Undertreatment Of Hypertension Research Articles

Communicating cardiovascular health information and improving coordination with primary care: A Childhood Cancer Survivor Study randomized trial.

10011 Background: Childhood cancer survivors are at risk of early cardiovascular disease (CVD). We conducted a survivorship care plan (SCP)-based counseling intervention to improve CVD risk factor control in adult-aged survivors. Methods: Randomized (1:1) trial of survivors at high CVD risk based on history of anthracycline or chest radiotherapy exposures with undertreated hypertension (≥130/80 mmHg), dyslipidemia (LDL ≥160 mg/dL or triglyceride ≥200 mg/dL), and/or glucose intolerance (threshold varied if history of pre-diabetes or diabetes) based on in-home testing. Approximating a survivorship clinic visit, the intervention consisted of a remotely delivered session with an advanced practice provider to review results, a SCP with personalized CVD risk information, and an action plan to help manage CVD risk factors. A remote booster session was provided 4 months later with the action plan updated. Control participants only received a copy of their in-home results with abnormalities noted and written encouragement to follow-up with their primary care provider (PCP). Blood pressure, lipid profile, and glucose tolerance were retested after 1y. For both groups, all participant materials were sent to PCPs throughout the study, and PCP medical records were abstracted at study completion. Logistic regression assessed the odds ratio (OR) for undertreatment at 1y associated with the intervention, adjusting for pre-specified variables (sex, current age, time since cancer, insurance status, recent history of survivorship clinic visit, and undertreated CVD risk factor). Results: Among 644 survivors who completed in-home testing, 347 met inclusion criteria and were randomized (175 intervention; overall 52% male, mean age 40y, 31y since cancer diagnosis); 264 with 1y follow-up (126 intervention). At baseline, rates of hypertension, dyslipidemia, and glucose intolerance were 53%, 52%, and 49%, respectively; 43% had > 1 undertreated condition. Although the intervention achieved > 95% satisfaction, it was not associated with reduced undertreatment vs control (OR 0.9, 95% CI 0.7-1.3). Notably, 48% of intervention and 44% of control participants had less undertreatment after 1y. In secondary analysis, greater internal locus of control was associated with less undertreatment at 1y (OR 0.7, 95% CI 0.6-0.9). The intervention group was more likely than controls to have CVD risk (+10 vs -1%), SCP (+17 vs -2%), and some late effects surveillance plan (+8 vs +2%) documented within PCP records at 1y vs baseline (p < 0.05 for all). Conclusions: While a remotely delivered counseling intervention did not reduce CVD risk factor undertreatment compared with provision of test results alone, both study arms had > 40% reduction in undertreatment. These results suggest that simply providing a formal CVD risk assessment to high-risk cancer survivors and their PCPs may be effective. Clinical trial information: NCT03104543 .

Identifying barriers and utility of obtaining ambulatory blood pressure monitoring in a pediatric chronic kidney disease population

BackgroundHypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population.MethodIn this retrospective analysis of patients with CKD stage 3–5 who were seen in one academic medical center’s outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM.ResultAmong 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity.ConclusionABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.

Abstract P163: Prevalence And Incidence Of Hypertension In 18-40-year-old Patients Referred For Palpitations With Normal Cardiac Monitor Findings

Background: Among referred patients 16% have no known cause for palpitations. Studies show that hypertension (HTN) intricately influences ‘heart rate’ and ‘contractility’, the key components of ‘palpitation’. While prevalence of HTN is 22.4% in 18-39-year-olds, the relationship between palpitations and HTN remains unknown in this age group. Objective: To assess the incidence and prevalence of HTN in 18-40-year-olds referred for palpitations without a known arrhythmic cause. Methods: Data from 130 patients with repeated normal cardiac monitor findings referred for palpitations to an electrophysiology clinic between 1/1/2016, and 12/31/2017, were retrospectively analyzed over a 5-year follow-up period. Results: The study cohort comprised of 94 females, 114 of white race with a mean age of 28 years. A 16% (21/130) prevalence of HTN was noted at initial evaluation. Over a period of 2.2 years additional 56% (73/130) patients were diagnosed with HTN. At the end of study period the prevalence of HTN increased to 72% (93/130) (p<0.0001). Hypertensive patients were obese (BMI: 29 kg/m 2 versus 25 kg/m 2 ; p=0.03), used NSAIDs regularly (81 versus 46; p=0.04), and had a stronger family history of HTN (72 versus 5; p<0.0001). Hypertensive patients exhibited higher systolic (124 mmHg versus 112 mmHg; p<0.0001) and diastolic (80 mmHg versus 72 mmHg; p<0.0001) blood pressures during the study period. Conclusion: Undiagnosed and hence under-treated HTN is common in 18-40-year-old patients without a known arrhythmic cause for palpitations. The possibility of untreated HTN causing palpitations needs further evaluation.

