bluuebunny/crossref_metadata_2025 huggingface dataset:
P013 EXPLORING THE BIDIRECTIONAL CAUSAL ASSOCIATION BETWEEN FRAILTY AND HYPERTENSION: FROM ASSOCIATION TO CAUSATION
Authors: Yin Zheng , Miao Huanhuan , Zhou Zhanyang , Yang Shijie , Zhang Yuqing
Published: September 2024

Background:

Studies have shown an association between frailty and hypertension. However, it remains uncertain whether this association reflects causality. We performed a Chinese Longitudinal Health Longevity Survey (CLHLS) analysis and a bidirectional Mendelian randomization (MR) study to assess the relationship between frailty and hypertension. Corroborative evidence for other heart diseases, including atrial fibrillation (AF), coronary artery disease (CAD), and heart failure (HF), was also analyzed.

Methods:

We performed the cross-sectional analysis based on CLHLS 2018 and used multivariable logistic regression to analyze the association between frailty and HTN. Then, we extracted independent single nucleotide polymorphisms for each phenotype at genome-wide significance levels from the latest genome-wide association summary data of European descent, including FI (N=175,226), HTN (N=462,933), AF (N=138,994), and HF (N= 977,323). The inverse variance weighted method was primarily used, followed by sensitivity and validation analyses.

Results:

In the cross-sectional study, compared to non-frail individuals, frail patients revealed a significantly higher risk of HTN (OR 5.32, 95% CI 3.46-8.17 P< 0.001) and heart disease (OR 13.50, 95% CI 8.18-22.28 P = 0.017) after full adjustment. In the MR study, higher FI significantly increased the risk of HTN (OR 1.12, 95% CI 1.07-1.16 P<0.001) and CAD (OR 2.57, 95% CI 1.72-3.84 P<0.001). FI suggestively increased the risk of AF (OR 1.83 95%CI 1.11-3.01 P<0.05). No association between FI and HF was observed (OR 1.30, 95% CI 1.00-1.71 P>0.05). In the reverse analysis, genetic predisposition to HTN (β 0.662, 95% CI 1.71, 2.19 P<0.001) and CAD (β 0.067, 95% CI 01.049-1.090 P<0.001) significantly increased FI. A suggestive causality from HF (β 0.088, 95% CI 1.000-1.192 P<0.05) to FI was also observed. No causality between AF to FI was observed (β 0.014, 95% CI 0.998-1.030 P>0.05).

Conclusion:

Our findings add new evidence to support the bidirectional causality between frailty and HTN. A deeper exploration of such associations is imperative to optimize the management of older patients.
P018 IMPLEMENTATION CONSIDERATIONS FOR SMS REMINDERS TO IMPROVE ANTIHYPERTENSIVE MEDICATION ADHERENCE IN BANGLADESH AND ETHIOPIA: A QUALITATIVE EVALUATION
Authors: Ogungbe Bunmi , Ayensu-Asiedu Christabelle , Berhane Hanna Y. , Tewahido Dagmawit , Fasil Rediet , Choudhury Sohel Reza , Bhuiyan Mahfuzur Rahman , Abrar Ahmad , Parvej Md. Aslam , Sultana Sarmin , Neupane Dinesh , Commodore-Mensah Yvonne Commodore-Mensah , Matsushita Kunihiro , Appel Lawrence , Riekert Kristin
Published: September 2024

Background:

Poor medication adherence remains a significant barrier to hypertension control, particularly in resource-limited settings.

Objective:

To qualitatively explore the feasibility and acceptability of SMS reminders to support antihypertensive medication adherence and identify local nuances of barriers, facilitators, and implementation considerations in resource-limited settings.

Methods:

Patients with hypertension and providers in primary care clinics in Ethiopia and Bangladesh were interviewed to assess perceptions and experiences with SMS reminders. Interviews were transcribed and translated, an inductive codebook was developed, thematic content analysis was used to identify key implementation considerations. The Consolidated Framework for Implementation Research (CFIR) constructs of innovation, outer, inner settings, individual-level factors were used to synthesize findings.

Results:

Fifty patients (mean age 53.1±13.1 years, 28(56%) female, 28(56%) from Ethiopia) and 50 providers (mean age 32±7.5 years, 24(48%) female, 27(54%) from Ethiopia) were interviewed. Facilitators included the perceived value of SMS reminders for adherence (patients) and improved patient-provider communication (providers). Patients and providers generally viewed SMS reminders as valuable for supporting adherence (innovation). However, concerns were raised about the timing of message delivery and the potential for missed messages. Unreliable network infrastructure was identified as a potential barrier, particularly in rural areas (outer setting). The absence of electronic medical and pharmacy records in many clinics was a reported challenge for automating reminders; providers highlighted the need for dedicated IT support and staff (inner setting). Focusing on the highest-need patients was suggested as a practical approach to begin implementation. Patient's access to mobile phones, literacy levels, and receptiveness to reminders were key individual-level factors that could influence engagement with SMS reminders. Providers emphasized that reminders may not be effective for all patients (Table).

