Antihypertensive Use Research Articles

The Implementation of Renal Denervation in the Management of Resistant Hypertension Despite Use of Multitherapy Antihypertensives at Maximally Tolerated Doses: A Contemporary Literature Review.

Refractory hypertension is highly prevalent among the hypertensive population, and current clinical management has failed to provide optimal control for these individuals. This subtype of arterial hypertension is defined as a persistently elevated systolic blood pressure reading of 140 mmHg, or higher, despite multiple antihypertensive use at maximally tolerated dosing. These patients have an elevated risk of cardiovascular and renal complications, urging for the need of more effective therapeutic management. Renal sympathetic efferent nerves have been noted to play an important role in volume and blood pressure homeostasis. Before the implementation of oral antihypertensives, the use of surgical lumbar sympathectomy for the reduction of persistent hypertension was considered a life-saving approach. However, individuals were left with debilitating side effects, such as postural hypotension, syncope, and impotence. A new and minimally invasive technique has been proposed, where the kidneys undergo selective denervation in hopes of providing decreased cardiovascular morbidity and mortality for patients with resistant hypertension. Some studies demonstrated promising outcomes with a reduction in blood pressure, a decrease in medication reliance, and a potential long-lasting effect of the procedure with an overall improvement in cardiovascular health. Unfortunately, most of the available data was obtained from observational, uncontrolled studies with short-term follow-up, small sample sizes, and high variability in blood pressure measurement. Therefore, further evidence is needed to determine whether renal denervation provides long-term benefits for blood pressure control and improves outcomes for mortality and cardiovascular events in this patient population.

Antihypertensive medication use during pregnancy in a real-world cohort of patients diagnosed with a hypertensive disorder of pregnancy.

Hypertensive disorders of pregnancy (HDP) are rising in prevalence and associated with adverse maternal and infant health outcomes. Current guidelines recommend labetalol, nifedipine, and methyldopa as acceptable first-line agents to treat HDP in outpatient settings. However, the current practice regarding antihypertensive medication usage and selection remain unclear. A retrospective, observational cohort study was conducted in 1,641 patients with a physician diagnosis of HDP who delivered at two academic medical centers in North Carolina from 2014 to 2017. Use of any antihypertensive medication, and the agent selected, at any encounter during pregnancy or on the delivery date was collected from the electronic health record. Proportions were compared across HDP diagnosis (eclampsia/severe preeclampsia, chronic hypertension with superimposed preeclampsia, preeclampsia, gestational hypertension) by Chi-square tests and multivariable logistic regression. Antihypertensive medications were used in 1,276 (77.8%) patients overall. Among treated patients, labetalol (74.9%) was the most frequently used medication followed by nifedipine (29.6%) and hydralazine (20.5%). Methyldopa was used infrequently (4.4%). HDP type was the strongest factor associated with use of an antihypertensive agent. Relative to gestational hypertension, antihypertensive use was significantly more likely [odds ratio (95% CI)] in patients with severe preeclampsia [5.94 (3.85-9.16)], chronic hypertension with superimposed preeclampsia [4.99 (3.46-7.19)], and preeclampsia [2.13 (1.61-2.82)]. In a real-world setting, antihypertensive medication use among HDP patients was common, labetalol, nifedipine, and hydralazine were the most commonly selected agents, and increasing HDP severity was associated with a higher likelihood of antihypertensive use. Future studies comparing medication effectiveness in pregnant patients with distinct HDP diagnoses are needed.

Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels.

Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.

Trends in antihypertensive drug utilization in British Columbia, 2004-2019: a descriptive study.