Accuracy of oscillometric-based blood pressure monitoring devices: impact of pulse volume, arrhythmia, and respiratory artifact.

An oscillometric waveform (OMW) envelope-based blood pressure (BP) monitoring device is widely used to monitor blood pressure and prevent hypertension and adverse cardiovascular events. At present, all primary care physicians and clinicians widely recommend oscillometric-based BP devices. The consumer selects the device based on their own decision, without knowing whether the device is validated or not, resulting in over- or under-treatment of hypertension. It is imperative that each device must comply with international protocols. In this study, we have investigated the accuracy of inflation and deflation-based oscillometric BP monitoring devices in the case of sinus rhythm (SR). Since different health conditions of the patient affect the oscillometric waveform, which can affect the device's accuracy, in such cases, many BP monitors are skeptical of succeeding in the norms of international protocols. Therefore, this study also aims to calculate the accuracy of these devices in various health conditions and measure the effect of pulse volume, arrhythmia, and respiratory artifact on it using a non-invasive blood pressure (NIBP) simulator. We found that the oscillometric BP devices failed to measure the correct blood pressure in several clinical conditions.

Factors Influencing the Control of Hypertension According to the Gender of Older Adults.

(1) Background: This study aimed to identify factors associated with hypertension control among older adults with hypertension based on their socio-demographic and health characteristics. (2) Methods: The sample consisted of a total of 1824 with hypertension and was obtained from the Eighth Korean National Health and Nutrition Examination Survey (VIII-1, VIII-2). (3) Results: As the factors associated with hypertension control among older men, 65-74 years old (OR = 1.76, CI = 1.04-2.96), a lower education level (OR = 2.23, CI = 1.17-4.28), with obesity (OR = 2.05, CI = 1.13-2.05), and under-treatment of hypertension (OR = 22.07, CI = 6.54-7.45) increased the likelihood of rating hypertension control. As the factors associated with hypertension control among older women, trying to weight maintain (OR = 1.70, CI = 1.01-2.85) and under-treatment of hypertension (OR = 12.16, CI = 3.65-40.46) increased the likelihood of rating hypertension control. (4) Conclusion: The factor affecting the control of hypertension differed between the two genders. To improve the control of hypertension, the guidelines for treatment interventions should be gender-specific for the early elderly. There is a need to increase control of hypertension by having health-related behavioral modifications such as reducing obesity for older men and trying weight maintenance for older women.

MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE.

Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease. Observational case report. An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes. Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.

Cross-sectional study on the association of periodontitis with arterial hypertension in the Hamburg City Health Study

AimAim of this study was to investigate the association between periodontitis and arterial hypertension, both of which show correlations with classical cardiovascular risk factors and inflammatory activity.Materials and methodsA cross-sectional analysis of data from a large population-based health survey (the Hamburg City Health Study, HCHS) including 5934 participants with complete periodontal examination and blood pressure data, of whom 5735 had medical records regarding anti-hypertensive medication, was performed. Probing depths, gingival recessions, bleeding on probing (BOP), dental plaque, and decayed-missing-filled teeth (DMFT) indices were recorded as measures of oral health. Clinical attachment loss (CAL) per tooth was calculated and periodontitis was staged into three groups (no/mild, moderate, severe). Arterial hypertension was diagnosed based on the participants’ medication history and systolic and diastolic blood pressure values. Logistic regression models were constructed accounting for a set of potential confounders (age, sex, smoking, body mass index (BMI), diabetes, educational level, alcohol intake) and high sensitivity-C-reactive protein (hsCRP).ResultsThe odds of arterial hypertension increased significantly along with periodontitis severity (OR for severe periodontitis: 2.19; 95% CI 1.85–2.59; p < 0.001; OR for moderate periodontitis: 1.65; 95% CI 1.45–1.87; p < 0.001). Participants with moderate or severe periodontitis also had significantly higher age- and sex-adjusted odds of arterial hypertension, which was slightly weakened when additionally adjusted for BMI, diabetes, smoking, educational level, and alcohol intake (OR for severe PD: 1.28, 95% CI 1.04–1.59, p = 0.02; OR for moderate PD: 1.30, 95% CI 1.11–1.52, p = 0.001). The fraction of participants with undertreated hypertension (untreated and poorly controlled hypertension) was considerably larger in participants with severe periodontitis than in those with no/mild periodontitis (50.1% vs. 37.4% for no/mild periodontitis).ConclusionsThe study shows an association between periodontitis and arterial hypertension that is independent of age, sex, diabetes, BMI, smoking, educational level, and alcohol intake. In addition, undertreatment of hypertension was more common in people with severe periodontitis compared with periodontally more healthy people.

