Hypertension Medication Use Research Articles

Evaluation of The Rationality of Hypertension Medication Use in Puskesmas Central Cimahi

Evaluation of The Rationality of Hypertension Medication Use in Puskesmas Central Cimahi

A Longitudinal Decline in Walking Speed Is Linked with Coexisting Hypertension and Arthritis in Community-Dwelling Older Adults.

Objective: The aim was to investigate the association between baseline coexistence of hypertension (HTN) and arthritis, HTN alone, or arthritis alone, and their impact on longitudinal physical function measures among community-dwelling older adults over 5 years of follow-up. Methods: Ours was a longitudinal prospective cohort study from the second wave (2010-2011) and third wave (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Data for older adults were used. Participants were categorized based on self-reported diagnoses into four groups: coexisting HTN and arthritis, HTN only, arthritis only, or neither. Physical performance measures included walking speed using the 3-Meter Walk Test and the Five Times Sit-to-Stand Test (FTSST). Multiple generalized estimating equations with linear regression analyses were conducted, adjusting for age, sex, race, body mass index (BMI) educational level, pain severity, and baseline use of pain and hypertension medications. Results: Data for 1769 participants were analyzed. Slower walking speed was only associated with coexisting HTN and arthritis (B = -0.43, p < 0.001) after accounting for covariates. The coexisting HTN and arthritis group showed no significant association with FTSST (B = 0.80, p = 0.072) after accounting for covariates. Conclusions: The coexistence of baseline HTN and arthritis in older adults is associated with a gradual decline in only walking speed as a physical performance measure in older adults.

Examining the Hypertension Control Cascade in Adults With Uncontrolled Hypertension in the US

Uncontrolled hypertension is a major contributor to cardiovascular disease (CVD) in the US. To determine the prevalence of hypertension control cascade outcomes (hypertension awareness, treatment recommendations, and medication use) among individuals with uncontrolled hypertension to inform action across cascade levels. This weighted cross-sectional study used January 2017 to March 2020 National Health and Nutrition Examination Survey (NHANES) data from noninstitutionalized adults aged 18 years or older in the US with uncontrolled hypertension. Data analysis occurred from January to February 2024. Calendar year of response to the NHANES survey. Mean blood pressure (BP) was computed using up to 3 measurements. Uncontrolled hypertension was defined as systolic BP of 130 mm Hg or greater or diastolic BP of 80 mm Hg or greater, regardless of medication use. Outcomes included patient awareness of hypertension, treatment recommendations, and medication use. To estimate population totals by subgroup, the age-standardized proportion of each outcome was multiplied by the estimated number of adults with uncontrolled hypertension. The study included 3129 US adults with uncontrolled hypertension (1675 male [weighted percentage, 52.3%]; 775 aged 18 to 44 years [weighted percentage, 29.4%]; 1306 aged 45 to 64 years [weighted percentage, 41.4%]; 1048 aged 65 years or older [weighted percentage, 29.2%]), resulting in a population estimate of 100.4 million adults (weighted percentage, 83.7%) with uncontrolled hypertension. More than one-half of study participants (57.8 million adults [weighted percentage, 57.6%]) were unaware that they had hypertension, and of the 35.0 million who were aware and met criteria for antihypertensive medication, 24.8 million (weighted percentage, 70.8%) took the medication but had hypertension that remained uncontrolled. These negative outcomes in the hypertension control cascade occurred across demographic groups, with notably high prevalence among younger adults and individuals engaged in health care. Among an estimated 30.1 million adults aged 18 to 44 years with hypertension, 10.4 of 11.3 million females (weighted percentage, 91.8%) and 17.7 million of 18.8 million males (weighted percentage, 94.3%) had uncontrolled hypertension. Of the 10.4 million females, 7.2 million (weighted percentage, 68.8%) were unaware of their hypertension status, and of the 17.7 million males, 12.0 million (weighted percentage, 68.1%) were unaware. Additionally, 9.9 of 13.0 million adults with uncontrolled hypertension (weighted percentage, 75.7%) reported no health care visits in the past year and were unaware. Conversely, among 70.6 million adults with uncontrolled hypertension reporting 2 or more health care visits, approximately one-half (36.6 million [weighted percentage, 51.8%]) were unaware. In this cross-sectional study, more than 50% of adults with uncontrolled hypertension in the US were unaware of their hypertension and were untreated, and 70.8% of those who were treated had hypertension that remained uncontrolled. These findings have serious implications for the nation's overall health given the association of hypertension with increased risk for CVD.