Clinical guidelines for hypertension were updated with lower blood pressure targets following new studies in 2015; the real-world impact of these changes on antihypertensive drug use is unknown. We aimed to describe trends in antihypertensive drug utilization from 2004 to 2019 in British Columbia. We conducted a longitudinal study to describe the annual prevalence and incidence rate of use of 5 antihypertensive drug classes (thiazides, angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers [ARBs], calcium channel blockers and β-blockers) among BC residents aged 30-75 years. We also conducted a cohort study to compare the risk of discontinuation and switch or add-on therapy between incident users of the above drug classes. We used linkable administrative health databases from BC. We performed a Fine-Gray competing risk analysis to estimate subhazard ratios. Among BC residents aged 30-75 years (population: 2 376 282 [2004] to 3 014 273 [2019]), the incidence rate of antihypertensive drug use decreased from 23.7 per 1000 person-years in 2004 to 18.3 per 1000 person-years in 2014, and subsequently increased to 22.6 per 1000 person-years in 2019. The incidence rate of thiazide use decreased from 8.9 per 1000 person-years in 2004 to 3.2 per 1000 person-years in 2019, and incidence rates for the other drug classes increased. Incident users receiving thiazide monotherapy had an increased risk of discontinuing any antihypertensive treatment compared with ACE inhibitor monotherapy (subhazard ratio 0.96, 95% confidence interval [CI] 0.95-0.97), ARB monotherapy (subhazard ratio 0.84, 95% CI 0.81-0.87) and thiazide combination with ACE inhibitor or ARB (subhazard ratio 0.86, 95% CI 0.84-0.88), and had the highest risk of switching or adding on. First-line use of thiazides continued to decrease despite a marked increase in incident antihypertensive therapy following updated guidelines; incident users receiving ARB monotherapy were least likely to discontinue, and incident users receiving thiazide monotherapy were more likely to switch or add on than users of other initial monotherapy or combination. Further research is needed on the factors influencing treatment decisions to understand the differences in trends and patterns of antihypertensive drug use.

Seminar Evaluation of the Use of Antihypertensive Drugs in Hospitalized Patients Suffering From Hypertension in Grandmed Hospital Lubuk Pakam in 2023

Proper treatment is needed to control high blood pressure, including drugs to minimize the strength of blood flow. This study aims to obtain information and knowledge related to the pattern of taking blood flow strength drugs in high blood patients located at Grandmed Lubuk Pakam Hospital 2023. This type of research is an illustrative study using descriptive design and retrospective data. Research shows the use of high blood pressure drugs by hypertensive patients at Grandmed Lubuk Pakam Hospital in 2023 are as follows: Partial accuracy, namely 56 hypertensive patients without complications, right indication 100%, right drug 98.21%, right patient 100%, and right dose 100%. It can be concluded that hypertensive patients at Grandmed Lubuk Pakam Hospital meet the criteria for the right patient, right indication and right dose. The description of the use of high blood pressure drugs at Grandmed Lubuk Pakam Hospital is: (0.1%), candesartan (46.4%), bisoprolol (7.1%), captopril (8.9%), valsartan (7.1%) and furosemide (3.6%). Then community service activities were carried out with the target of 125 Pharmacy students to increase student knowledge related to the use of antihypertensive drugs used in hospitals. The socialization was carried out virtually via zoom and pre-test and post-test were given to assess students' understanding of the service material. The questionnaire is presented in the form of a googleform as an assessment of feedback on the results of socialization materials issued after the activity is completed. The activity was also filled with responses and questions and answers with service participants. The conclusion obtained is that 87% of students understand the use of hypertension drugs very well, 12% understand well, and 1% understand the use of hypertension drugs enough.

Gender features of left ventricular myocardial remodeling in patients with arterial hypertension and anxiety and depressive disorders and possibilities of complex antihypertensive and psychocorrective pharmacotherapy

Relevance. Anxiety-depressive disorders are a frequent companion of arterial hypertension (AH). It is known about the deterioration of the prognosis in patients with a combination of these conditions. At the same time, it is unclear whether complex antihypertensive therapy (AHT) with the inclusion of an antidepressant will improve the control of hypertension, slow down target organ damage, and whether it will be equally effective in men and women.The aim of the study – identify gender characteristics of the structural and functional state of the myocardium of the left ventricle (LV) and the effect of antihypertensive therapy with and without the inclusion of an antidepressant on left ventricular myocardial remodeling in patients with AH and ADD, taking into account the gender of the patient.Materials and methods. The study included 182 patients: 62 with AH (32 men and 30 women) and 120 – with AH and anxiety-depressive disorders (30 men – group 1, 30 women – group 2). Patients with AH and anxiety-depressive disorders were randomized into 2 subgroups (A and B). Patients of subgroup A received a fixed combination of an angiotensin II receptor blocker and a diuretic, a beta-blocker and an antidepressant, patients of subgroup B received similar antihypertensive therapy without including an antidepressant. All patients at inclusion in the study and after 24 weeks underwent a general clinical examination, office measurement of blood pressure (also after 4,8,12 weeks), 24-hour blood pressure monitoring, echocardiography, testing on the HADS, CES-D scales, and a psychiatrist's consultation.Results. Men and women with AH and anxiety-depressive disorders, the negative changes in the main parameters of the LV structural and functional state were more significant than in patients with a normal psychoemotional status. At the same time, in women with anxiety-depressive disorders, LV hypertrophy (LVH) was more pronounced than in men. Target levels of blood pressure were achieved faster in the groups treated with antidepressant, however, intergroup differences reached the level of statistical significance only in women. Complex pharmacotherapy led to a more significant improvement in LV structural and functional state than traditional AHT, especially in women. The use of an antidepressant led to a reduction in anxiety and depressive symptoms, which was not observed in patients only with AHT groups.Conclusions. Patients with AH and anxiety-depressive disorders develop more pronounced remodeling of the LV myocardium than patients with AH with a normal psychoemotional status, especially in women. The combined use of sertraline and antihypertensive drugs contributes to a more rapid achievement target levels of blood pressure, a significant improvement in LV structural and functional state, which is more pronounced in women than in men. It is also important to normalize the psycho-emotional status against the background of an integrated approach to the pharmacotherapy of patients with AH and anxiety-depressive disorders.