Conclusions:

SMS reminders can potentially improve antihypertensive medication adherence in resource-limited settings, but several implementation barriers need to be addressed. Tailoring SMS reminders to patient needs, strengthening infrastructure, and providing adequate IT and staff support are essential for successful implementation.
P023 THE CLINICAL SPECTRUM OF COVID-19 SEVERITY AND OUTCOME ON HOSPITALIZED PATIENTS AT JABRA ISOLATION CENTRE – SUDAN, 2021
Authors: Almarrani Zakarya , Alhusen Ahmed , Muhyadin Mariam , Hazaea Shehab , Elbashir Omer , Hamdan Gaafar , Mahyoub Omar , Farhan Osman , Elhassan Marwa , Nouri Saada , Jaber Mohammad , Jebreel Waleed , Ahmed Amjad , Elmadhoun Wadie , Beheiry Hind
Published: September 2024

Background:

The COVID-19 pandemic has highlighted how crucial to comprehend the various clinical presentations of the illness to improve patient treatment and healthcare resources.

Objective: To investigate potential gender-based disparities in the severity and outcome of COVID-19 patients in Jabra Isolation Center 2021

Methodology:

A descriptive-analytic record-based study was conducted at Jabra Isolation Centre, Sudan, 2021. A random selection of 317 patients was performed. The three zones of severity were: mild (ward stay, Green Zone), moderate (high dependence unit, Yellow Zone), and severe (intensive care unit, Red Zone). Fever, SOB, cough and SPO2, and mortality based on the 3 zones and gender distribution were analyzed by MOH triage procedure checklist using SPSS(version 21)

Results:

The age ranged between 25-91 years. The findings were as follows: At Green Zone, 46.63% of patients were admitted, with 65.91% being males, The hypertensive patients were 38.16%, and the diabetic were 39.47%. The presenting signs were fever, SOB, cough, and SPO2 (77.39%, 67.11%, 56.58%, and 92% respectively). The mortality rate was 52.63%. While at Yellow Zone, 15.64% of patients were admitted, with 75% being males. The hypertensive patients were 49.02%, and the diabetic were 39.22%. Fever, SOB, cough, and SPO2 were (78.43%, 74.51%, 70.59% and 90% respectively). The mortality rate was 49.02%. At the Red Zone, 37.73% of patients were admitted with males 61.05%. The hypertensive patients were 45.53%, and the diabetic were 36.59%. Fever, SOB, cough, and SPO2 (65.85%, 71.54%, 43.9%, and 92% respectively). The mortality rate was 62.6%. The mortality rate across all 3 zones of severity was 55.83% of which males were 66.0%.

Conclusions: This study showed that COVID-19 hospitalized patients at Jabra Isolation Centre in 2021 were predominately males and associated with hypertension and diabetes at 3 zones of severity. The mortality rate was highest at the Red Zone. The overall mortality rate was 55.83% of which males were 66%.
P024 NEPAL TAKES ACTION FOR BLOOD PRESSURE SCREENING: RESULTS FROM MAY MEASURE MONTH 2022
Authors: Kumar Payal Rajender , Koirala Sweta , Paudel Kiran , Inagaki Yoko , Neupane Dinesh
Published: September 2024

Objective:

To present the result of May Measure Month (MMM) 2022 in Nepal.

Methods:

An opportunistic cross-sectional survey of adults ≥ 18 years was conducted in 32 districts from Jun-October 2022. Trained volunteers administered the structured questionnaire into the local language and took 3 BP readings in a sitting position at 1-minute intervals. The mean of the second and third BP readings was calculated. Hypertension was defined as a systolic BP ≥ 140 mmHg or a diastolic BP ≥90 mmHg or being on antihypertensive medication. Ethical approval was obtained from the Nepal Health Research Council.

Results:

MMM 2022 included 13,125 participants. The mean age of the participants was 38.8(±16.1) years. There were 52.2% females. The mean was 118.6 mmHg ±15.8 for systolic BP, and 78.8 mmHg ±10.67 for diastolic BP. Around one-fifth (19.5%) of participants were found to be hypertensive. The odds of hypertension in young males were 1.49 times than females (OR=1.49, 95% CI: 1.37 to 1.63). Only about 43.5% of the population were aware, 37.5% were on medication and only 21.5% of hypertensive had controlled blood pressure (< 140/90 mm Hg). Less males were aware and on medication as compared to females (OR = 0.86, 95% CI: 0.74 -1.01). 26.3% hypertensive females have controlled blood pressure as compared to 17.7% in males (p<0.05). Among all participants, 11.3% (n= 1473) had their BP measured for the first time, and nearly 22.6% (n= 2953) did not measure it within the last one year. More than 90% of individuals taking medicine reported that they took medicine regularly and more than 80% reported that they did not pay for medicine.