Impact of Hypertension on the Dose-Response Association Between Physical Activity and Stroke: A Cohort Study.

Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals. A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%). Compared with Q1, adjusted hazard ratios were 0.87 (0.69-1.10; P=0.23), 0.75 (0.59-0.95; P=0.02), and 0.94 (0.74-1.20; P=0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50-1.25; P=0.32), 0.75 (0.48-1.18; P=0.22), 0.97 (0.62-1.51; P=0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68-1.17; P=0.41), 0.74 (0.56-0.98; P=0.03), 0.92 (0.69-1.23; P=0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found. Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted.

P203 IMPACT OF IMPLEMENTING A COMMUNITY CARE STRATEGY TO REDUCE THE RISK OF CARDIOVASCULAR DISEASE IN SANTANDER, COLOMBIA: PRELIMINARY RESULTS OF THE RE-HOPE STUDY

Background: Hypertension is the main risk factor of cardiovascular disease (CVD), affecting 1.28 billion adults and resulting in 1.16 million deaths. In Colombia, hypertension affected 7.8 million adults in 2019. Different sociocultural and health system-related barriers may interfere with hypertension management. Our aim was to determine the preliminary impact of this community-based strategy on the changes in hypertension control in Colombia. Methods The Re-Hope study is a community-based strategy to reduce CVD risk in 13 municipalities of Santander, Colombia. Nursing assistants referred patients to the cardiovascular risk program (CVRP), facilitated medical appointments, and provided health counseling. A longitudinal analysis was conducted on data from the first three follow-up visits. Included were adults &gt;18 years with hypertension not enrolled in the CVRP. Standardized questionnaires gathered sociodemographic, medication, and lifestyle data. Anthropometric and blood pressure measurements were taken. Hypertension was defined as systolic BP &gt;140 mmHg, diastolic BP &gt;90 mmHg, self-reported hypertension, or antihypertensive medication use. Pharmacological adherence was assessed with the Morisky 4-item scale. Tobacco and alcohol use were categorized as never or current consumers. Blood pressure changes were evaluated with a paired t-test, and categorical variable changes with McNemar and Stuart-Maxwell tests. Analysis was done using Stata software. Results A total of 2,585 participants were included. The mean age was 65.1 years (SD 11.9) and 64.3% were women. After 6 months of follow-up, the mean systolic and diastolic blood pressure reduced 17.03 mmHg (SD 17.95) and 7.04 mmHg (SD 11.22), respectively. Hypertension control increased on 11.7%. Antihypertensive combination therapy increased by 4.4% for dual therapy and 4.6% for triple therapy. The low pharmacological adherence was reduced by 3.35%. Conclusions The implementation of a community-based care strategy in Santander at the first three visits achieved a relevant reduction of hypertension values and greater use of combined antihypertensive therapy. Continuation of the study is required to identify the total results.

Association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar: a population-based study

BackgroundDiabetes is a major public health problem in Qatar and is associated with an increased risk of depression. However, no study has been conducted in Qatar on the relationship between dietary patterns and depression symptoms in adults. The aim of this study was to assess the association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar.MethodsA total of 1000 participants from the Qatar Biobank (QBB) were included in this cross-sectional study. Food intake was assessed using a computer-administered food frequency questionnaire (FFQ), and dietary patterns were identified using factor analysis. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9).ResultsDepression symptoms were present in 13.5% of the sample. Two dietary patterns were identified: “unhealthy” (high consumption of fast food, biryani, mixed dish (chicken/meat/fish), croissant) and “prudent” (high consumption of fresh fruit, salads/raw vegetables, canned/dried fruit, and dates). After adjusting for sociodemographic, lifestyle factors (smoking and physical activity), diabetes and medication use for diabetes and hypertension, a high intake of “unhealthy” pattern was associated with an increased prevalence of depressive symptoms in individuals with diabetes (prevalence ratio, PR = 1.41; 95% CI = 1.28, 1.56; p-value < 0.001), while there was no statistically significant association between depressive symptoms and the “prudent” dietary pattern. The “prudent” pattern was inversely and significantly associated with depressive symptoms in individuals with a normal body weight (PR = 0.21; 95% CI = 0.06, 0.76; p-value = 0.018).ConclusionThe “unhealthy” dietary pattern was positively associated with depression symptoms in those with diabetes, whereas the “prudent” dietary pattern was inversely associated with depression symptoms in those with a normal body weight. Promoting healthy eating habits should be considered in the prevention and management of depression.

