Uncontrolled Hypertensive Patients Research Articles

The Efficacy of Single-pill Combination of Olmesartan Medoxomil and Amlodipine Besylate on Office Blood Pressure in Hypertensive Patients who did not Respond to Amlodipine Besylate Monotherapy.

As combination therapy, switching to single-pill combination (SPC) medication after a short period of monotherapy is helpful because reducing pill numbers can improve patients' adherence to medications. This study was aimed to assess the effect of the single-pill combination (SPC) of olmesartan medoxomil 20 mg and amlodipine besylate 5mg (OLM 20 mg/AML 5 mg) on blood pressure (BP) reduction in hypertensive patients who did not respond to amlodipine besylate 5 mg (AML 5 mg) monotherapy for 4 weeks. This study was a prospective, open-label, multi-center, non-comparative study. Patients whose BP was not got the target BP (≥140 mmHg and if diabetic patients ≥130 mmHg) after 4 weeks treatment with AML 5 mg, were enrolled. AML 5 mg was switched to the SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The primary effectiveness endpoint was the reduction of seated systolic blood pressure (SeSBP) after SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The changes of brachial-ankle pulse wave velocity (baPWV), central BP (CBP), and augmentation index (AIx@75) were evaluated also. Forty-seven patients were enrolled (mean age = 52±9 years, 36 men). After the SPC treatment for 8 weeks, SeSBP was reduced from 153±9 mmHg to 131±18 mmHg and seated diastolic BP (SeDBP) from 95±8 mmHg to 81±11 mmHg (p<0.001 and p<0.001, respectively). The reduction of SeSBP/SeDBP were 22 mmHg and 14 mmHg, respectively. The target goal BP achievement rate was 74.5%, and baPWV, CBP, and AIx@75 were improved. SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks was effective in reducing BP, achieving target BP goal, and also improving arterial stiffness in uncontrolled hypertensive patients with AML 5 mg monotherapy.

PS-BPC11-9: ADMA/SDMA RATIO AND ITS RELATIONS TO URIC ACID AND ALBUMIN IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS IN INDONESIA

Background and Aims: Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA), rarely reported together, are markers of endothel dysfunction and kidney function. ADMA was inversely related to albumin, while SDMA was positively correlated to albumin. Meanwhile, uric acid was positively correlated to both SDMA and ADMA. By using ADMA and SDMA as ratio, we postulated that their ratio can more precisely predict activity dimethylarginine dimethylaminohydrolase (DDAH), a key enzyme that metabolized ADMA, and not SDMA, and can be used as marker of NO activity. Low NO activity is related to high vascular tonus and peripheral resistance, hypertension and low Sodium excretion and cardiac output. Method: This was a cross-sectional study conducted in adults underwent chronic Continuous Ambulatory Peritoneal Dialysis (CAPD) in tertiary hospital in Jakarta, Indonesia. Uric acid, albumin, ADMA and SDMA levels were measured at the same time patients controlled to outpatient clinic after washout from hyperuricemia drug for 2 to 4 weeks. Analysis performed using Pearson for normal distribution data, Spearman for nonparametric analysis and linier regression test and ROC curve with SPSS v20. Results and Discussion: Total of 55 subjects (83%) were included, male 63.6%, mean age of 40.71 ± 14,4 year old. Median of CAPD use was 27 months. Causes of CKD were glomerulonephritis (47.3%), diabetes mellitus (25.5%), hypertension (25.5%) and polycystic kidney disease (1.8%). At the time of research, 90.9%, were uncontrolled hypertension patients. Median level of UA was 7.30 ± 1.59 mg/dl and 60% had UA levels of 7 mg/dl or higher. Albumin level lower than 3.5 g/dl (mean 3.55 ± 0.49 g/dl) were 24 patients (43.6%). Median ADMA level was 87.5 ± 16.64 ng/ml and SDMA level was 633.73 ± 231.54 ng/mL. Median ADMA/SDMA ratio was 0.13 + 0,08 ng/ml. ADMA, SDMA, ADMA/SDMA ratio were correlated with uric acid with p = 0.027 (95%CI 0.175–0.471), p &lt; 0.001 (95%CI 0.688–0.928) and p &lt; 0.001 (95%CI -14,96 to -5,03) with sensitivity and specificity 91% and 95%, 97% and 68% and 79% and 96%, respectively. ADMA, SDMA, ADMA/SDMA ratio were not statistically significantly correlated with albumin with p = 0.26, p = 0.14 and p = 0.23, respectively. Albumin level was caused by many factors that are not in the scope of this research, this might explain this result. Conclusion: ADMA/SDMA ratio had comparable sensitivity and specificity to ADMA or SDMA alone when correlated with uric acid in CAPD patients. Albumin might not correlated with ADMA, SDMA, or ADMA/SDMA ratio in CAPD patients.

