 26 weeks, and which reported data for follow-up mean SBP and BP control (clinic BP &lt;140/90 mmHg) at the last follow-up visit. We also included cluster RCTs (cRCTs), of adults with hypertension, randomised to any BP-lowering intervention, for any duration. The association between follow-up mean SBP and BP control at the last follow-up visit was assessed using a linear regression model. The coefficient was interpreted as the increase in percentage of patients with BP control for every 1 mmHg decrease in follow-up mean SBP. Results: Seventy iRCTs (45,836 participants) and 36 cRCTs (28,154 participants) were included. Each 1 mmHg decrease in follow-up mean SBP was associated with about 2% improvement in BP control in both iRCTs and cRCTs (R2= 78% and 76%, respectively). This finding was broadly consistent in the subgroups of BP-lowering drug classes, baseline SBP categories, and pre-trial BP-lowering treatment status in iRCTs, and country income and baseline SBP categories in cRCTs. Mean SBP levels of 125, 130, and 135 mmHg were associated with BP control rates of 78%, 67%, and 55%, respectively, in iRCTs and 80%, 68%, and 56% in cRCTs. Conclusion: Mean SBP levels of 125 mmHg are required for achieving BP control of &lt;140/90 mmHg in about 80% of the patients. These findings should inform clinical care, guideline recommendations and hypertension control programs.

Abstract P117: Provider Concordance to the Current 2017 High Blood Pressure (BP) Clinical Practice Guidelines and Patient Blood Pressure Control

Introduction: The AHA/ACC 2017 High BP guidelines introduced key changes, compared to previous guidelines, including a new hypertension definition (≥130/80 mm Hg) and lower medication thresholds for patients at cardiovascular risk. The impact of provider adherence to these guidelines on patient BP control has not been fully explored. Methods: We identified 3,749 new stage 1 hypertension patients (7,214 visits) and 11,013 new stage 2 hypertension patients (33,321 visits), aged ≥18, from the Vanderbilt University Medical Center database. We scrutinized outpatient BP levels, prescribed medications, follow-up visits, lab results, demographics, comorbid conditions, and physician notes from January 2018 to December 2022. This data was compared to hypertension treatment criteria developed from the 2017 guidelines that was validated by six hypertension experts. Active primary care patients (with 1 visit per year) were included. Mixed-effects Poisson regression and mixed-effects linear regression examined the relationship between guideline adherence and controlled BP (&lt;130/80 mm Hg) and continuous BP, respectively. Results: Among stage 1 hypertension visits, 12.2% were treated with at least one antihypertensive drug according to guidelines, resulting in a 13% increase in BP control and a reduction in systolic BP by 2.02 mm Hg. For stage 2 hypertension visits, 26% received treatment with at least two first-line antihypertensive drug classes, leading to a 45% increase in BP control and reductions in systolic and diastolic BP by 3.79 mm Hg and 1.93 mm Hg, respectively. No significant difference in BP control was observed among stage 2 patients treated with two versus one first-line drug. Adherence to follow-up guidelines resulted in a 24% improvement in BP control for stage 1 patients and stage 2 patients when their follow-up visit occurred within 1 month. Subsequent follow-up visits within 1-month improved BP control by 34% if BP was not controlled previously. Additionally, 42.4% of patients with uncontrolled BP for 1 month received an increase in medication dose or a change/addition of medication class and showed a 7% increase in BP control within next month. Conclusion: Provider adherence to recommended antihypertensive drug treatment guidelines (12%-26%), follow-up assessments guidelines (29%-37%), and treatment intensification (42.4%) were poor. However, patients treated according to the guidelines showed significant improved BP control.

P071 ASSOCIATION BETWEEN DIFFERENT TIMEPOINT AND THRESHOLD-CALCULATED TIME-IN-SYSTOLIC-BLOOD-PRESSURE-TARGET-RANGE AND INCIDENT MAJOR ADVERSE CARDIOVASCULAR EVENTS: INSIGHT FROM THE SPRINT TRIAL

Objective: To evaluate the prognostic value of different timepoint and threshold of systolic blood pressure (SBP) Time in Target Rang (TTR) in Major Adverse Cardiovascular Events (MACEs). Method: A post-hoc analysis of the SPIRNT trial was conducted. Participants with complete BP data and no adverse events occurred in next 2-years follow-up were enrolled. SBP TTR was calculated at different timepoints (3, 12, 24 months) and thresholds (110-130mmHg; 110-140mmHg; 110-130mmHg for intensive and 120-140mmHg for standard treatment groups)(Fig 1). The primary outcome was MACEs occurred 2 years later, defined as the composite of myocardial infarction, stroke, heart failure and cardiovascular death. Results: 7134 participants in SPIRNT were enrolled in this study. SBP TTR indexes with independent predictive value of MACEs were selected by multivariable COX models adjusted for basic cardiovascular risk factors (Fig 2). Multivariable COX models identified SBP TTR calculated with 110-140mmHg threshold over 3 months (3month SBP TTR110-140) as the best predictor of MACEs. (Table 1). the nonlinear trend of 3month SBP TTR110-140 was also evaluated. (Fig 3) Then, a cut-off value of 0.65 for 3month SBP TTR110-140 was obtained by the point with the largest likelihood value in the RCS curve.(Fig 3). Patients with 3month TTR110-140 &gt; 0.65 had 23.9% lower incidence of MACEs than patients with TTR ≤ 0.65 (HR 0.761[0.592-0978], P=0.033).(Table 2) In addition, for patients with early SBP well-control (3month SBP TTR110-140 &gt;0.65), there was no significant difference in mean SBP between 110-130 mmHg and 130-140 mmHg (Fig4). Lasso regression also suggests that TTR110-140 has more informatics advantages than TTR110-130 in cox model at different timepoints (Fig5). Conclusions: 3month SBP TTR110-140 was considered to be the best predictor of MACEs occurred 2 years later in different SBP TTR indexes, which indicated the importance of early SBP control. This study also proposed 0.65 as the critical value of 3-month SBP TTR110-140 for prevention of the incident of MACEs.