Transition of mild cognitive impairment to Alzheimer's disease: Medications as modifiable risk factors.

Mild cognitive impairment (MCI) is a pre-clinical stage of Alzheimer's disease (AD). Understanding the transition probabilities across the disease continuum of AD, ranging from MCI to AD to Mortality is crucial for the economic modeling of AD and effective planning of future interventions and healthcare resource allocation decisions. This study uses the Multi-state Markov model to quantify the transition probabilities along the disease progression and specifically investigates medications as modifiable risk factors of AD associated with accelerated or decelerated transition times from MCI to AD, MCI to mortality, and AD to mortality. Individuals with MCI were identified from the National Alzheimer's Coordinating Center between September 2005 and May 2021. A three-state Markov model was postulated to model the disease progression among three states: MCI, AD, and mortality with adjustment for demographics, genetic characteristics, comorbidities and medications. Transition probabilities, the total length of stay in each state, and the hazard ratios of the use of medications for diabetes, hypertension, and hypercholesterolemia (the known modifiable risk factors of AD) were evaluated for these transitions. 3,324 individuals with MCI were identified. The probability of developing AD after one year since the initial diagnosis of MCI is 14.9%. After approximately 6 years from the initial diagnosis of MCI, the probability of transitioning to AD increases to nearly 41.7% before experiencing a subsequent decline. The expected total lengths of stay were 5.38 (95% CI: 0.002-6.03) years at MCI state and 7.61 (95%CI: 0.002-8.88) years at AD state. Patients with active use of lipid-lowering agents were associated with significantly lower hazards of transitioning from MCI to AD (HR: 0.83, 95%CI:0.71-0.96), MCI to mortality (HR: 0.51, 95%CI:0.34-0.77), and AD to mortality (HR: 0.81, 95%CI:0.66-0.99). Results suggest that lipid-lowering agents may confer a protective effect, delaying the onset of AD. Additionally, lipid-lowering agents indicate a favorable association with a longer survival time.

Associations of actigraph sleep characteristics with blood pressure among older adults

ObjectivesMany studies have examined links between sleep and blood pressure, with mixed findings, mostly using self-reported sleep data and cross-sectional designs. We examined whether actigraph-estimated sleep characteristics are associated with concurrent blood pressure or 5-year blood pressure change in a national cohort of older adults (National Social Life, Health and Aging Project), and whether these associations differ by hypertension medication use. MethodsSubjects were 669 older adults (62-90years), 471 with 5-year follow-up data. Sleep characteristics were duration (linear plus quadratic terms); sleep percentage; and categorical onset, midpoint, and waking times. Multivariable linear models adjusted for age, race, gender, obesity, smoking, daytime napping, and hypertension medication use. Interactions between sleep characteristics and hypertension medication were tested among the 401 subjects with consistent hypertension medication status over time. ResultsWe found U-shaped cross-sectional and longitudinal relationships between duration and blood pressure, with shorter and longer sleep times associated with higher blood pressure. Later onset times were cross-sectionally associated with higher systolic blood pressure, while earlier onset times were longitudinally associated with systolic blood pressure increase. Midpoint, wake time, and sleep percentage were not significantly associated with blood pressure. Significant interaction terms suggested hypertension medications attenuated associations of sleep onset and wake time with diastolic blood pressure. ConclusionsThese results with actigraph-estimated parameters confirm some, but not all, associations reported from research based on self-reported sleep data. Our findings are consistent with recommended intermediate sleep durations for cardiovascular health and suggest hypertension medication use may attenuate some associations between sleep timing and blood pressure.

Association of intradialytic hypertension and antihypertensive medication use in patients undergoing maintenance hemodialysis: a prospective observational study