Assessing statins use in a real-world primary care digital strategy: a cross-sectional analysis of a population-wide digital health approach

The digitization of the primary care system provides an opportunity to evaluate the current use of statins in secondary prevention populations (myocardial infarction or stroke). We conducted a cross-sectional study (ClinicalTrials.gov, NCT05285085), analysing anonymised data routinely collected by community health workers (CHW) in Brazil between May 2016 and September 2021 to assess the proportion of self-reported statins use and associated factors. From the 2,133,900 individuals on the database, 35,103 (1.6%), mean age 66.2 years (SD14.6), 49.5% (17,382/35,103) male sex, 50.5% (17,721/35,103) female sex, and 29.6% (10,381/34,975) Caucasians, had a previous myocardial infarction (MI) (n=11,628; 33.1%) or stroke (n=25,925; 73.9%). Approximately 50% (17,020/35,103) were from the Northeast region, 78.7% (27,605) from urban zones, and 39.4% (13,845) with social development index (SDI)>0.7. Overall, 6.7% (2346) and 0.6% (212) reported statins and high dose statins use, respectively. Age over 60 years old (OR 1.32 [95% CI 1.19-1.47), living in the Southern region (OR 4.53 [95% CI 3.66-5.60]), having a previous diagnosis of MI (OR 4.53 [95% CI 3.66-5.60]), heart failure (OR 2.29 [95% CI 1.13-1.47]), diabetes (OR 1.50 [95% CI 1.37-1.64]), dyslipidaemia (OR 2.90 [95% CI 2.55-3.29]), chronic kidney disease (OR 1.27 [95% CI 1.08-1.48]) and use of anti-hypertensives (OR 5.47 [95% CI 4.60-6.47]) were associated with statin use. The analysis of a real-world database from a digitized primary care system, allowed us to identify a very low use of statins in secondary prevention Brazilian patients, mostly influenced by socio-demographic factors and co-morbidities. Novartis Biociências, Brazil.

1367-P: Type 2 Diabetes Mellitus and Obesity Amplifies Nonalcoholic Fatty Liver Disease Risk with Age

Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent in the general population with multiple known metabolic risk factors. There is limited evidence on the impact of age on the prevalence of hepatic steatosis and fibrosis, and their relationship to cardiometabolic risk factors. To this end, we recruited 761 patients 35-75 years of age, with and without T2DM, who underwent screening for NAFLD with laboratory tests and imaging by elastography (steatosis by controlled attenuation parameter [CAP]; fibrosis by liver stiffness measurement [LSM]). Patients were divided into 3 age groups: &amp;lt;45 years (young), 45-64 years (middle age), and ≥65 years old (older age), with results reported in this order. Of the 761 patients included, 21% (n=161) were young, 52% (n=397) middle age, and 27% (n=203) older. In the older age group, prevalence of obesity was lower (53% vs. 53% vs. 40%, p=0.01) but T2DM was higher (15% vs. 39% vs. 44%; p&amp;lt;0.01). Similarly, hypertension, atherogenic dyslipidemia, and use of antihypertensives and statins were more frequent in the older age group. Despite this, there were no differences in steatosis (CAP ≥274 dB/m: 50% vs. 54% vs. 52%, p=0.7). A marker of NAFLD disease activity (NIS4) worsened with increasing age (p&amp;lt;0.01). There was a trend for fibrosis (LSM≥7.0 kPa) to be higher in middle (11%) and older (8%) vs. younger (5%) age. After multivariable analysis (sex, race, ethnicity, BMI, A1c, cardiometabolic risk factors), BMI was associated with both steatosis and fibrosis in all age groups (p&amp;lt;0.01). There was a significant association between A1c as a continuous variable and steatosis only in the older age group (OR 2.8, 95% CI 1.6-4.9), while its association with fibrosis started at middle age (OR 1.3, 95% CI 1.1-1.7) and was stronger in older age (OR 1.8, 95% CI 1.01-3.2). Conclusion: Age was not associated with steatosis or fibrosis. BMI was the strongest predictor of hepatic steatosis and synergizes with T2DM for the development of fibrosis with age. Disclosure A. Sharma: None. E. Godinez Leiva: None. R. Lomonaco: None. E. Valdez Saenz: None. A. Ortiz Rocha: None. M.A. Gonzalez: None. S.A. Marangi: None. S. Shrestha: None. S.S. Shetty: None. J.T. Budd: None. S. Kalavalapalli: None. D. Barb: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck &amp; Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns.