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

BackgroundAlthough awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors.MethodsNationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest.ResultsThe overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively.ConclusionSocio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.

EFFECTS OF LEFT VENTRICULAR MASS INDEX AND LEFT VENTRICULAR GEOMETRY ON 6 MINUTE STEPPER TEST RESULTS IN PATIENTS WITH HYPERTENSION

Objective: Exercise has effects on blood pressure (BP) and while systolic blood pressure increases with exercise, diastolic blood pressure is expected to remain in same values or decrease due to vasodilatation. Left ventricular concentric remodelling develop in patients with uncontrolled or undertreated hypertension and it results in deterioration in diastolic functions. Six-minute stepper test (6MST) is a simple test for evaluating performance status of patients. We aimed to evaulate effects of ventricular remodelling and left ventricular mass index (LVMI) on results of 6MST in patients with hypertension. Design and method: Adult patients with hypertension were enrolled after taking informed consent. Patients with significant valvular disease, coronary artery disease, malignancy, lung diseases and disabling orthopedic disorders that makes performing 6 MST difficult were excluded. Beta blockers were stopped 48 hours before the test. All patients underwent transthoracic echocardiography just before 6MST in order to assess LVMI and left ventricular geometry. Results: A total of 40 patients were included. Mean age of the population was 47.5 ± 6.5 years and 24 (60%) of them were female. Baselince characteristics were presented in Table-1. Left ventricular geometry was normal in 13 patients and left ventricular concentric remodelling was present in remaining cases. Number of steps during 6MST were similar between patients wih concentric remodelling and normal geometry. Difference between both systolic and diastolic BP values of at the end of test and beginning were recorded. Both systolic and diastolic BP differences were similar between patients with concentric remodelling and normal geometry. However, LVMI was significantly positively correlated with diastolic BP difference (r = 0.389,p = 0.03) while there was not any correlation with systolic BP difference. Conclusions: Left ventricular geometry has no relationship between change of blood pressure during exercise however, LVMI is correlated with change in diastolic BP. Large scale studies are required for evaluating effects of left ventricular geometry on changes of blood pressure during exercise.

Abstract 9744: Cardiovascular Stroke Nursing Best Abstract Award : Investigating Sexual Identity Disparities in Hypertension and Hypertension Treatment Among Adults

Introduction: Recent evidence suggests that sexual minority (e.g., gay/lesbian, bisexual) adults are at increased risk for hypertension. However, sexual identity disparities in the use of anti-hypertensive medications among adults with hypertension have not been examined. We sought to investigate sexual identity differences in diagnosis of hypertension and use of anti-hypertensive medication among adults in the United States. Hypothesis: Sexual minority adults will have higher odds of hypertension and use of anti-hypertensive medication than heterosexual adults. Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (2015-2019) to examine sexual identity differences in diagnosis of hypertension and use of anti-hypertensive medication. We ran sex-stratified logistic regression models to estimate the odds ratios of diagnosis of hypertension and use of anti-hypertensive medication among sexual minority and heterosexual adults (reference group). Models were adjusted for demographics, insurance, body mass index, and smoking status. Results: The sample included 424,084 participants; 95.8% were heterosexual, 1.8% were gay or lesbian, and 2.3% were bisexual. Participants had a mean age of 49.6 (±16.9) years. Compared to heterosexual participants of the same sex, gay men (AOR 1.24, 95% CI = 1.08-1.42) and bisexual women (AOR 1.17, 95% CI = 1.02-1.35) were more likely to report having been diagnosed with hypertension. Among men diagnosed with hypertension those who identified as gay were more likely than heterosexual men to report current use of anti-hypertensive medication (AOR 1.44, 95% CI = 1.13-1.83). Among women with diagnosed hypertension, bisexual women had lower odds of current use of anti-hypertensive medication (AOR 0.70, 95% CI = 0.55-0.89). No differences were identified when lesbian women and bisexual men were compared to their heterosexual peers of the same sex. Conclusion: Gay men and bisexual women had a higher prevalence of hypertension than their heterosexual counterparts of the same sex. Bisexual women may also be at higher risk for under-treated hypertension than heterosexual women. Future research should examine factors that contribute to hypertension disparities among gay men and bisexual women.