PS-C17-9: RELEVANT BLOOD PRESSURE REDUCTION WITH ORAL SEMAGLUTIDE IN PATIENTS WITH TYPE 2 DIABETES AND OBESITY, INDEPENDENT OF PREVIOUS ANTIHYPERTENSIVE TREATMENT

Objective: The antihypertensive effect of oral semaglutide is apparently modest in published trials but it has not been explored in uncontrolled hypertensive patients. We sought to assess whether oral semaglutide may elicit a clinically relevant reduction of systolic blood pressure (SBP) in patients with type 2 diabetes (T2D), obesity and uncontrolled hypertension, and whether the attained SBP reduction is diluted by the previous antihypertensive treatment. Design and Methods: Retrospective analysis of the SBP and antihypertensive medication data were performed in consecutive patients with T2D and obesity who started therapy with oral semaglutide. Data were obtained from a baseline visit in which oral semaglutide was initiated, and a second visit after 3–4 months. Patients who initiated or changed antihypertensive medication simultaneously with oral semaglutide were excluded. Consent for anonymous analysis and reporting of data were obtained from all included subjects. Results: 50 patients with T2D (by usual clinical criteria) and obesity (BMI &lt; 30 kg/m2) were included; their age was 56 ± 11 years. 32 (64%) were female, and their diabetes duration was 6.9 ± 2.9 years. 41 (82%) of them were diagnosed with hypertension (sitting office SBP &gt; 140 and/or taking antihypertensive drugs). Globally there was a significant but modest reduction in SBP (149.8 ± 11.7 to 146.7 ± 12.4 mmHg, p = 0.041, paired t-test), but this reduction was strongly correlated with the baseline SBP (Pearson's r 0.39, p &lt; 0.001). In the Figure (A) the reductions in SBP for patients with controlled SBP (&lt; 140 mmHg), stage 1 (SBP 140–159 mmHg), stage 2 (160–179 mmHg) and stage 3 hypertension (&gt; 180 mmHg) are shown (p = 0.0056 for differences among SBP categories, one-way ANOVA). The Figure (B) also shows the reductions in SBP for patients taking 0, 1, 2 or &gt; 3 different antihypertensive drugs, but there are no significant differences (p = 0.2312, one-way ANOVA). In the second visit the number of patients with SBP &lt; 140 mmHg had increased from 19 (38%) to 25 (50%). Conclusions: Treatment with oral semaglutide in patients with T2D, obesity and uncontrolled hypertension elicits a clinically significant decrease in SBP, enough to bring about acceptable SBP control in a relevant fraction. As expected, the reduction in SBP was strongly dependent on the baseline SBP. Interestingly, this reduction does not seem to be diluted by the use of multiple antihypertensive drugs, suggesting that oral semaglutide could be considered as an add-on in patients with apparent resistant hypertension.

PS-P15-7: EFFECT OF ESAXERENONE ON UNCONTROLLED NOCTURNAL HYPERTENSION FIRST EVALUATED BY 2 UPPER-ARM/WRIST HOME MONITORING DEVICES (EARLY-NH STUDY)