Background In patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis, intradialytic hypertension and intradialytic hypotension are the common complications. The study aimed to collect and assess intradialytic Blood Pressure (BP) complications and their association with different factors, including BP medication. Methods This was a prospective observational study, conducted at the hemodialysis center in a teaching hospital in the UAE, that provide a specialist’s care for the patients receiving ongoing hemodialysis. Patient demographics, medications used, lab data and the peridialytic BP (pre-, intra-, and post-) dialytic BP were collected for a period of 6 months. SPSS Version 29, Armonk, NY was used for statistical analysis. Pearson Chi-square test and Fischer’s Exact test were used to compare the association between categorical variables to intradialytic hypertension and hypotension. Results Blood pressure data was collected from 47 hemodialysis patients for a total of 2616 hemodialysis sessions during the 6 months study period. Beta-blockers (68%) and calcium channel blockers (66%) were the commonly used antihypertensive medications in the study population. Intradialytic hypertension events were diagnosed in 49 hemodialysis sessions and intradialytic hypotension was diagnosed in 23 hemodialysis sessions. On comparing the effect of antihypertensive medication to the occurrence of intradialytic BP complications, ARBs and alpha-1 blockers showed no association to intradialytic hypertension, but beta-blockers and calcium channel blockers use were associated with increased number of intradialytic hypertension events (p-value &lt;0.05). On the other hand, antihypertensive medication use showed no association with intradialytic hypotension. Conclusions Patients using ARBs or alpha-1 blockers had higher intradialytic hypertension events. Beta-blocker and calcium channel users had lower intradialytic hypertension events. Antihypertensive use showed no association with intradialytic hypotension events.

Abstract 4829: Pre-diagnostic comorbid conditions and survival among black women with ovarian cancer

Abstract Introduction: Black women with epithelial ovarian cancer (EOC) have worse survival compared to other racial groups, and the causes of these poor outcomes remain unclear. Compared to other racial groups, Black women are disproportionately affected by comorbid conditions which can adversely impact cancer care and outcomes. Thus, we examined the association of pre-diagnostic comorbid conditions and their associated medications with survival among Black women with EOC. Methods: Using data from Black women with EOC in the African American Cancer Epidemiology Study, we evaluated the self-reported Charlson comorbidity index (CCI) and three cardiometabolic comorbidities (diabetes mellitus, hypertension, and hyperlipidemia). We also characterized whether women with each cardiometabolic condition were using medication for their condition. Kaplan-Meier survival curves and log-rank tests were used to examine survival by the CCI, each cardiometabolic comorbidity, and medication use. Cox proportional hazards regression models were used to examine the association of comorbid conditions and medications with survival while adjusting for age at diagnosis, stage, histotype, and study site. Results: Among 592 Black women with EOC, 35% had a CCI ≥2, and the prevalence of diabetes, hyperlipidemia, and hypertension was 19%, 31%, and 62%, respectively. Among women with each cardiometabolic condition, the prevalence of medication use for diabetes, hypertension, and hyperlipidemia was 73%, 78%, and 60%. In bivariate analyses, women with a higher CCI, diabetes, hyperlipidemia, and hypertension had worse survival compared to women without these conditions (P&amp;lt;0.05). However, when adjusting for prognostic factors, only a high CCI (≥2 vs. 0) and diabetes were significantly associated with higher hazard of death (HR=1.36, 95% CI=1.06-1.74 and HR=1.40, 95% CI=1.08-1.81, respectively). Investigating the independent associations of each condition included in the CCI with survival revealed that diabetes was largely driving the association of CCI with survival. When considering medication use, women with diabetes, irrespective of medication use, women with hypertension not on medication, and women with hyperlipidemia on medication had worse survival compared to women without these conditions in bivariate models (P&amp;lt;0.05). Compared to women without diabetes, women with diabetes on medication and women with diabetes not on medication had a statistically significant higher hazard of death in multivariable models (HR=1.39, 95% CI=1.02-1.88 and HR=1.63, 95% CI=1.04-2.57, respectively). No associations with survival were observed when considering medication use for hypertension and hyperlipidemia after adjusting for prognostic factors. Conclusion: Similar to prior studies among White women with EOC, diabetes, regardless of medication status, was strongly associated with poorer survival among Black women with EOC. Citation Format: Alicia Richards, Courtney E. Johnson, Anthony J. Alberg, Elisa V. Bandera, Melissa Bondy, Michele L. Cote, Theresa A. Hastert, Kristen Haller, Jeffrey R. Marks, Edward S. Peters, Paul D. Terry, Andrew B. Lawson, Joellen M. Schildkraut, Lauren C. Peres. Pre-diagnostic comorbid conditions and survival among black women with ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4829.