A prediction model on incident chronic kidney disease among individuals with type 2 diabetes in the United States.

Early identification of incident chronic kidney disease (CKD) in individuals with diabetes may help improve patients' clinical outcomes. This study aimed to develop a prediction equation for incident CKD among people with type 2 diabetes (T2D). A time-varying Cox model was applied to data from the ACCORD trial to predict the risk of incident CKD. A list of candidate variables was chosen based on literature reviews and experts' consultations, including demographic characteristics, vitals, laboratory results, medical history, drug use and health care utilization. Model performance was evaluated. Decomposition analysis was conducted, and external validation was performed. In total, 6006 patients with diabetes free of CKD were included, with a median follow-up of 3 years and 2257 events. The risk model included age at T2D diagnosed, smoking status, body mass index, high-density lipoprotein, very-low-density lipoprotein, alanine aminotransferase, estimated glomerular filtration rate, urine albumin-creatinine ratio, hypoglycaemia, retinopathy, congestive heart failure, coronary heart disease history, antihyperlipidaemic drug use, antihypertensive drug use and hospitalization. The urine albumin-creatinine ratio, estimated glomerular filtration rate and congestive heart failure were the top three factors that contributed most to the incident CKD prediction. The model showed acceptable discrimination [C-statistic: 0.772 (95% CI 0.767-0.805)] and calibration [Brier Score: 0.0504 (95% CI 0.0477-0.0531)] in the Harmony Outcomes Trial. Incident CKD prediction among individuals with T2D was developed and validated for use in decision support of CKD prevention.

The prevalence of masked hypertension in patients with lone atrial fibrillation: a cross sectional analytical study

Atrial fibrillation (AF) is prevalent in individuals with essential hypertension (HTN). Masked hypertension occurs in up to 15% of the general population and is associated with adverse clinical outcome. The aim of the current study was to evaluate the prevalence of masked hypertension in apparently normotensive individuals with lone AF. A cross sectional analytical study performed at the Rabin Medical Center included all patients > 18 years who visited the emergency department (ED) in the years 2018–2021 with idiopathic AF, had normal blood pressure (BP) values during their ED visit and did not have a history of hypertension or current use of anti-hypertensives. Ambulatory blood pressure monitoring (ABPM) was performed in all eligible patients within 30 days from ED visit. Data collected included information from the ED visit and data extracted from the monitoring device. A total of 1258 patients were screened for eligibility, of which 40 were included in the analysis. The average age was 53.4 ± 16 years, 28 patients (70%) were males. Overall, 18 individuals (46%) had abnormal BP values according to the 2017 ACC/AHA guidelines for the diagnosis of hypertension. Of these, 12 had abnormal 24-h BP average (≥ 125/75 mmHg), one had isolated daytime abnormal average (≥ 130/80 mmHg) and 11 had isolated night time abnormal average (≥ 110/65 mmHg). Masked hypertension is prevalent in patients with lone AF without a diagnosis of HTN and performing ABPM in such individuals should be strongly considered.