Objective: Nocturnal hypertension is one of the phenotypes of masked hypertension, which affects 30–50% of hypertensive patients, and it cannot be adequately controlled with a single agent. The mineralocorticoid receptor (MR) is activated in an aldosterone-independent manner in diabetes, obesity, salt sensitivity, and excessive salt intake. As all of these conditions are associated with nocturnal hypertension, MR blockers which exert not only antihypertensive but also organ-protective effects are considered the optimal antihypertensive option. Recently, we have developed 2 types (upper-arm and wrist) of nocturnal home blood pressure (BP) monitoring (HBPM) devices. Using these devices, we evaluated the effects of esaxerenone on nighttime home BP and organ damage (UACR and NT-proBNP) in uncontrolled nocturnal hypertensive patients on medication using one drug, either angiotensin receptor blocker (ARB) or calcium channel blocker (CCB). Design and method: EARLY-NH study (jRCTs031200364) was a multicenter, open-label, interventional study in nocturnal hypertensive patients. Nighttime BP was automatically measured at 2, 3, and 4AM with upper-arm (OMRON HEM-9700T), and wrist (OMRON HEM-9601T) HBPM devices. The BP data were electronically collected. Inclusion criteria were: 1) aged ≧ 20 years, 2) receiving one ARB or CCB, 3) nighttime home systolic BP (SBP) ≧ 120 mmHg. Over the 12-week study period, esaxerenone was started at the initial dose of 1.25 or 2.5 mg/day, and could be titrated up to 5 mg/day at weeks 4 and 8, based on the individual patient's condition. The primary efficacy endpoint was the change from baseline in nighttime home BP [SBP and diastolic BP (DBP)] measured by the upper-arm device at week 12. Secondary endpoints included changes in nighttime home BP measured by the wrist device, and levels and control rate of office and home BPs, %change in UACR and NT-proBNP, and safety variables including adverse events, eGFR, and serum potassium. Results: The 93 patients with uncontrolled nocturnal hypertension were successfully enrolled [age: 67.6 years; man: 50.5%; ARB/CCB: 48.4/51.6%; nighttime home SBP/DBP (upper-arm: 132.4/78.4 mmHg; wrist: 130.4/73.1 mmHg); morning home SBP/DBP: 143.8/86.7 mmHg; office SBP/DBP: 147.2/84.1 mmHg; UACR: 110.4 mg/gCr; NT-proBNP: 83.7 pg/mL; serum potassium: 4.0 mEq/L; eGFR: 69.7 mL/min/1.73m2]. Results for the efficacy, safety, and exploratory analysis will be presented. Conclusions: EARLY-NH study will provide the first clinical evidence of the efficacy and safety of esaxerenone on uncontrolled nocturnal hypertension evaluated by 2 newly developed different upper-arm and wrist HBPM and on organ damage. These results will contribute to digital management of hypertension using home BP.

Remote Patient Monitoring for Hypertension: Feasibility and Outcomes of a Clinic-Based Pilot in a Minority Population.

In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population. In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs. A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, P = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, P = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, P < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, P = .135). Financially, the program generated margins of $29 per patient at 90 days. Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.

PS-C10-3: THE EFFECT OF E HEALTH ESH APPLICATION ON BP MANAGEMENT PRELIMINARY RESULTS

Objective: Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits. Design and method: 30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months. Results: In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p &lt; 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p &lt; 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p &lt; 0.005) and -18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p &lt; 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04). Conclusions: The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.

The independent role of nasal obstruction in resistant hypertension for uncontrolled hypertensive patients with obstructive sleep apnea.

To determine the independent predictive role of nasal obstruction in resistant hypertension (RH) in uncontrolled hypertensive patients with obstructive sleep apnea (OSA). This prospective cohort study comprised of 236 OSA patients with uncontrolled blood pressure (BP) using 1 or 2 classes of antihypertensive drugs visiting Sleep Medicine Center from April 2021 to March 2022. Information on demographic characteristics, comorbidities, BP control and classes of antihypertensive medication, sleep-related symptoms, Nasal Obstruction Symptom Evaluation (NOSE) Scale and sleep parameters was collected. RH incidence according to the BP control and classes of antihypertensive drugs data during the 5month follow-up was collected. After 5month follow-up, 217 participants were included for final data analysis. Ninety-five subjects had nocturnal nasal obstruction with a higher proportion of RH (36.8% vs. 17.2%, p = 0.001) compared to those without nocturnal nasal obstruction. After adjustment for demographic characteristics, sleep-related symptoms and OSA severity, multinomial logistic regression models showed that nocturnal nasal obstruction (all ORs > 2.5, p < 0.05) or NOSE ≥ 8 (all ORs > 4.5, p < 0.05) was independently associated with a higher odds of RH. Nasal obstruction treatment improved NOSE score significantly, but did not reduce the incidence of RH significantly. Effective nasal obstruction treatment was associated with antihypertensive drugs reduction (OR 4.43; 95% CI 1.20-16.27). Nasal obstruction is an independent predictor of RH in uncontrolled hypertensive patients with OSA. In addition to the treatment of OSA, assessment and treatment of nasal obstruction should be considered in the management of uncontrolled hypertensive patients with OSA.