Conclusions:

MMM seems to be a promising community-based program for increasing awareness and identifying high risk population. As more than 50% of participants were unaware of their hypertension status, there is an opportunity in Nepal to identify these patients and increase awareness by adopting nationwide screening campaign such as MMM.
P025 GLOBAL, REGIONAL AND NATIONAL BURDEN OF HIGH SYSTOLIC BLOOD PRESSURE, 1990-2021: FINDINGS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2021
Authors: Razo Christian , Johnson Catherine , Decleene Nicole , Roth Gregory A
Published: September 2024

High systolic blood pressure (SBP) is the leading preventable global health risk. As part of the Global Burden of Disease Study 2021, we quantify the SBP-associated burden (relative to a theoretical risk exposure level of 105-115 mmHg) among adults over 25, by age and sex, for 204 countries from 1990 to 2021.

Standard GBD Bayesian methods were used to estimate SBP mean, standard deviation and corresponding distribution from 1,116 studies. Meta-analyses of 70 randomized controlled trials and cohorts were used to estimate the relative risks for seven outcomes: ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), atrial fibrillation, aortic aneurysm, peripheral arterial disease (PAD) and hypertensive heart disease. Then, the population attributable fraction and SBP attributable burden were computed with 95% uncertainty intervals (UI).

In 2021, 10.9 million deaths (9.2-12.5 million) and 225 million (190 - 259 million) disability-adjusted life years (DALYs) were attributable to elevated SBP worldwide, a decrease, since 1990, of 32% and 30% in age-standardized rates, respectively. In 2021, high SBP accounted for 7.8% of total DALYs; 49.9% (40.6 - 58.2%) of DALYs due to IHD; 57.3% (42.7-68.4%) due to stroke; 24.8% (13.0-36.1%) due to CKD; 30.1% (10.7-47.6%) due to atrial fibrillation; 17.1% (12.9-21.4%) due to aortic aneurysm; 13.0% (2.7-23.8%) due to PAD and 100% of the DALYs due to hypertensive heart disease. Globally, the burden attributable to SBP was higher in men than in women (3,162.9 [2,654.8-3,666.4] vs 2,167.3 [1857.4 -2510.9] age-standardized DALYs per 100,000).

Age-standardized DALYs attributable to high SBP were highest in Central Asia and Eastern Europe, rates above six thousand per 100,000. The lowest levels were observed in high-income Asia Pacific, Australasia and Western Europe with less than 1000 DALYs per 100,000.

Despite a decrease in age-standardized rates since 1990, high SBP remains a major global health risk with considerable regional variations. Targeted interventions are crucial to address these disparities and reduce SBP-related health impacts.
P029 PERCEPTIONS AND PERSPECTIVES OF RURAL NEPALESE PATIENTS WITH HYPERTENSION: A QUALITATIVE STUDY GUIDED BY THE LEVESQUE FRAMEWORK
Authors: Acharya Ashraya , Shakya Rajani , Shrestha Abha , Adhikari Puspanjali , Shrestha Jenisha , Karki Jasmine , Shrestha Rashmi , Wang Yuxuan , Ostbye Truls , Karmacharya Biraj Man , Yan Lijing
Published: September 2024

Background and objective:

High blood pressure is a major risk factor for heart disease and stroke. These diseases can be reduced if hypertension is identified, managed and controlled. Disease burden in Nepal is high, resources are limited, and the population is socioeconomically vulnerable. Developing tailored interventions for hypertension management requires understanding of challenges and facilitators of healthcare. This qualitative study investigated barriers and facilitators impacting treatment and control of patients with hypertension in rural Nepal.

Methods:

We conducted in-depth interviews among hypertensive patients(n=15), medical officers(n=3), Female Community Health Volunteers(FCHVs)(n=9), Frontline Health Workers(FLHWs)(n=15), medical officers(n=3), and local government representatives(n=5) from Panchkhal and Bethanchowk municipalities of Kavrepalanchok district, Nepal. Focus group discussions with FCHVs(n=7) were also conducted. Recordings were coded, transcribed and themes were identified. Patients with hypertension were approached door-to-door by FCHVs. FCHVs and FLHWs were accessed through health facilities. The framework developed by Levesque et al., was used to conceptualize access to care from the viewpoints of various stakeholders. Emerging themes were mapped as the ability to-perceive, seek, reach, pay and engage.