Abstract MP09: Population Level 24-Hour Urinary Sodium and Potassium Associations With Blood Pressure Differs by Sex: Findings From the New York City Heart Follow-Up Study 2010 and 2018

Introduction: Hypertension (HTN) is a leading cause of heart disease and stroke amongst New York City (NYC) residents, with notable sex-based disparities in prevalence and cardiovascular (CV) outcomes. While prior 24-hour urinary population-based studies in other populations have shown that the association between sodium and potassium and blood pressure (BP) is primarily driven by hypertensive adults, the studies did not adequately evaluate how these associations may differ by sex. Hypothesis: Our study examined whether the relationship between sodium, potassium, and the sodium/potassium ratio and BP varies significantly by sex assigned at birth, stratified by HTN status, in the NYC population. Methods: The Heart Follow-Up Study (HFUS) is a cross-sectional survey conducted in 2010 and 2018 among NYC residents ages 18 and older. Study data included BP measurements, sodium and potassium urinary analytes, and self-reported information about CV health. Analyses were based on 1,606 and 2,327 participants, respectively, and weighted to the NYC population. HTN was defined as per the National Health and Nutrition Survey criteria: systolic BP≥140, diastolic BP≥90, or current use of HTN medication. We applied t -tests to detect differences in mean age-adjusted electrolyte excretions between hypertensive and normotensive adults, stratified by sex. Furthermore, we used multivariable linear regression models, which included sex as an interaction term, to assess the association between sodium and potassium intake and BP at the two time points, and to evaluate potential effect modifications by sex. Results: In 2018, we observed no substantial difference between the mean age-adjusted 24-hour urinary excretion of sodium, potassium, and sodium/potassium ratio and HTN status among NYC males or females ( p &gt;.05). From multivariable models, we observed a consistent positive association between sodium/potassium ratio and mean BP in normotensive males; the relationship was stronger in 2010 (2.060, 95% CI: 0.865-3.255) compared to 2018 (0.312, 95% CI: 0.101-0.523). However, this association was not evident in normotensive females at both time points. We did not observe a consistent association between sodium, potassium, and sodium/potassium ratio and BP within the HTN group in males or females at either time point. Conclusions: The association between sodium/potassium levels and BP differs by sex. This association was evident exclusively in normotensive males, although we noted that the magnitude of this association was smaller in 2018 than in 2010. This suggests that sodium/potassium excrement may be a stronger indicator for BP variations within this subgroup. Recognizing that sex-based variations exist, our results suggest conducting intra-sex analysis to better understand CV health disparities and develop tailored public health strategies that will reduce adverse CV outcomes.

Abstract 42: Metabolite Risk Scores of Lifestyle Measures Improve Incident Hypertension Prediction

Introduction: Metabolites capture the metabolic environment associated with exposures. Objective: To develop and assess the usefulness of metabolite risk scores (MRSs) as biomarkers representing exposure measures. Methods: We used two separate sets of individuals sampled from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Both sets of individuals had metabolite data measures on the Metabolon HD4 platform. We applied the least absolute selection and shrinkage operator (LASSO) to develop MRSs for current smoking, physical activity, Mediterranean diet, and anxiety in set 1 (n=2,178), cross-sectionally, and evaluated them for replication in set 2 individuals (n=4,002). We defined hypertension as SBP140, DBP90, or hypertension medication use, and estimated MRS associations with incident hypertension longitudinally (6 years after the baseline exam, on average) in set 2 individuals free of hypertension at baseline (426 cases and 1,556 controls). The association models were adjusted for age, sex, and BMI. We compared the estimated association with those of self-reported phenotypes. Results: All MRSs were developed in set 1 individuals have replicated associations in set 2 individuals. The figure provides the estimated association of MRSs for diet, smoking, physical activity, and anxiety with incident hypertension and compares them to the associations of self-reported Mediterranean diet, anxiety measured using the Spielberger trait anxiety scale, pack-years of smoking, and self-reported physical activity in MET-min/day. All associations are per 1 SD increase in the exposure measure. The figure shows that the MRS associations are often stronger than those of the self-reported measure. Conclusions: MRSs have the potential to serve as accurate biomarkers of self-reported exposures.