Status of home blood pressure monitoring and influencing factors of regular home blood pressure monitoring among elderly uncontrolled hypertensive patients in Central and Western China

Objective: To describe the prevalence of home blood pressure monitoring and analyze the factors influencing regular blood pressure monitoring among elderly uncontrolled hypertensive patients in Central and Western China. Methods: It was a cross-sectional study, which enrolled hypertensive patients aged over 60 years with office blood pressure ≥140/90 mmHg (1 mmHg=0.133 kPa) from September 2019 to July 2020 in 72 hospitals in Central and Western China. Patients completed the electronic questionnaires, and were divided into regular and irregular home blood pressure monitoring groups. The proportion of patients using different types of sphygmomanometers and the percentage of patients with regular home blood pressure monitoring (at least weekly) were explored. The generalized linear mixed model was used to define the influencing factors of regular home blood pressure monitoring. Results: A total of 3 857 patients were included in this study. Age was 67(64,71) years old and there were 2 163 males (56.1%). Overall, sphygmomanometer was available at home for 3 044(78.9%) patients, 2 168(56.2%) patients conducted regular home blood pressure monitoring. Among the patients with a sphygmomanometer at home, 2 370(77.9%) of the sphygmomanometers were upper arm electronic device. Older age, higher income, longer history of hypertension, multiple antihypertensive medications and awareness of diagnostic criteria of hypertension and hypertension complications were associated with a higher prevalence of regular home blood pressure monitoring (all P<0.05). Conclusions: Among the elderly hypertensive patients with uncontrolled blood pressure in Central and Western China, there is a relatively high prevalence of home sphygmomanometer ownership and regular monitoring. Age, family income, history of hypertension, number of antihypertensive drugs and knowledge of hypertension are the influencing factors of regular home blood pressure monitoring in this population.

A Cross-Sectional Descriptive Study on the Prevalence of Depression amongst Controlled and Uncontrolled Hypertension patients in Legazpi

A Cross-Sectional Descriptive Study on the Prevalence of Depression amongst Controlled and Uncontrolled Hypertension patients in Legazpi

Awareness, treatment, and practices of lifestyle modifications amongst diagnosed hypertensive patients attending the tertiary care hospital of Karachi: A cross-sectional study

BackgroundDespite massive research guidelines, high blood pressure remains a major public health concern since barriers to treatment and control are on the rise. Lack of awareness is one of the serious impediments to managing hypertension. Therefore, this study is designed to gauge awareness, beliefs, and practices related to hypertension amongst diagnosed subjects. MethodsA total of 425 hypertensive patients were recruited from the wards and outpatient department of Jinnah Medical College Hospital located in Korangi district, Karachi. Data was obtained regarding socio-demographics, comorbidity, duration of HTN, current BP readings, and BMI. Additionally, awareness, practices, treatment, and control of hypertension were also assessed. Using IBM SPSS version 25.0, a chi-square test was run for categorical variables to analyze the differences in demographic variables, awareness, practices, and treatment between controlled and uncontrolled hypertensive patients. Multivariate regression model was used to identify the risk factors associated with uncontrolled hypertension. A p-value of less than 0.05 was considered significant. Results65.6% of the total study population was females, of which, 70.7% had uncontrolled hypertension, with a p-value of 0.007. Majority of the candidates were between the ages of 50 and 59 and there was a significant difference in age groups of controlled and uncontrolled hypertensive patients (p-value = 0.019). Co-morbidities and duration of hypertension yielded no significant results. Awareness, treatment, and practices of lifestyle modifications amongst controlled or uncontrolled hypertension groups were not statistically significant. Age and female gender were the only risk factors significantly linked with uncontrolled hypertension. ConclusionOverall, there was no significant difference in the statistics of controlled and uncontrolled hypertensive patients. This requires further investigation and evaluation to identify the unknown risk factors and co-morbid contributing to these findings. Most of the patients are on treatment and still not controlled, and this could be considered under treatment. Health professional's advice and counseling skills, social media, internet, and public awareness sessions can play an active role in the management of BP and its associated complications.

Independent Association of 25[OH]D Level on Reduced Glutathione and TNF-α in Patients ‎with Diabetes and/or Hypertension.