Results:

Most participants felt the need for care after experiencing symptoms like headaches, dizziness, and blurred vision. Trust in health facilities facilitated care, although unavailability of medicines and insufficient qualified staff were important obstacles. Some used homemade therapies for hypertension control highlighting a gap in awareness of treatment methods. Geographical inaccessibility of health facilities, as well as financial difficulties, were other important barriers identified. Patient's expected prompt service and reduced out-of-pocket expenditure. Medication-taking behavior was influenced by factors including forgetfulness, perceived need and side effects. Support from family, community, and local levels was identified as crucial for hypertension management.

Conclusions:

This qualitative study highlights the multifaceted challenges for hypertension treatment and control in rural Nepal. Addressing identified barriers and leveraging facilitating factors are essential for reducing hypertension.
P030 EFFECTS OF GENDER-RELATED FACTORS ON THE HYPERTENSION-WHITE MATTER HYPERINTENSITIES ASSOCIATION: A SEX-STRATIFIED ANALYSIS
Authors: Angarita-Fonseca Adriana , Kaur Amanpreet , Peebles Alexandra , Behlouli Hassan , Rajah M. Natasha , Pilote Louise
Published: September 2024

Background:

Hypertension (HTN) is a global health issue affecting various vascular beds, including the brain. There is a gap in understanding how gender-related factors, such as roles, identity, relationships, and institutionalized gender, contribute to sex differences in the relationship between HTN and brain structure changes. This study aims to investigate the role of gender-related factors in the relationship between HTN and white matter hyperintensities (WMH) in both males and females.

Methods:

This cohort study used MRI data from 41,300 UK Biobank participants. HTN status was determined through hospital records and self-report, and WMH volumes were measured using MRI. Eight gender-related factors, including unpaid work, caregiving, unemployment, risk-taking behavior, living alone, education, income, and material deprivation, were examined. Generalized linear models were used to evaluate the interactions between each gender-related factor and HTN in males and females. Effect modification was evaluated using the Z-test to compare the beta coefficients of the HTN-WMH association across strata.

Results:

The study included 19,260 males and 22,040 females aged 40-69 years at baseline, with 27.3% hypertensive. Hypertensive males (7.7±9.2 mL) and females (7.2±8.8 mL) exhibited greater WMH volumes compared to their normotensive counterparts (males: 4.7±5.9 mL; females: 3.9±5.2 mL). The main effects model revealed that low income was significantly associated with greater WMHs in females, while no gender-related factors were linked to WMHs in males after adjusting for clinical, behavioral, and gender-related variables. No significant interactions between HTN and gender-related factors were found in either males or females after adjustment. In the stratified analysis, females with lower material deprivation showed a significantly greater increase in WMHs compared to those with higher material deprivation. No other gender-related factors in either group interacted with HTN to amplify the association with WMHs.

Discussion:

Socioeconomic factors, particularly in females, were associated with WMH. These findings highlight the importance of considering biological and social determinants to address hypertension risks effectively.
P037 IMPROVING WELLBEING AND MENTAL HEALTH IN HYPERTENSIVE PATIENTS: A PILOT STUDY ON NATURE IMMERSION THERAPY
Authors: Redondo Camilo Pimienta , Barros-Bohórquez Guillermo , Urina-Triana Manuel , Orozco-Acosta Erick , Urina-Triana Miguel , Quintero-Baiz Adalberto
Published: September 2024

Background and Objective:

Nature immersion therapy, also known as “Vitamin N,” has demonstrated a significant impact on enhancing well-being and mental health indicators. This pilot study aims to investigate the effects of Vitamin N treatment on the well-being, mental health, and affect scores of hypertensive patients undergoing medical treatment.

Methods:

A convenience sample of stable hypertensive individuals participated in a standardized 3-hour nature immersion session. Participants completed pre- and post-treatment assessments using the World Health Organization-Five Well-Being Index (WHO-5), Positive and Negative Affect Schedule (PANAS), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Paired samples analysis, including the Wilcoxon signed-rank test, was employed to assess changes in scores, along with effect size calculations.

Results:

The study comprised 18 participants, including 12 females (64.67%) and 6 males (33.33%), with 6 having a history of diabetes. Following conscious nature immersion therapy, a significant improvement was observed in the scores of the well-being scale, WHO-5, WEMWBS, and PANAS positive affect scale (p < 0.05).

Conclusions:

Conscious immersion therapy in nature yielded notable improvements in well-being assessment scales and increased positive affect scores (PANAS), suggesting potential benefits for enhancing well-being in patients with arterial hypertension.
P038 DIAGNOSIS AND TREATMENT OF HYPERTENSION BY NON-PHYSICIAN HEALTHCARE WORKERS UNDER REMOTE SUPERVISION OF PHYSICIANS IS FEASIBLE AND EFFECTIVE IN RURAL BANGLADESH: PRELIMINARY RESULTS FROM CB-HEARTS PILOT STUDY
Authors: Abrar Ahmad , Akhtar Jubaida , Karim Md Abbas Ibn , Sayem Noor Nabi , Jubayer Shamim , Bhuiyan Mahfuzur , Mamun Mohammad Abdullah Al , Liu Hairong , Foti Kathryn , Matsushita Kunihiro , Appel Lawrence , Choudhury Sohel
Published: September 2024

Background and Objective:

In rural Bangladesh, there are multiple barriers to receiving treatment for hypertension, including distant healthcare facilities [Upazila Health Complex (UHC)] and inadequate numbers of physicians. This pilot aimed to design and assess the feasibility of implementing a community-based (CB) WHO HEARTS package involving non-physician health workers (Community Healthcare Providers [CHCP]) for diagnosing and treating hypertension who are remotely supervised, using telemedicine, by a UHC physician.