The burden, correlates and outcomes of left ventricular hypertrophy among young Africans with first ever stroke in Tanzania

BackgroundLeft ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography.MethodsThis cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics.ResultsWe enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%–83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04–1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively.ConclusionsWe identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.

Abstract P080: Lifetime Trauma Is Associated With Elevated Blood Pressure In Middle-aged And Older Latinas

Introduction: Latina women are more likely than non-Latina White women to have uncontrolled and undertreated hypertension. Prior research suggests greater exposure to traumatic experiences (such as interpersonal violence) is associated with elevated blood pressure and higher cardiovascular disease risk in women. However, few studies have investigated these associations among Latina women, a population that is at increased risk for hypertension. The purpose of this pilot study was to fill knowledge gaps by examining the associations of lifetime trauma (including childhood and adulthood) with blood pressure in middle-aged and older Latinas. Hypothesis: We assessed the hypothesis that lifetime trauma is associated with elevated blood pressure in middle-aged and older Latinas. Methods: Participants were recruited from an existing study in New York City called the Washington Heights/Inwood Comparative Effectiveness Research Project. Data collection consisted of a questionnaire administered by a research coordinator and in-office assessment of two blood pressure readings using recommended guidelines. The average systolic and diastolic blood pressures were calculated from these two measurements. Lifetime trauma was assessed with the Life Events Checklist which assesses 17 potentially traumatic experiences. We summed responses to the Life Events Checklist to create a count of lifetime trauma. Posttraumatic stress disorder (PTSD) symptoms were assessed with the PTSD Checklist-Civilian Version that assess presence and severity of 17 PTSD symptoms in the last month. We used linear regression models to separately examine the associations of lifetime trauma with systolic and diastolic blood pressure adjusted for demographic characteristics, health behaviors, PTSD symptoms, sociocultural factors (such as discrimination and acculturation). Results: The final sample included 50 Latina women (ages 42-77, mean=63.1 [9.7]). All women reported at least one traumatic experience with an average of 4.8 traumatic experiences in their lifetimes (range 1-10). A higher count of lifetime trauma (B [SE] = 5.56 [2.63], p = 0.04) was positively associated with greater systolic blood pressure in adjusted regression models. Although women who reported a higher count of lifetime trauma had higher diastolic blood pressure, this association was not statistically significant (B [SE] = 2.14 [1.67], p = 0.21). Conclusion: Findings indicate a higher count of lifetime trauma is associated with elevations in systolic blood pressure among Latina women. This is consistent with results of studies that have examined associations of lifetime trauma with blood pressure among women in the general population. There is a need for larger studies that incorporate longitudinal designs to investigate the associations of trauma and other sociocultural factors with blood pressure among Latina women.

Impact of Uncontrolled Hypertension at 3Months After Intracerebral Hemorrhage.

BackgroundSurvivors of intracerebral hemorrhage (ICH) are at high risk for recurrent stroke, which is associated with blood pressure control. Because most recurrent stroke events occur within 12 to 18 months of the index ICH, rapid blood pressure control is likely to be crucial. We investigated the frequency and prognostic impact of uncontrolled short‐term hypertension after ICH.Methods and ResultsWe analyzed data from Massachusetts General Hospital (n=1305) and the University of Hong Kong (n=523). We classified hypertension as controlled, undertreated, or treatment resistant at 3 months after ICH and determined the following: (1) the risk factors for uncontrolled hypertension and (2) whether hypertension control at 3 months is associated with stroke recurrence and mortality. We followed 1828 survivors of ICH for a median of 46.2 months. Only 9 of 234 (4%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled hypertension, 755 (41%) had undertreated hypertension, and 360 (20%) had treatment‐resistant hypertension. Black, Hispanic, and Asian race/ethnicity and higher blood pressure at time of ICH increased the risk of uncontrolled hypertension at 3 months (all P<0.05). Uncontrolled hypertension at 3 months was associated with recurrent stroke and mortality during long‐term follow‐up (all P<0.05).ConclusionsAmong survivors of ICH, >60% had uncontrolled hypertension at 3 months, with undertreatment accounting for the majority of cases. The 3‐month blood pressure measurements were associated with higher recurrent stroke risk and mortality. Black, Hispanic, and Asian survivors of ICH and those presenting with severe acute hypertensive response were at highest risk for uncontrolled hypertension.