PurposeOxidative and inflammatory pathways play a significant role in the pathophysiology of a wide variety of non-communicable diseases such as type 2 diabetes mellitus (T2DM) and hypertension. However, the effect of serum 25-hydroxyvitamin D ‎‎(25[OH]D) on these pathways is still controversial. To evaluate the association of 25[OH]D on ‎antioxidant and pro-inflammatory biomarkers, reduced glutathione (GSH) and tumor ‎necrosis factor (TNF)-α, in T2DM and hypertensive patients.Patients and MethodsThis is a cross-sectional study of a consecutive sample of patients attending the the Family Medicine clinic at King Abdullah bin Abdulaziz University Hospital (KAAUH). Participants were screened for eligibility according to the following ‎criteria: aged above 18 years and diagnosed with T2DM and/or hypertension for at least one ‎year. Patients receiving any kind of vitamin D or calcium supplements within the last three ‎months were excluded, as were those with a history of ‎renal failure, cancer, liver, thyroid, or any other chronic inflammatory diseases.ResultsIn total 424 T2DM and/or ‎hypertensive patients (mean age 55±12 years) were recruited. In addition to routine ‎physical and laboratory examinations, levels of serum 25[OH]D, GSH and TNF-α were ‎measured. The prevalence of 25[OH]D deficiency (<50 nmol/L) was 35.1%, which was ‎independent from GSH and TNF-α levels. In T2DM, hypertensive and patients having ‎both diseases, GSH levels were 349.3±19, 355.4±19 and 428.8±20 μmol/L, ‎respectively. Uncontrolled T2DM and hypertension patients showed significantly higher ‎GSH compared with the controlled group. ‎Males showed slightly higher level ‎of TNF-α compared with females and uncontrolled hypertensive patients had relatively ‎higher TNF-α level when evaluated against controlled hypertensive patients. ‎Conclusion25[OH]D level is independent of oxidative stress and inflammation, ‎assessed by levels of GSH and TNF-α, respectively, in T2DM and hypertensive Saudi ‎patients. ‎

Plasma Renin-guided Therapy in Patients of Primary Hypertension on Antihypertensives: A Prospective Cohort Study.

Most guidelines for hypertension overlook the underlying pathophysiologic basis in deciding antihypertensives. Based on renin levels, hypertension may be classified as high-renin hypertension (HRH), low-renin hypertension (LRH), and normal-renin hypertension (NRH). The study examined the renin levels in a hypertensive population and assessed the effect of renin-guided antihypertensive management on blood pressure (BP) control. This study was a single-center prospective cohort study. Subjects with primary hypertension (aged 20-60 years) on antihypertensives were included in the study. Initial BP was recorded and subsequently, all antihypertensives were discontinued. After 2 weeks, second BP was recorded and plasma renin assay (PRA) sample was collected. All patients were restarted on the previous antihypertensives and further modification of medication was performed based on their PRA. Anti V drugs, such as diuretics and calcium channel blockers (CCBs) were used in LRH while beta-blockers and antirenin drugs (Anti R drugs) were used in HRH. The study included 918 patients with hypertension and 896 cases were finally analyzed. Of these patients, 287 (32.03%) had LRH (&lt;0.51 ng/mL/hr), 412 (45.98%) had HRH (&gt;2.64 ng/mL/hr), while 197 (21.99%) had NRH (0.51-2.64 ng/mL/hr). Renin-guided management caused significant BP reduction. In controlled BP group, the systolic BP (SBP)/diastolic BP (DBP) before and after modification were 133.83 ± 3.36/84.77 ± 3.12 and 123.87 ± 10.59/84.05 ± 1.84, respectively (p-value &lt; 0.05). In uncontrolled BP group, the corresponding SBP/DBP were 152.17 ± 2.95/90.36 ± 5.02 and 138 ± 1.23/87.78 ± 0.84, respectively (p-value &lt; 0.05). The number of hypertensives used in patients also reduced with reduction in patients on two, three, or four drugs. Renin-guided therapy is useful for improving BP control in both controlled and uncontrolled hypertensive patients and in reducing the number of antihypertensive drugs.