Methods

We are conducting this single-arm pilot study in four Community Clinics (CC) in rural Bangladesh. We included patients with untreated hypertension (blood pressure [BP] 140-180/90-110 mmHg). We excluded patients with diabetes, pregnancy, and cardiovascular and kidney diseases. The CB-HEARTS package intervention components were 1) simplified treatment protocol, 2) reliable medication supply, 3) team-based care, 4) standardized follow-up, and 5) a mobile app to track patients’ BP control. After assessing eligibility, CHCPs from the CC communicated with designated physicians at UHC to confirm hypertension diagnosis and to start anti-hypertensive medications in the CC. Patients with BP controlled (<140/90 mmHg) during follow-up were provided a refill for 3 months. Patients with complications or uncontrolled BP, even after the maximum allowable dose, were referred to the UHC. Outcomes were enrollment and follow-up rates (primary), BP change from baseline and hypertension control (secondary).

Results:

We screened 4,220 adults, of whom 531 were eligible for the study and 220 were enrolled (Table; mean age 55.9 years, 75.9% female). Enrollment (41.4%) and follow-up within 3 months of enrollment (93.6%) rates were high. Mean systolic and diastolic BP were 153 and 92 mmHg at enrollment, respectively. BP was lowered by 31 mmHg systolic and 15 mmHg diastolic after a mean of 84 days follow-up. After this follow-up duration, 90% of participants had their BP controlled.

Conclusions:

This pilot study provides evidence that hypertension care provided by non-physician health workers under remote supervision of physicians in rural Bangladesh is feasible and may effectively lower BP and improve hypertension control.

Table: Participant screening, enrollment, and follow-up
P042 EFFECTIVENESS OF STRUCTURED TELEMONITORING BLOOD PRESSURE IN PRIMARY CARE: UNCONTROLLED HYPERTENSE COHORTS
Authors: De La Asunción Ramírez D , Barrios A Gámez , Herrera G Hernández
Published: September 2024

Introduction:

E-health has emerged as a pivotal resource in healthcare delivery due to its widespread coverage, ease, and acceptance, particularly for chronic diseases. We aim to establish the effectiveness of structured telemonitoring in managing blood pressure among patients with uncontrolled essential arterial hypertension.

Methods:

An analytical observational retrospective cohort study of uncontrolled hypertensive patients aged ≥ 18 was conducted, with follow-ups at 150 and 240 days. Patients in the telemonitoring cohort were provided with validated digital blood pressure monitors, underwent remote monitoring, and received weekly feedback for 30 days from a multidisciplinary team. Conversely, the non-telemonitoring cohort received usual care consisting of attendance to in-person medical consultations as part of our institution's cardiovascular-risk-prevention program.

Results:

350 patients were included, with median ages of 55 and 66 years in the telemonitoring and non-telemonitoring cohorts, respectively. Over the 240-day follow-up, the telemonitoring group achieved a significant reduction in systolic (-20.99 mmHg; 95% CI 14.99- 27.50; p 0.000) and diastolic blood pressure (- 14.99 mmHg; 95% CI 10.00- 18.99; p 0.000) compared to usual care, which demonstrated reductions of 19.99 mmHg (95% CI 16.49- 22.50; p 0.000) in systolic blood pressure and 6.50 mmHg, (95% CI 4.50- 9.00; p 0.000) in diastolic blood pressure.

Conclusion: Telemonitoring is an effective strategy for patients with uncontrolled arterial hypertension, leading to earlier and significant blood pressure reductions.
P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN
Authors: Ishaq Mohammad , Abidi Syed Hussain Baqar , Maqbool Samra , Ahmed Osama , Javed Wajiha
Published: September 2024

Background:

Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings.

Objectives:

• To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) & PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages

Methodology:

Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs.

Results \Conclusion:

We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.
P044 TEAM-BASED CARE TO MANAGE COMPLEX CASES OF HYPERTENSION
Authors: Lokteva Inna , Logan Alexander
Published: September 2024

Background and Objectives:

Team-based care that uses home blood pressure (BP) telemonitoring to facilitate hypertension management is safe and effective in lowering BP in routine primary care. However, its usefulness to manage more complex cases of hypertension is uncertain. This 6-month study explores its use in such patients attending a hypertension clinic.