#6373 EFFECT ON BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS IN PEDIATRIC PATIENTS DURING COVID-19 PANDEMIC CONFINEMENT (COBECOR STUDY)

Abstract Background and Aims Patients monitored in the cardiovascular risk (CVR) consultation usually present overweight/obesity, metabolic syndrome, tendency to hypertension (HT), poor eating habits and sedentary lifestyle, with great resistance to change, great influence of the environment and, frequently, psychosocial limitations. We asked whether home confinement for COVID-19 (March-May 2020) could have negative effects in relation to CVR in these patients. The main objective of this work is to assess this hypothesis with respect to HTN and the use of antihypertensive drugs in these patients. As a secondary objective, we assessed changes in other parameters: body mass index (BMI), level of physical activity and diet. Method Retrospective cohort study with review of 738 ambulatory blood pressure monitoring (ABPM) between 2019-2022 obtaining, after applying the exclusion criteria (no overweight/obesity, poor therapeutic compliance, underlying renal pathology or failure to perform two ABPM in the study period), a final cohort of 46 patients divided into two groups (23 each): one group exposed to home confinement (G1) with one ABPM before and after home confinement and another group not exposed to confinement (G2) with two ABPM in different periods between 2021-2022. Blood pressure (BP) percentile values, dipper pattern, variability and blood pressure load, as well as the rest of the CVR parameters were compared in both periods. Results The mean age was 13 years (13.8 G1/13.2 G2) with a mean time between the 1st and 2nd ABPM of 11 months (11.08 G1/10.95 G2) and a greater reduction in BMI in G2 than in G1 (1.05 G1/1.21 G2). Despite this, the results were not statistically significant. Nor were the results significant in terms of differences in AT or worsening of the dipper pattern (30.4% in G1 and 21.7% in G2). We did observe differences (p&amp;lt;0.022) in the use of antihypertensive drugs, although contrary to our initial hypothesis, with greater use of drugs in G2. Conclusion Although the low sample size, the biases inherent in the design and the lack of previous studies make the interpretability and statistical significance of some results difficult, they reinforce that the measures during confinement did not contemplate all spheres of health and the need to implement specific CVR consultations. Obesity and its associated pathologies are an important public health problem that pediatricians have the responsibility to address.

Clinical factors for predicting cardiovascular risk, need for renal replacement therapy, and mortality in patients with non–dialysis-dependent stage 3–5 chronic kidney disease from the Salford Kidney Study

BackgroundEstablished cardiovascular risk assessment tools lack chronic kidney disease–specific clinical factors and may underestimate cardiovascular risk in non–dialysis-dependent chronic kidney disease (CKD) patients.MethodsA retrospective analysis of a cohort of patients with stage 3–5 non–dialysis-dependent chronic kidney disease in the Salford Kidney Study (UK, 2002–2016) was performed. Multivariable Cox regression models with backward selection and repeated measures joint models were used to evaluate clinical risk factors associated with cardiovascular events (individual and composite cardiovascular major adverse cardiovascular events), mortality (all-cause and cardiovascular-specific), and need for renal replacement therapy. Models were established using 70% of the cohort and validated on the remaining 30%. Hazard ratios ([95% CIs]) were reported.ResultsAmong 2192 patients, mean follow-up was 5.6 years. Cardiovascular major adverse cardiovascular events occurred in 422 (19.3%) patients; predictors included prior history of diabetes (1.39 [1.13–1.71]; P = 0.002) and serum albumin reduction of 5 g/L (1.20 [1.05–1.36]; P = 0.006). All-cause mortality occurred in 740 (33.4%) patients, median time to death was 3.8 years; predictors included reduction of estimated glomerular filtration of 5 mL/min/1.73 m2 (1.05 [1.01–1.08]; P = 0.011) and increase of phosphate of 0.1 mmol/L (1.04 [1.01–1.08]; P = 0.021), whereas a 10 g/L hemoglobin increase was protective (0.90 [0.85–0.95]; P < 0.001). In 394 (18.0%) patients who received renal replacement therapy, median time to event was 2.3 years; predictors included halving of estimated glomerular filtration rate (3.40 [2.65–4.35]; P < 0.001) and antihypertensive use (1.23 [1.12–1.34]; P < 0.001). Increasing age, albumin reduction, and prior history of diabetes or cardiovascular disease were risk factors for all outcomes except renal replacement therapy.ConclusionsSeveral chronic kidney disease–specific cardiovascular risk factors were associated with increased mortality and cardiovascular event risk in patients with non–dialysis-dependent chronic kidney disease.Graphical abstract

RENIN-ANGIOTENSIN SYSTEM INHIBITOR IS BETTER IN SLOWING PROGRESSION OF MILD COGNITIVE IMPAIRMENT (MCI): A META-ANALYSIS ON ANTIHYPERTENSIVE DRUG AND RISK OF DEMENTIA IN MCI PATIENT