Perbandingan Identifikasi Obat yang Berpotensi Tidak Tepat Menggunakan Kriteria Beers dan Kriteria STOPP pada Pasien Geriatri Rawat Inap di Jakarta

Adverse Drug Events (ADE) are closely related to Potentially Inappropriate Medications (PIMs) among the elderly, and can cause an increase in morbidity, mortality, and medical cost. The tools often used to assess PIMs include Beers and Screening Tool of Older Persons’ Prescriptions (STOPP) Criteria. Therefore, this study aimed to compare the PIMs identification using Beers 2019 and STOPP version 2 2016 Criteria. A descriptive-analytical method was used, and data were collected retrospectively from the medical records of 340 patients at Pondok Kopi Islamic Hospital period in 2018. The results showed that among 324 patients who met the inclusion criteria with Beers 2019, PIMs were present in 136 (41.85%), with 181 cases. Most of them were on criteria 3, namely 46 (25.41%) and 33 (18.23%) cases of furosemide and spironolactone, respectively. Meanwhile, out of 308 patients who met the inclusion criteria with STOPP, PIMs were found in 14 (4.55%) with a total of 18 cases. The use of aspirin or clopidogrel was observed in 7 people (38.89%) with uncontrolled severe hypertension, while NSAID usage was found in 3 uncontrolled severe hypertension patients (16.67%). Furthermore, there were 3 cases of aldosterone antagonist or ARB usage, which was combined with other drugs that can increase potassium without proper monitoring of the serum level (16.67%). In Pondok Kopi Islamic Hospital, Beers 2019 criteria can describe PIMs data better than the STOPP version 2 2016 due to data availability. Clinician and pharmacist collaboration is also needed in formulating the critical supporting data.

EVALUATION OF BLOOD PRESSURE CONTROL AND THE EFFECTIVENESS OF DIFFERENT ANTIHYPERTENSIVES BY MEANS OF THE STRESS TEST

Objective: To evaluate different antihypertensive drug regimens for the control of BP according to selected variables of the exercise stress test during cardiac rehabilitation Design and method: Observational, longitudinal, retrospective study in 419 debutant or uncontrolled hypertensive patients, between 18–87 years, treated at ‘El Instituto del Corazón de Querétaro’, from January 2015-December 2021, to which a stress test was performed. The statistical analysis was performed using the statistical software SPSS, Version 28.0.1.0, the comparison of the means between groups was made using the one-way analysis of variance (ANOVA) test. Three variables were considered to evaluate the response to exercise in blood pressure; the blood pressor response to exercise (hypertensive &gt; 10, 7 -10 as normal, 0–7 as flat and &lt; 0 as hypotensive), BP index (&gt;1.22 were taken as normal) and recovery of systolic blood pressure (normal &lt; 0.95) Results: When analyzing 75.5% were men and 24.5% were women, under hypertensive treatment includes Beta blockers (BB), calcium channel blocker (CCBs), angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs), Loop diuretics and mineralocorticoid receptor antagonist (MCRA). There was no significant difference in the pressor response under any antihypertensive treatment in monotherapy, however a better response was found in the BP index to exercise. In patients with two or more antihypertensive drugs, it was found a better response to the combined treatment with ARBs + MCRA, in the three variables evaluated Conclusions: The exercise stress test may represent a unique tool to assess the effective protection potential of drugs against an important increase in SBP in patients with hypertension during physical activity. The study design elements proposed have the potential to establish exercise testing as a valid tool to assess the efficacy of antihypertensive treatments during stress conditions. Cardiac rehabilitation can significantly improve the parameters assessed in the stress test. It will be useful to compare these data with a short- and long-term stress test and thus evaluate the effectiveness of antihypertensive therapy.