Methods:

BP telemonitoring consisted of smartphone with BP app paired with wireless home BP device to transmit BP readings to a central server, accessible to patients and clinic staff. Patients were asked to contact the clinic about worrisome home BP readings, treatment problems and technical issues. Home readings were integrated into clinical decision-making. Outcomes were patients’ experience and clinical measures.

Results:

Of 90 enrolled patients, 38% had grade 3 or 4 chronic kidney disease, 23% diabetes, 31% heart disease, 12% stroke and 12% aortic dissection. Mean number (standard deviation) of co-morbid conditions was 4.2 (2.0). Most patients were at very high (30%) or high risk (50%) for a cardiovascular event. During follow-up, one patient died and one dropped-out of care. Mean number of in-person and virtual assessments by a physician were 1.6 (0.6) and 2.0 (1.8), respectively. Eighty-three percent (n=75) contacted clinic staff. Mean number of contacts for technical reasons was 1.2 (1.8), treatment-related issues 0.5 (1.0) and personal support 4.2 (5.9). From baseline to exit mean automated office BP fell (p<0.001), BP control improved (p<0.001) and mean number of antihypertensive drug classes increased (p=0.049). Most patients, 91% (80/88), felt BP telemonitoring to be a valuable tool for managing their hypertension. Nonetheless, 38% also considered cost to be potentially a barrier to long-term use. Only 6% had data security concerns.

Conclusions:

Team-based care was highly rated by patients to manage their hypertension and may account for the low drop-out rate, high number of patient-provider contacts, good patient acceptance of more intensified pharmacological treatment and better BP control. However, cost potentially may be a barrier for long-term use.
P046 FIRST-LINE TREATMENT OF HYPERTENSION WITH SINGLE PILL COMBINATIONS: A SIMPLE STRATEGY TO SAVE COSTS FOR THE PATIENT AND GOVERNMENT
Authors: Pikkemaat Miriam , Schutte Alta , Atkins Emily , Rodgers Anthony
Published: September 2024

Background:

Single pill combinations (SPCs) of blood pressure (BP) lowering medicines contribute to improved BP control by reducing treatment inertia and improving medication adherence. But high out-of-pocket payments reduce adherence. We compared the costs for SPCs and free-drug combinations for the patient and government in Australia.

Methods:

We reviewed the “Pharmaceutical Benefits Scheme item drug map” to identify all BP lowering SPCs, their free-drug combinations, and their costs in March 2024. We reviewed costs before and after reaching the “Safety Net” – a threshold where people access medicines at lower rates, differing for general patients and Concession Card holders (typically pensioners or low paid workers). We also calculated the total cost per mmHg systolic BP (SBP) reduction based on a mean reduction of 9, 16 and 23 mmHg for treatment with one, two or three drugs at standard dose.

The main outcome measures were the total costs for patients and the government in Australian Dollars.

Results:

For patients, SPCs always cost less than free drugs with the greatest savings for general patients before reaching the safety net, averaging 30%. For the government SPCs cost less than free drugs for Concession Card holders both before (11%) and after reaching the safety net (26%) and in general patients after the safety net (11%). There was a slight increase in costs (16%) for the government for patients before reaching the safety net. The mean cost per mmHg SBP reduction was 27% lower in SPCs compared to free drugs. Dual SPCs cost little more than monotherapy but provide a much lower cost per mmHg SBP reduction.

Conclusion:

In Australia, SPCs, instead of free-drug combinations, result in cost savings, for both patient and government. These are the direct costs, and do not factor in the expected benefits from improved adherence and BP control. The large cost savings of SPCs should be considered when prescribing multiple separate pills or starting treatment.
P047 DIGITAL THERAPEUTICS FOR HYPERTENSION MANAGEMENT: A REVIEW
Authors: Damodaran Pavithran
Published: September 2024

Background and Objective:

Digital therapeutics have emerged as a viable approach to manage chronic conditions, including hypertension. This review evaluates the effectiveness of digital therapeutic interventions in hypertension management.

Methods

A literature review was conducted on studies published from 2010 to 2023, focusing on digital health tools such as mobile apps, wearable devices, and telemonitoring systems. Data was extracted from PubMed, Cochrane Library, and IEEE Xplore.

Results

Digital health interventions, including smartphone apps for BP monitoring and lifestyle modification, resulted in significant BP reductions and improved patient adherence. Wearable devices providing real-time feedback enhanced patient engagement and self-management. Telemonitoring systems facilitated timely interventions by healthcare providers.