Objective: Antihypertensive drugs has been known to reduce risk of mild cognitive impairment (MCI) and dementia in hypertensive patients. The current meta-analysis aims to assess association of antihypertensive drugs and risk of dementia in MCI patients. Design and method: PubMed, Embase and Web of Science were searched for articles from database inception until October, 2022. Longitudinal cohort studies in subjects aged 18 or above with MCI at baseline involving (1) comparison of use of antihypertensive drugs and non-user, or (2) comparison among classes of antihypertensive drugs were included. Primary outcome was risk of dementia. Reported risk of dementia was extracted as hazard ratio or odds ratio. Peto fixed effects meta-analysis was performed to estimate the pooled effect size of antihypertensive drugs on risk of dementia. Results: Eight studies were included in current analysis. One was post-hoc analysis of randomised controlled trial, while the others were observational cohort study. A total number of 1,107 dementia cases were identified. Use of antihypertensive drugs, regardless of therapeutic class, reduced risk of dementia by 27% (Peto odds ratio (OR) 0.73, 95% confidence interval (CI) 0.62-0.86). Use of renin-angiotensin system (RAS) inhibitor, including angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB), reduced risk of dementia by 47% (Peto OR 0.53, 95% CI 0.39-0.72), while use of non-RAS antihypertensives reduced risk of dementia by 28% (Peto OR 0.72, 95% CI 0.57-0.91). When directly comparing use of RAS and non-RAS antihypertensives, RAS inhibitor further reduced 20% risk of dementia (Peto OR 0.80, 95% CI 0.68-0.94). Among RAS inhibitor, ARBs showed trend of reducing dementia risk but could not achieve statistical significance (Peto OR 0.85, 95% CI 0.69-1.06). Conclusions: Antihypertensive drug reduced risk of dementia in MCI patients. Among different classes of antihypertensive drugs, RAS inhibitor performed better than other non-RAS antihypertensive drug in slowing progression of mild cognitive impairment to dementia, while ARB and ACEI were comparable in this aspect.

DRUG-MEDIATED IMPROVEMENT IN GLOBAL DNA METHYLATION AMONG HYPERTENSIVE INDIVIDUALS: OBSERVATIONS FROM NORTH-INDIAN POPULATION-BASED STUDY

Objective: Hypertension has been reported to affect global DNA methylation levels negatively. However, the effect of anti-hypertensive drugs on methylation levels remains understudied. The present study aims to explore the relationship between the use of anti-hypertensive drugs and peripheral blood leucocyte global DNA methylation levels in two North-Indian populations. Design and method: The present study combines the observations of two population-based cross-sectional studies conducted among adult individuals (aged 30 years and above) of either sex belonging to the Jat community of Palwal, Haryana (n = 543) (completed), and the Jat Sikh community of Mansa district, Punjab (n = 148) (ongoing). Data pertaining to socio-demographic variables and the use of anti-hypertensive drugs were collected using pre-tested and modified interview schedules. Anthropometric measurements and blood pressure were captured from each participant using standard protocols. Peripheral blood leucocyte global DNA methylation levels were estimated using ELISA-based colorimetric technique. SPSS version 22 was used to perform statistical analysis. Results: Hypertensive cases were found to be significantly hypomethylated than the control groups in both communities. When stratified for medication, the median global DNA methylation level of hypertensive cases on any type of anti-hypertensive drug was found to be significantly higher than that of those hypertensive individuals who were not on medication. In fact, median DNA methylation levels of hypertensive cases on medication were comparable to that of controls. These trends were consistent in both the studied populations. Conclusions: The use of anti-hypertensive drugs appears to improve the global DNA methylation level among hypertensive cases. More studies are required to understand the pathway through which antihypertensive drugs act on DNA methylation levels and if improving DNA methylation levels through dietary interventions would have a similar antihypertensive effect.