EFFECT OF SINGLE PILL COMBINATIONS ON CENTRAL SYSTOLIC BLOOD PRESSURE

Objective: Central systolic blood pressure (cSBP) is considered an important haemodynamic parameter, and a relevant prognostic risk factor. Data about control of cSBP with single-pill combination (SPC) treatment are lacking. Therefore we assessed the effect of perindopril/amlodipine (P/A; dual SPC arm) and perindopril/amlodipine/indapamide (P/A/I; triple SPC arm) in naïve and uncontrolled hypertensive patients on 24-hour cSBP compared to office BP. Design and method: 440 adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial PRECIOUS. ABPM was performed at the baseline and end of the trial (Mobilograph PWA). At inclusion, naïve or patients uncontrolled on previous mono or dual therapy other than P/A were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Patients uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg P/A/I. If not reaching office BP control, initial dose was up titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg or 8/10/2.5 mg P/A/I in triple SPC arm. Results: In 16 weeks mean office BP decreased from 156.3 ± 10.9/98.6 ± 8 mmHg to 128.4 ± 9.4/81.7 ± 7.2 mmHg in dual SPC arm and from 157.9 ± 12.6/97.5 ± 9.5 mmHg to 127.7 ± 11.4/80.3 ± 7.5 mmHg in triple SPC arm. The average cSBP decreased from 132.1 ± 9.4 mmHg to 115.4 ± 8.9 mmHg in dual SPC and from 135.8 ± 11.1 mmHg to 114.7 ± 9.8 mmHg in triple SPC arm. All BP reductions were statistically significant (p &lt; 0.001). 77.7% of patients achieved normal office BP values in dual SPC arm and 82.5% in triple SPC arm. A reduction of cSBP below 120 mmHg was reached by 68.9% of patients in dual SPC and by 71.5% in triple SPC arm. Conclusions: In triple SPC arm, higher proportion of patients reached target office BP which was reflected also in lower cSBP compared to dual SPC arm. This is important information showing the advantageous effect of triple SPC on cSBP. Usefulness of putting cSBP as additive information, reflecting effect of SPC treatment in clinical practice, will need to be proven with longer patients’ follow up.

BASELINE CHARACTERISTICS, ANTIHYPERTENSIVE EFFECTIVENESS, AND TREATMENT ADHERENCE IN HYPERTENSIVE PATIENTS DEPENDING ON AGE: POST-HOC ANALYSIS OF THE TRICOLOR STUDY

Objective: To describe baseline (BL) characteristics, changes in systolic (SBP) and diastolic blood pressure (DBP) and in adherence to treatment in patients from TRICOLOR study stratified by age (under 65 years (&lt; 65 y.o.) and 65 years old and older (&gt;= 65 y.o.). Design and method: TRICOLOR (NCT03722524) was a multicenter, 3-month, open-label, uncontrolled observational study that included 1 247 uncontrolled hypertensive (HTN) patients in outpatient settings in Russia, in whom perindopril/indapamide/amlodipine single-pill combination (SPC) was initiated in accordance with the Russian label. Treatment adherence was assessed at the final visit (V4) using Girerd’s adherence questionnaire. This post-hoc-analysis is focused on antihypertensive effectiveness, and treatment adherence in HTN patients depending on age. Results: Of 1 116 patients included in the analysis, 66.9% (n = 747) were under 65 y.o. and 33.1% (n = 369) were &gt; = 65 y.o. At BL, a higher grade of HTN was observed more often in patients &gt; = 65 y.o. (96.9% vs 88.9%; p &lt; 0.001), they had longer HTN duration (15.11 ± 7,82 vs 8.07 ± 5.31 years; p &lt; 0.001) and more often had HTN-associated comorbidities such as dyslipidemia (73.4% vs 58.5%; p &lt; 0.001), history of coronary artery disease (40.4% vs 17.0%; p &lt; 0.001), prior myocardial infarction or stroke (18.7% vs 8.3%; p &lt; 0.001) comparing to those &lt; 65 y.o. At V4, in patients treated with the SPC, SBP significantly decreased by 33.5 (95%CI 34.3, 32.7) and 33.2 mmHg (95%CI 34.4, 31.9), DBP by 14.6 (95%CI 15.1, 13.9) and 13.9 mmHg (95%CI 14.8, 12.9), in patients &lt; 65 y.o and &gt; = 65 y.o. respectively, with no significant between group difference. More patients &lt; 65 y.o. achieved target SBP level &lt; 140/90 mmHg at V4 compared to those &gt; = 65 y.o. (96.7% vs 93.6%, respectively; p = 0.027). Proportion of patients adherent to the treatment increased from 54.8% to 95.5% and from 51.2% to.94.0% in both groups, while only 4.6% and 6.0% of patients in these groups remained non-adherent to the treatment. Conclusions: Treatment with perindopril/indapamide/amlodipine SPC showed high antihypertensive effectiveness and significantly increased adherence in both age-stratified groups of patients, despite more severe and comorbid conditions observed in patients &gt; = 65 y.o. comparing to those under 65 y.o.

BLOOD PRESSURE MANAGEMENT WITH THE ESH CARE APP – PRELIMINARY RESULTS

Objective: Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits. Design and method: 30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients’ BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months. Results: In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p &lt; 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p &lt; 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p &lt; 0.005) and -18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p &lt; 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04) Conclusions: The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.