Abstract P878: Racial and Ethnic Disparities in Early Hypertension Control After Intracerebral Hemorrhage

Introduction: Survivors of Intracerebral Hemorrhage (ICH) are at high risk of recurrent stroke. This risk is inversely proportional to average Blood Pressure (BP) after ICH. Racial/ethnic minority ICH survivors in the US demonstrate greater hypertension severity after ICH and are at higher risk of recurrent cerebral bleeding. Since most recurrent strokes occur within 12-18 months of index ICH, rapidly achieving BP control is likely to be crucial. We investigated the frequency, prognostic impact, and racial/ethnic disparities in uncontrolled short-term hypertension (HTN) after ICH. Methods: We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital (MGH-ICH, n=1305) and the University of Hong Kong (HK-ICH, n=523). We classified HTN as controlled, uncontrolled or treatment-resistant and determined: 1) risk factors for uncontrolled and treatment-resistant HTN; and 2) whether HTN control at 3 months is associated with long-term BP control, stroke recurrence and mortality across self-reported race/ethnicity groups. Results: We followed 1828 ICH survivors (1128 White, 565 Asian, 59 Hispanic, 49 Black, 27 other) for a median of 46.2 months. Only 9 of 172 (5%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled HTN, 755 (41%) had undertreated HTN, and 360 (20%) had treatment-resistant HTN. BP measurements at 3 months were highly correlated with measurements during follow-up (p&lt;0.001). Black, Hispanic and Asian race/ethnicity were associated with higher prevalence of uncontrolled HTN at 3 months (all p&lt;0.05). Both undertreated and uncontrolled HTN at 3 months were associated with increased risk of recurrent stroke and mortality during follow-up (all p&lt;0.05). Conclusions: Most ICH survivors have inadequate HTN control 3 months after ICH, with under-treatment accounting for the majority of cases. Three-month BP measurements are associated with inadequate long-term HTN control, higher recurrent stroke risk and mortality. ICH survivors self-reporting as Black, Hispanic or Asian appear to be at highest risk for uncontrolled HTN. Optimizing HTN control at 3 months is a unique opportunity to address racial/ethnic disparities in quality of care among survivors of primary ICH.

Matchmaking and the Future of Hypertension Management.

Matchmaking and the Future of Hypertension Management.

An improvement in self-care behaviour in heart failure patients lead to better management of hypertension

Abstract Background A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control. Methods SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg &amp;lt; MAP &amp;lt;100 mmHg. Results Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP &amp;gt;100 mmHg, with 22% in the CG versus 16% in the IG having MAP &amp;gt;100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002). Conclusions There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention. Funding Acknowledgement Type of funding source: None

Author response: The dimension of preventable stroke in a large representative patient cohort.

We thank Dr. Goldstein for the valuable comment on our article.1 Diabetes is a major risk factor for ischemic stroke and every fifth patient with diabetes dies of stroke.2 Guidelines recommend target control for hypertension and use of statins, whereas the benefit of prophylactic antiplatelet therapy remains controversial.3,4 In our cohort of ischemic stroke and TIA patients, 321 (18.6%) had diabetes and 60 of them were newly diagnosed (3.5% of all stroke/TIA patients). Among diabetic patients, 47.6% had undertreated hypertension, which is similar to the situation in patients without diabetes (45.3%). However, the proportion of patients not receiving adequate antithrombotic therapy—based on previous cardiovascular disease or carotid stenosis—was higher among diabetics (34.6% vs 7.3%, p < 0.001) as was the proportion of inadequately treated hypercholesterolemia (63.6% vs 51.1%, p = 0.002). Overall, risk factor control in diabetic patients was even worse than in non-diabetic patients—the proportions of patients with at least one untreated or inadequately treated risk condition at the time of the index event: 93.8% vs 76.2%, p < 0.001. Substantial improvement in primary prevention is one of the over-arching goals in the Action Plan for Stroke in Europe 2018–2030,5 and concerted actions are required to reduce the worrisome proportion of preventable strokes.