ANTIHYPERTENSIVE THERAPY INTAKE IN THE PURE COLOMBIA COHORT 2005-2021

Objective: Describe changes in antihypertensive therapy in prevalent hypertension (HT) cases in the PURE cohort (The Prospective Urban Rural Epidemiology) Colombia in 2005-2021. Design and method: A prospective cohort study including 7552 participants from the baseline PURE Colombia cohort from 11 departments (Atlántico, Bolívar, Caldas, Casanare, Cauca, Cesar, Cundinamarca, Nariño, Quindío, Santander, Tolima). We conducted a descriptive analysis of the change in antihypertensive therapy between the 2005 baseline and the cut-off point to 2021. Results: At baseline, 2846 (37.7%) hypertensive participants were identified, 65.7% of which were women, with a mean age of 55.2 (SD 9.2) years. After 13 years of follow-up, 902 incident cases of HT were reported, 67.2% of which were women, increasing the prevalence within the cohort to 50.2% Regarding the prevalences of antihypertensive drug use, in 2005 vs 2021 the observed changes were: angiotensin-converting enzyme inhibitors (ACEI) 23.7% vs 9.2%, thiazide diuretics (TD) 10.1% vs 6.0%, angiotensin receptor antagonists (ARBs) 4.5% vs 28.8% and lastly, dihydropyridine calcium channel blockers (DCCB) 4.0% vs 5.2%. The differences in the use of antihypertensive drugs between baseline and follow-up were significant, 55.7% of the patients reported no use of antihypertensive drugs at baseline vs 59.8% at follow-up, 20.0% were on monotherapy and the proportion dropped to 18.9%, 24.3% reported use of 2 or more drugs at baseline and 21.3% at follow-up. Conclusions: The significant increase in hypertension suggests the need to adopt recommendations for drug consumption that have abandoned the use of monotherapy; however, the changes in the management of hypertensive patients in the cohort show no improvement. There is a need to undertake strategies that encourage access to fixed-dose combination antihypertensive therapy.

Reduction of Intravenous Antihypertensives through Clinical Decision Support in a Large Safety Net System.

Asymptomatic severe hypertension (also known as hypertensive urgency) is frequently encountered in the hospital. Previous evidence suggests that management with one-time doses of intravenous (IV) antihypertensives may increase adverse events. Despite this, single-dose treatment remains common in the emergency department and inpatient settings. This quality initiative was launched at New York City Health + Hospitals, the largest safety net hospital system in the United States. The initiative involved two changes to electronic orders for IV hydralazine and IV labetalol: a nonintrusive advisory statement within the order instructions and a mandatory requirement to document the indication for IV antihypertensive use. This initiative took place from November 2021 to October 2022. Of the indications selected for IV antihypertensive orders, 60.7% were for hypertensive emergency, 15.3% were for patients who were strictly NPO, 21.2% were for other, and 2.8% selected more than one indication. For ED-only encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient encounters were 2.53 preintervention and 1.55 postintervention (38.7% reduction, p < 0.001). For inpatient encounters, aggregate IV hydralazine and IV labetalol orders per 1,000 patient-days were 18.25 preintervention and 15.81 postintervention (13.4% reduction, p < 0.001). Similar trends were observed for individual orders of IV hydralazine and IV labetalol. There were significant reductions in 7 of the 11 hospitals in inpatient administration of aggregate IV hydralazine and labetalol orders per 1,000 patient-days. This quality improvement initiative successfully reduced unnecessary IV antihypertensive use in an 11-hospital safety net system.

FAKTOR-FAKTOR YANG MEMPENGARUHI TERJADINYA HIPOTENSI INTRADIALISIS PADA PASIEN GAGAL GINJAL KRONIK DI RUANGAN HEMODIALISIS MELATIRSUP PROF DR. R. D. KANDOU MANADO

Backgroud One of the most frequent complications in patients with hemodialysis is an intradialysis hypotension. Some conditions of patients who can trigger a drop in blood pressure during hemodialysis: age, gender, comorbidities such as diabetes and cardiomyopathy, anemia, weight gain and the use of antihypertensive drugs. Aim: this study aim to identify factors that affect the intradialysis hypotension of chronic kidney failure patients with hemodialysis. Method the uses the kind of quantitative with a cross-sectional study design, total sample of 296 hemodialysis patients. Data analysis using chi square test and coefficient correlation. Results showed a correlation between age and cardiovascular history with the incidence of intradialysis hypotension and while gender have nothing to do with the incidence of intradialysis hypotension. Conclusion monitoring needs to be improved while the patient is undergoing hemodialysis so as not to cause intradialysis hypotension which threatens the health and safety of the patient while undergoing hemodialysis. Keywords: Chronic Kidney Diseases; Hemodialysis; Intradialysis Hypotension