Successful perindopril/amlodipine+indapamide treatment as second line in uncontrolled hypertensive patients in line with european guidelines

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The study was sponsored by Servier. Background ESC/ESH guidelines recommend use of a RAAS inhibitor + CCB + Thiazide as second step treatment for hypertensive patients with uncontrolled blood pressure (BP), preferably as single-pill combination. Purpose We investigated the results of adding indapamide SR 1.5 mg to the single-pill combination of perindopril/amlodipine (Per/Aml) in a context of a randomized double-blind controlled trial. Method The study compared 2 treatment strategies over 6 months: initiation with Per/Aml with further conditional uptitration up to Per/Amlo 14/10 mg, followed after 3 months of bi-therapy by addition of indapamide SR 1.5 mg for 3 additional months, versus initiation with Valsartan (Val) and further addition of amlodipine, then uptitration up to Val/Amlo 160/10 mg. The study was completed by an additional 8-month extension period (M14) at the same dose for the patients controlled at M6, for safety purposes. Results Compared with initiation of Val alone, initiation of treatment with Per/Amlo led to lower number of patients needing further uptitration at M3 (23% vs 31%). In 202 patients uncontrolled with Per/Amlo 14/10, the addition of indapamide SR 1.5 mg led to a large additional decrease in systolic BP (-14.8±13.3 mmHg) and diastolic BP (-7.2±9.7 mmHg) with BP control achieved in 82.5% of the patients (&amp;lt;140/90 mmHg) and BP response in 94%. During the whole period (11 months), 5.9% of the patients (n=10) discontinued the triple therapy due to 11 adverse reactions, versus 3.9% of those receiving Per/Amlo 14/10 over the same period. Conclusion These findings confirm the BP-lowering efficacy and safety of adding the thiazide-like indapamide to a previous ACE inhibitor+CCB (Per/Amlo) combination providing clinical evidence for this triple therapy, preferably to be given as single-pill combination.

41 THE IMPACT OF HYPERTENSION MANAGEMENT EDUCATIONS TOWARDS BLOOD PRESSURE IN UNCONTROLLED HYPERTENSION PATIENTS: QUASI-EXPERIMENTAL STUDY IN FEER RURAL, SOUTHEAST MOLUCCAS

Background: Hypertension is a chronic medical condition in which the blood pressure of the arteries is elevated. It is diagnosed when there is persistent rise (Measured on two occasions) of ≥140 mmHg in systolic blood pressure (SBP) and/or ≥90 mmHg in diastolic blood pressure (DBP) among individual without diabetes, and ≥130 mmHg SBP and/or ≥80 mmHg DBP among individuals with diabetes. Objective: To Know The Impact of Hypertension Educations Towards Blood Pressure in Uncontrolled Hypertension patients. Methods: This was a Quasi-experimental study involving all Hypertension patients (n=80) within Feer public health centers, South West Kei Besar District in August 2021. We conducted7 interventions in the form of counseling for hypertension management education on the first day and evaluated every two-weeks for five-months. Data collection was performed by checking blood pressure at pre-intervention and post-intervention. The mean differences between pre-intervention and post-intervention values were analyzed by paired t-tests. All statistical analyses in this study assumed a confidence value of 95 percent. Results: A paired-samples t-test was conducted to compare pre-intervention and post-intervention values for blood pressure of Uncontrolled Hypertension patients in Hypertension Management Educations. There was a significant difference in Systolic Blood Pressure (Mean=189.08, SD=5.93 vs Mean=119.0, SD=11.42; MD=70.07) and Diastolic Blood Pressure (Mean=106.00, SD=10.47 vs Mean=64.25, SD=3.51; MD=41.75), with p-value &lt;0.05. Discussion: Interventions in the form of Hypertension management education in Uncontrolled Hypertension Patients can decrease their blood pressure.

A-30 | Radio Frequency Renal Denervation has High Specificity for Renal Nerves with Minimal Observable Effects to the Non-Target Perivascular Tissue

Radio frequency (RF) renal denervation (RDN) safely and durably lowers blood pressure in uncontrolled hypertensive patients. Histological evidence and sham-RCTs support the safety and efficacy of RDN. In this study the specificity of tissue ablation by RF RDN in the renal artery perivascular tissues was evaluated in a normotensive swine model.