Differences Between Current and Desired Physician Hypertension Management Roles Among Chinese American Seniors: a Qualitative Study.

Though patient-physician racial concordance correlates with better perceived shared decision-making, Chinese immigrants report low quality of care and have undertreated hypertension regardless of concordance. To inform efforts to change physician behavior and improve quality of hypertension care, we used role theory to explore differences between Chinese American seniors' descriptions of current and desired physician roles in hypertension management. Qualitative interviews. Immigrant Chinese Americans with hypertension age ≥ 65years in Los Angeles County. We recruited 15 participants from a senior wellness center for language-matched interviews and blood pressure (BP) checks. Participants described current and desired physician activities for hypertension management. Bilingual research assistants translated audio recordings. Using thematic analysis, a three-member team independently reviewed and coded transcripts to identify themes regarding physician roles in hypertension management; discrepancies were discussed to achieve consensus. Themes were checked for validity in four subsequent focus groups. We completed interviews in 2014. Interviewees' mean age was 70.6years; seven were female and five had a systolic BP over 150mmHg. All interviewees reported having race- and language-concordant primary care providers, were prescribed at least one BP medication, and had Medicare. Three major themes encompassed current and desired physician roles in hypertension management: technical expert, empathetic health steward, and health educator. Descriptions of current and desired physician roles differed for all themes, most prominently for empathetic health steward and health educator. Participants desired but did not consistently experience interpersonal engagement or receive hypertension lifestyle counseling, citing visit time pressures. Among these Chinese American seniors, there remains a gap between current and desired physician roles in hypertension management, particularly interpersonal behaviors and education. Seniors deprioritized these roles in response to perceived physician role strain. Increased attention to the impact of perceived physician role strain might improve shared decision-making and hypertension management.

Author response: The dimension of preventable stroke in a large representative patient cohort.

We thank Dr. Goldstein for the valuable comment on our article.1 Diabetes is a major risk factor for ischemic stroke and every fifth patient with diabetes dies of stroke.2 Guidelines recommend target control for hypertension and use of statins, whereas the benefit of prophylactic antiplatelet therapy remains controversial.3,4 In our cohort of ischemic stroke and TIA patients, 321 (18.6%) had diabetes and 60 of them were newly diagnosed (3.5% of all stroke/TIA patients). Among diabetic patients, 47.6% had undertreated hypertension, which is similar to the situation in patients without diabetes (45.3%). However, the proportion of patients not receiving adequate antithrombotic therapy—based on previous cardiovascular disease or carotid stenosis—was higher among diabetics (34.6% vs 7.3%, p < 0.001) as was the proportion of inadequately treated hypercholesterolemia (63.6% vs 51.1%, p = 0.002). Overall, risk factor control in diabetic patients was even worse than in non-diabetic patients—the proportions of patients with at least one untreated or inadequately treated risk condition at the time of the index event: 93.8% vs 76.2%, p < 0.001. Substantial improvement in primary prevention is one of the over-arching goals in the Action Plan for Stroke in Europe 2018–2030,5 and concerted actions are required to reduce the worrisome proportion of preventable strokes.

Role of Palmer Dermatoglyphics in Essential Hypertension in Dentistry

Introduction: Hypertension is a common disease encountered in dentistry. It has terrible consequences, so dentist role in screening undiagnosed and undertreated hypertension is very important to evaluate risk assessment which may lead to improved monitoring and life-long treatment. So this study is carried out with the objective to find the correlation of palmer dermatoglyphics with essential hypertension. Material and methods: Group 1 was the study group of essential hypertensive male 50 in number with age range between 40-65 years patients with inclusion criteria of informed consent of history of hypertension. Group 2 was the control group of male 50 in number matched for gender, age, life style and economic status as that of patients were selected. Dermatographical parameters included in the study are finger tip ridge pattern of all five digits (arch, loop, whorl), Angles (atd, adt, dat) and palmar dermatoglyphic pattern (interdigital and hypothenar areas). Results: Patient have significantly more whorls and lees loop in comparison with control of the right hand. The decreased 'atd'angle is observed in patient in comparison with control in both right and left hand respectively and absent pattern in hypothenar area of left hand is found more in patient as compare to controls. Conclusion: Palmer Dermatoglyphics shows a certain positive association with hypertension. It can be as an adjunctive screening biomarker for early detection of essential hypertension which will be helpful in avoiding complication such as acute complications such as cardiac arrest or stroke in various dental surgical procedures