Abstract P540: Sleep Duration, Rapid Eye Movement Sleep, and Subclinical Myocardial Damage

Introduction: Sleep is strongly linked to clinical cardiovascular disease and was added in 2022 to the AHA’s Life’s Essential 8. Optimizing sleep duration and quality may reduce the risk of cardiovascular disease. Few studies have examined self-reported sleep duration and percent time in rapid eye movement (REM) sleep measured by single night in-home polysomnography with high sensitivity cardiac troponin T (hs-troponin T), a biomarker of subclinical cardiovascular disease. Methods: We conducted a cross-sectional study of adults without a history of cardiovascular disease who participated in both the Atherosclerosis Risk in Communities (ARIC) Study and the Sleep Heart Health Study (SHHS) in 1995-1998. We used linear regression with sleep duration and percentage time of REM sleep modeled as predictors with restricted cubic splines and examined associations with the outcome, hs-troponin T. We adjusted for age, sex, body mass index, waist-to-hip ratio, alcohol intake, smoking status, systolic blood pressure, hypertension medication use, diabetes, HDL- and LDL-cholesterol, and cholesterol-lowering medication use. Results: Among 1,587 participants (mean age 63, 54% female), the mean sleep duration was 7.3 hours, and mean % REM time was 20.7. Sleep duration was not associated with hs-troponin T ( Figure, Panel A ). However, percentage REM sleep was negatively associated with hs-troponin T, but with a threshold effect; there was a negative linear association of hs-troponin T with % REM sleep but only at values &lt;15% ( Figure, Panel B ). Conclusion: While self-reported sleep duration was not associated with TnT levels, there was evidence that low % REM sleep, a specific neurophysiological sleep state, was associated with subclinical cardiovascular disease. These findings suggest that multiple sleep dimensions should be considered in efforts to optimize cardiovascular health.

Abstract 44: Soluble CD14 and Risk of Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: Black adults in the U.S. experience a greater burden of systemic inflammation and cognitive impairment and dementia compared with White adults. Increasing evidence suggests peripheral inflammation is a risk factor for cognitive decline, however few longitudinal studies have investigated these relationships. CD14 is a pattern recognition receptor expressed by monocytes and macrophages that promotes inflammation. Concentrations of the soluble form of CD14 (sCD14) vary by race, and higher sCD14 was associated with incident coronary heart disease (CHD) and stroke in Black but not White participants in the REGARDS cohort study. We hypothesized higher sCD14 would also be more strongly associated with incident cognitive impairment (ICI) in Black compared to White adults. Methods: We performed a nested case-control study of ICI in the REGARDS study, a biracial cohort of 30,239 American adults ≥45 years old. Cases were 495 participants without cognitive impairment or stroke at baseline who developed ICI during a median 3.5 years of follow-up based on abnormal scores on ≥2 of 3 cognitive tests. 587 controls were selected from a cohort random sample and free of cognitive impairment or stroke at baseline. Logistic regression models estimated odds ratios (OR) of ICI by concentration of sCD14 measured from stored baseline serum samples. We tested for a sCD14-by-race interaction a priori. Results: The sCD14-by-race interaction term was statistically significant in each model (p-interaction &lt;0.05). In analyses stratified by race, adjusting for demographic factors (age, sex, and region), a 1-SD increment sCD14 was associated with a 40% higher odds of ICI among Black adults (OR: 1.40; 95% CI: 1.07, 1.95) with no association among White adults (OR: 1.08; 95% CI: 0.90, 1.28). In models adjusted for cognitive and vascular risk factors (income, education, systolic blood pressure, hypertension medication use, dyslipidemia, BMI, history of heart disease, atrial fibrillation, diabetes, smoking, and alcohol use), the relationship was attenuated in Black participants (OR: 1.33; 95% CI: 0.96, 1.84) and remained null among White participants (OR: 0.99; 95% CI: 0.81, 1.22). Comparing those with sCD14 concentration &gt;90th percentile to below, adjusted for risk factors, Black participants had a 2.47 (95% CI: 1.08, 5.67) higher odds of ICI with no association in White participants (OR: 0.91; 95% CI: 0.46, 1.80). Discussion: Higher sCD14 was associated with ICI risk in Black but not White adults, similar to prior observations for stroke. Results suggest that sCD14-associated inflammatory responses may be a risk factor for ICI among Black adults.

Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose&gt;200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p&lt;0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.

Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31 st , 2019, as the administrative censoring endpoint. Results: Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia (Figure A) and death (Figure C) . In competing risk models ( Figure B ), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%). Conclusion: Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies. Figure: Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.