Abstract MP08: Long-Term Impact of Bariatric Surgery on Hypertension Control and Remission: A Meta-Analysis of Randomized Controlled Trials

Background: Bariatric surgery is widely recognized as a highly effective intervention for addressing obesity and its associated metabolic complications. However, there is a paucity of evidence from randomized controlled trials (RCTs) with primary endpoints focusing on its impact on hypertension. Objective: We aimed to synthesize findings from pivotal RCTs until May 2024 to evaluate the long-term effects of bariatric surgery on hypertension in obese individuals compared to medical or lifestyle management. Methods: We analyzed data using RevMan 5.4 with a random effects model, employing the inverse variance method to report outcomes as risk ratios (RR) or weighted mean differences (WMD) with 95% confidence intervals (CI). Our study protocol is registered in PROSPERO (CRD42024527369). Results: The study comprised 18 RCTs involving 1386 obese patients (62.7% women) with a mean BMI of 38 kg/m 2 and an average follow-up duration of 1 to 5 years. On pooled analysis, there was a statistically significant difference in the rate of hypertension remission between patients who underwent bariatric surgery versus patients on medical/lifestyle management with an RR of 2.77 (95% CI: 1.26 to 6.10, p = 0.01). Additionally, a substantial reduction in the use of antihypertensive medications while maintaining controlled blood pressure was observed (RR: 7.10; 95% CI: 4.38 to 11.51, p &lt; 0.00001), with no heterogeneity. Bariatric surgery also significantly improved systolic blood pressure control (WMD: -3.67; 95% CI: -5.53 to -1.80, p = 0.0001). Conclusion: Bariatric surgery emerges as a durable solution for obesity-related hypertension, offering remission and control of hypertension while reducing the dependence on antihypertensive medications.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension

BackgroundHypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN. MethodsWe studied VLWH with a diagnosis of HTN who received care in the Veterans Health Administration (VHA) from January 2018 to December 2019. We evaluated HTN treatment and blood pressure control across demographic variables, including race, and by medical comorbidities. Data were also compared among VHA facilities. Predictors of HTN treatment and control were assessed in 2-level hierarchical multivariate logistic regression models to estimate odds ratios (ORs). The VHA facility random-effects parameters from the hierarchical models were used to calculate the median odds ratios to characterize the variation across the different VHA facilities. ResultsA total of 17,468 VLWH with HTN (mean age 61 years, 97% male, 54% Black, 40% White) who received care within the VHA facilities in 2018-2019 were included. 73% were prescribed antihypertension medications with higher prescription rates among Black vs White patients (75% vs 71%) and higher prescription rates among patients with a history of cardiovascular disease, diabetes, and kidney disease (>80%), and those receiving antiretroviral therapy and with controlled HIV viral load (∼75%). Only 27% of VLWH with HTN had optimal BP control of systolic BP <130 mmHg and diastolic BP <80 mmHg, with a lower rate of control among Black vs White patients (24% v. 31%). In multivariate regression, Black patients had a higher likelihood of HTN medication prescription (OR 1.32, 95% CI: 1.22-1.42) but were less likely to have optimal BP control (OR 0.82; 0.76-0.88). Important positive correlates of antihypertensive prescription and optimal BP control included: number of outpatient visits in prior year, and histories of diabetes, coronary artery disease, and heart failure. There was about 10% variability in both antihypertensive prescription and BP control patterns between VHA facilities for patients with similar characteristics. There was increased inter-facility variation in antihypertensive prescription among those with a history of heart failure and those not receiving antiretroviral therapy. ConclusionIn a retrospective analysis of large VHA data, we found that VLWH with HTN have suboptimal antihypertensive medication prescription and BP control. Black VLWH had higher HTN medication prescription rates but lower optimal BP control.

Effects of Music Therapy on Postoperative Pain Perception in Patients Undergoing Abdominal Surgeries Under General Anesthesia: A Prospective Controlled Randomized Comparative Clinical Study.

Background Music therapy has been shown to reduce the need for sedation and analgesics, as well as lower plasma cortisol and epinephrine levels in patients undergoing regional anesthesia. This study evaluates the efficacy of perioperative music therapy in reducing pain perception and its impact on cortisol levels. Materials and methods This prospective randomized control trial was conducted at the tertiary care center in Western Maharashtra. Sixty adult patients (males/females) undergoing elective lower abdomen surgery were included and randomized equally into two groups to listen to music using headphones at a preselected volume (Group M) or to use only headphones without any music played (Group C) for 2 hours in the preoperative, intraoperative, and postoperative periods. Demographic information, anthropometric (height, weight), and biochemical (serum cortisol) measurements were performed. American Society of Anesthesiologists (ASA) grades 1 and 2, and patients aged 18 to 65 years were included. Pain perception was assessed using the Visual Analog Scale (VAS). Results The demographic data, including mean age, BMI, ASA status, average duration of anesthesia, and average duration of surgery, were comparable between the two groups. Group M showed improved control of systolic blood pressure (SBP) at 10- and 30-minutepost-induction of general anesthesia and had a significantly lower VAS score (p < 0.05). Additionally, patient satisfaction was higher in Group M (81.4%) compared to Group C (51.4%) with a p-value of < 0.05. Intraoperative awareness was non-significant between the groups. Conclusion Music therapy is a safe, cost-effective, and efficacious method for reducing pain perception and can be used in conjunction with other treatments for postoperative pain management.