Conclusions:

Digital therapeutics offer effective solutions for hypertension management by enhancing patient engagement and enabling continuous monitoring. Future research should aim to integrate these tools into routine clinical practice to maximize their potential benefits.
P051 ASSOCIATION OF BASELINE PLASMA ALDOSTERONE CONCENTRATION WITH ARTERIAL STIFFNESS PROGRESSION IN HYPERTENSIVE PATIENTS
Authors: LI Nanfang
Published: September 2024

Objective:

Limited studies have examined the relationship between plasma aldosterone concentration (PAC) and arterial stiffness progression. The objective of this study was to investigate the longitudinal association between baseline PAC and arterial stiffness progression in hypertensive patients.

Methods:

A total of 1138 hypertensive patients were enrolled in the study. PAC was measured using standard techniques while in a sitting position. Arterial stiffness was quantified using brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness that is non-invasive in nature. Progression of baPWV was assessed using the baPWV change rate(the absolute difference between baseline and follow-up baPWV, divided by the follow-up time in years. Multivariate linear regression models were employed to idenitify the associations between baseline PAC and the baPWV change rate. Additionally, multivariable restricted cubic splines were utilized to investigate the dose-response relationship between baseline PAC and baPWV change rate.

Results:

Multivariate linear regression analyses revealed that an increase of one unit in PAC at baseline was associated with a 1.96 cm/s/year increase [95% confidence interval (CI), 0.99, 2.92] in baPWV change rate. Furthermore, RCS demonstrated a significant dose-response relationship between baseline PAC and the baPWV change rate.

Conclusion:

This study found that higher levels of PAC were associated with a faster progression of arterial stiffness. These findings should be confirmed by further investigations.
P052 OPTIMAL ADRENAL VEIN SAMPLING LATERALIZATION CRITERIA FOR DIAGNOSIS OF UNILATERAL PRIMARY ALDOSTERONISM USING ALDOSTERONE CONCENTRATION MEASURED BY LC-MS/MS POST-ACTH STIMULATION
Authors: Thuzar Moe , Zaal Kassem , Ma Derrick , Morkos Michael , McWhinney Brett , Ungerer Jacobus , Stowasser Michael
Published: September 2024

Background:

Primary aldosteronism (PA) is characterized by excessive, autonomous secretion of aldosterone from one or both adrenal glands. Identification of unilateral disease and surgical resection can lead to cure, and is dependent on accurate criteria for lateralization of excess aldosterone during adrenal vein (AV) sampling (AVS). Current evidence for AVS lateralization cut-offs using plasma aldosterone concentration (PAC) measured by LC-MS/MS and post-surgical outcomes is limited.

Aim:

To determine optimal cut-off criteria to define lateralization of PA on AVS based on PAC measured by LC-MS/MS post-ACTH stimulation and post-surgical outcomes data.

Methods: This study involved 60 subjects with PA who had PAC measured by LC-MS/MS post ACTH-stimulation during bilaterally-cannulated AVS, underwent unilateral adrenalectomy between July 2015-July 2021 and were followed up for ≥6 months. AVS lateralization parameters (lateralization index [LI; dominant PAC/cortisol(AV) ÷ non-dominant PAC/cortisol(AV)], contralateral suppression index [CSI; non-dominant PAC/cortisol(AV) ÷ PAC/cortisol(Peripheral Vein)], lateralization ratio [LR; dominant PAC/cortisol(AV) ÷ PAC/cortisol(Peripheral Vein)] and post-surgical outcome data were examined. Complete biochemical remission (CR) of PA post-surgery was defined using PASO International Consensus Criteria. Receiver operating characteristic (ROC) analysis was performed to determine optimal cut-offs for LI, CSI and LR based on cases who achieved CR of PA post-surgery (n=55) vs those who did not (n=5).

Results:

Optimal cut-off LI during ACTH-stimulated AVS to identify unilateral PA cases who achieved CR post-surgery was 5.1 (AUC=0.92, P<0.001; 92.7% sensitivity, 80.0% specificity) while the optimal cut-off for CSI was 0.6 (AUC=0.887, P<0.001; 82.1% sensitivity, 100.0% specificity), and for LR was 3.3 (AUC=0.695, P=0.202; 80.0% sensitivity, 80.0% specificity). Cases with LR of 2.0-3.3 also achieved CR post-surgery if it was associated with CSI <0.6.

Conclusion:

LI of >5.1 provides high sensitivity and CSI <0.6 high specificity for identification of surgically curable unilateral PA during ACTH-stimulated AVS when PAC is analyzed by LC-MS/MS.
P053 ANGIOTENSIN II RECEPTOR TYPE 1 (AT1) AUTOANTIBODIES IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Waraich Ms. Jotinder , Kline Gregory A. , Choi May Y. , Sigal Ronald J. , Caughlin Cori , Przybojewski Stefan J. , Leung Alexander A.
Published: September 2024

Background:

Primary aldosteronism (PA) is a common cause of hypertension and is characterized by excessive aldosterone secretion. Determination of PA subtype (i.e., unilateral vs. bilateral) is clinically important to inform treatment. Immune mechanisms may have a role in the pathogenesis of PA. The aim of this study was to examine whether angiotensin receptor type 1 (AT1) autoantibodies predict the underlying subtype of PA.