Discontinuation of blood pressure–lowering, glucose–lowering, and lipid–lowering medications after bariatric surgery in patients with morbid obesity: a nationwide cohort study in South Korea

BackgroundLimited evidence exists on the patterns of medication use for hypertension, diabetes mellitus (DM), and dyslipidemia after bariatric surgery among Asian patients. ObjectivesTo investigate the patterns in the use of blood pressure–lowering, glucose-lowering, and lipid-lowering medications following BS in Korean patients with morbid obesity. SettingThis study is a retrospective cohort study using the Health Insurance Review and Assignment claims database of South Korea (from 2019 to 2021). MethodsWe included patients who underwent BS between 2019 and 2020 in South Korea. We evaluated the treatment patterns of blood pressure–lowering, glucose-lowering, and lipid-lowering medications at 3-month intervals for 1-year following BS, including medication use, individual medication classes, and the number of medications prescribed. Furthermore, we estimated remission rates for each disorder based on patient characteristics by defining patients who discontinued their medications for at least 2 consecutive quarters as remission. ResultsA total of 3810 patients were included in this study. For 1-year following BS, a marked decrease in the number of patients using blood pressure–lowering, glucose-lowering, and lipid-lowering medications was observed. The most remarkable decrease occurred in glucose-lowering medications, which decreased by approximately −75.1% compared with that at baseline. This tendency was consistently observed when analyzing both the number of medications prescribed and the specific medication classes. Regarding remission rates, patients who were female, younger, and received the biliopancreatic diversion-duodenal switch as their BS showed a relatively higher incidence of remission than other groups. ConclusionsBS was associated with a decrease in the use of medications for hypertension, diabetes mellitus (DM), and dyslipidemia.

Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults - United States, 2017-2021.

Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke. It increases with age and is highest among non-Hispanic Black or African American persons, men, persons aged ≥65 years, those of lower socioeconomic status, and those who live in the southern United States. Hypertension affects approximately one half of U.S. adults, and approximately one quarter of those persons have their blood pressure under control. Reducing population-level hypertension prevalence and improving control is a national priority. In 2017, updated guidelines for high blood pressure in adults recommended lowering the blood pressure threshold for diagnosis of hypertension. Analysis of data from the Behavioral Risk Factor Surveillance System found that age-standardized, self-reported diagnosed hypertension was approximately 30% during 2017-2021, with persistent differences by age, sex, race and ethnicity, level of education, and state of residence. During this period, the age-standardized prevalence of antihypertensive medication use among persons with hypertension increased by 3.1 percentage points, from 59.8% to 62.9% (p<0.001). Increases in antihypertensive medication use were observed in most sociodemographic groups and in many states. Assessing current trends in hypertension diagnosis and treatment can help guide the development of policies and implementation of interventions to reduce this important risk factor for cardiovascular disease and can aid in addressing health disparities.

Cardiometabolic Disease Staging and Major Adverse Cardiovascular Event Prediction in 2 Prospective Cohorts

BackgroundCardiometabolic risk prediction models that incorporate metabolic syndrome traits to predict cardiovascular outcomes may help identify high-risk populations early in the progression of cardiometabolic disease. ObjectivesThe purpose of this study was to examine whether a modified cardiometabolic disease staging (CMDS) system, a validated diabetes prediction model, predicts major adverse cardiovascular events (MACE). MethodsWe developed a predictive model using data accessible in clinical practice [fasting glucose, blood pressure, body mass index, cholesterol, triglycerides, smoking status, diabetes status, hypertension medication use] from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study to predict MACE [cardiovascular death, nonfatal myocardial infarction, and/or nonfatal stroke]. Predictive performance was assessed using receiver operating characteristic curves, mean squared errors, misclassification, and area under the curve (AUC) statistics. ResultsAmong 20,234 REGARDS participants with no history of stroke or myocardial infarction (mean age 64 ± 9.3 years, 58% female, 41% non-Hispanic Black, and 18% diabetes), 2,695 developed incident MACE (13.3%) during a median 10-year follow-up. The CMDS development model in REGARDS for MACE had an AUC of 0.721. Our CMDS model performed similarly to both the ACC/AHA 10-year risk estimate (AUC 0.721 vs 0.716) and the Framingham risk score (AUC 0.673). ConclusionsThe CMDS predicted the onset of MACE with good predictive ability and performed similarly or better than 2 commonly known cardiovascular disease prediction risk tools. These data underscore the importance of insulin resistance as a cardiovascular disease risk factor and that CMDS can be used to identify individuals at high risk for progression to cardiovascular disease.

Prescription drug coverage and effective coverage of three chronic conditions of high prevalence in Chile: Hypertension, diabetes and dyslipidemia.

Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. Cross-sectional analytical study with information from the 2016-2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.