CHANGE IN ARTERIAL STIFFNESS AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS: THE JOINTHEART STUDY

Objective: Use of disease modifying antirheumatic drugs (DMARDs) has been associated with reduction in blood pressure (BP) and arterial stiffness in clinical trials, but real-word data is lacking. We investigated change in ambulatory BP and arterial stiffness in outpatients with rheumatoid arthritis (RA) eligible for initiation or change in targeted synthetic (ts) or biological (b) DMARDs. Design and method: Eighty-nine consecutive RA patients (age 53±13, 68% women) were examined at initiation of ts/bDMARDs and repeated after 22 months. Ambulatory BP, carotid-femoral-pulse wave velocity (cfPWV) and Disease Activity Score in 28 joints using C-reactive protein (DAS28) were measured at baseline and at follow-up. High cfPWV was defined as cfPWV &gt; 10 m/s in accordance with guidelines. Results: At follow-up, 20% used tsDMARDs, 57% bDMARDs and 67% had achieved remission or low disease activity. DAS28 decreased from 3.9±1.3 at baseline to 2.8±1.2 at follow-up (p&lt;0.001). The ambulatory systolic BP increased (116±11 mmHg vs 120±13 mmHg, p = 0.010), while the ambulatory diastolic BP decreased (76±7 mmHg vs. 73±8 mmHg, p = 0.001) from baseline to follow-up. Body mass index (BMI) increased from 26.5±5.2 kg/m2 to 27.1±4.9 kg/m2, p = 0.009. Changes in ambulatory systolic and diastolic BP were associated with presence of diabetes at baseline, but not DAS28 or use of ts or bDMARDs. Mean cfPWV increased from 7.8±1.6 m/s at baseline to 8.5±1.8 m/s at follow-up (p&lt;0.001). The prevalence of high cfPWV increased from 10.8% to 16.3 %, p = 0.03. DAS28 (beta = 0.32, p = 0.01) and diabetes at baseline (beta = 0.39, p = 0.001) were associated with increase in cfPWV, independent of achieved remission/low disease activity at follow-up, baseline systolic BP, BMI, age, sex and use of antihypertensive drugs. Conclusions: In outpatients with RA, higher disease activity at baseline was associated with an increase in arterial stiffness during follow-up, despite DMARD therapy and significant decrease in disease activity.

ASSOCIATION OF PRESSURE CONTROL RATE AND USE OF ANTI-HYPERTENSIVE DRUGS AMONG BRAZILIAN HYPERTENSIVE PATIENTS

Objective: To analyze the association between the rate of blood pressure (BP) control and the use of antihypertensive drugs among hypertensive patients. Design and method: Analytical cross-sectional study, using data from the TeleMRPA platform, which records data from Residential Blood Pressure Measurements (MRPA). Variables used: age, sex, systolic BP (SBP) and diastolic BP (DBP) at office and residential, amount of medication in use, categorized into monotherapy, dual therapy, triple combination and four or more; BP variability. Comparison between categories was performed using the chi-square test and ANOVA test for comparison of means, considering a 95% confidence interval and significance level p&lt;0.05. Results: Participants were 25,543 hypertensive patients, with a mean age of 60.6 (±14.4) years, minimum age 18 and maximum age 114 years. 63.1% were women and were older (mean 61.9 (±14.3) than men (58.5 (±14.2). The BP control rate was 42.3% in total sample, being proportionally higher among women (67.6%). The BP control rate was higher among young adults (&lt;60 years) than among the elderly; 60 to 70 years. The amount of antihypertensive drugs was distributed in 42.6% in monotherapy, 37.4% double, 15.7% triple, and 4.4% four or more. Women used proportionally more triple combination (16.2%) than men (14.7%; p = 0.014) and in the other combinations there was no difference in the distribution of therapies and gender. than among the elderly (38.2%); drug combinations had higher proportions among the elderly. BP control rates were higher among those on monotherapy (42.7%) and dual combination (43.4%) than among the elderly what a triple combination (41.4%) and four or more (32.5%). Conclusions: The BP control rate was higher among women and among young adults. Monotherapy was more present among young adults and as the amount of drug combination increased, the rate of BP control decreased.

EE467 Prescription Patterns and Estimation of Cost of Illness of Type-II Diabetic Patients in a Tertiary Care Hospital Nepal

The impact of diabetes on health care expenditures has been increasingly recognized. Number of ‘cost of illness’ studies has shown a threefold increase in the direct costs of diabetic patients compared with non-diabetic patients. This study aimed to evaluate the prescription patterns and cost of illness of type II diabetic patients along with the trends in anti-diabetic and antihypertensive drug use patterns among patients with type II diabetes patients with and without comorbidities.