Methods:

We conducted a cross-sectional study of patients with PA who were referred for adrenal vein sampling (AVS). Patients had AT1 autoantibody titres measured. AT1 antibodies were defined as present when >17 U/mL, negative if <10 U/mL, and indeterminate if between 10-17 U/mL. AVS was used as a standard to determine PA subtype. The frequency of AT1 autoantibodies was determined according to PA subtype and major clinical predictors of lateralization.

Results:

54 patients with successful AVS were included (mean age, 52.7 years; 46.3% male). Positive AT1 antibodies were detected in 14 (25.9%), negative antibodies in 32 (59.3%), and indeterminate antibodies in 8 (14.8%) patients. There was no significant association detected between AT1 antibody status and lateralization (p=0.39). There were no associations found between AT1 autoantibody status and any of the major clinical factors traditionally predictive of PA severity or prognosis, including sex (p=0.94), age (p=0.76), hypokalemia (p=0.91), estimated glomerular filtration rate (p=0.46), or aldosterone-to-renin ratio (p=0.58).

Conclusion:

AT1 autoantibodies are common in patients with PA; over a quarter of patients who underwent AVS in our study. However, AT1 autoantibodies were not predictive of PA subtype.
P060 A NOVEL NON-INVASIVE METHOD FOR ESTIMATING CENTRAL SYSTOLIC BLOOD PRESSURE USING AMBULATORY BLOOD PRESSURE MONITORING
Authors: Álvarez-Montoya Diego , Gallo-Villegas Jaime , Aristizábal-Ocampo Dagnovar
Published: September 2024

Background and Objective:

Central blood pressure (BP) holds superior prognostic value compared to peripheral BP in predicting cardiovascular events. Despite its significance, measuring central BP in outpatient settings is impractical. To address this limitation, our research group devised a novel non-invasive method for estimating central systolic blood pressure (cSBP) using peripheral data based on the equation proposed by Chemla et al. However, its validity remains uncertain. The objective was to assess the validity of our new non-invasive method for estimating cSBP by comparing it to a validated brachial oscillometric method.

Methods:

A cross-sectional study was conducted, involving 132 patients who underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM). A total of 8,112 BP records were obtained. The cSBP was measured during 24-h ABPM using a Custo Screen 310 device (Custo, Ottobrunn, Germany), which has been validated. The cSBP was estimated using the formula: cSBP= MAP2/DBP, where MAP2 represents the estimated mean arterial pressure using the equation: MAP2=(Ts/T) × SBP + (Td/T) × DBP, where T, Ts, and Td denote the cardiac, systolic, and diastolic periods, respectively. The SBP indicate systolic blood pressure and DBP denote diastolic blood pressure. Ts was calculated as: Ts=0.2061+ (Age/2244) + (T/8.17).

Results:

Among the participants, 53.8% were men, with an average age of 55±16 years. The average height was 1.65±0.1 m, weight 74±12 kg, heart rate 71±12 bpm, SBP 125±19 mmHg, DBP 79±12 mmHg, and cSBP 120±19 mmHg. The agreement of cSBP between the new method and the brachial oscillometric method was very good. Bland-Altman plots revealed that the differences between the methods were randomly distributed along the mean difference line (Figure).

Conclusions:

The new non-invasive method to estimate cSBP from peripheral BP data, using MAP2 and cardiac periods, has been demonstrated to be valid. The equation, which allows for the estimation of cSBP without a pulse wave, could be easily implemented in conventional 24-h ABPM systems.
P061 AMBULATORY BLOOD PRESSURE MONITORING (ABPM) CHARACTERIZATION IN PATIENTS CONSULTING A CARE CENTER IN THE CITY OF POPAYÁN, COLOMBIA BETWEEN JANUARY 2019 AND JUNE 2021
Authors: Salazar Camilo Chará , Eraso Andrés Andrade , López Nelson Adolfo , Pinzón María Virginia , Patiño Valentina
Published: September 2024

Background:

Ambulatory blood pressure monitoring (ABPM) provides important information on the circadian behavior of this variable. This measure provides different phenotypes that can be analyzed in more depth than office blood pressure measurement. Several associations have been identified between altered circadian phenotypes, such as non dipper, and adverse cardiovascular outcomes, such as cardiovascular mortality, coronary heart disease, cerebrovascular disease, chronic kidney disease, and hospitalization for heart failure. To date, the behavior of blood pressure according to the MAPA is unknown in the population of the department of Cauca, Colombia. Therefore, our objective was to characterize the arterial hypertension profiles in a sample of this population.

Materials and methods:

A cross-sectional descriptive study was conducted in patients over 18 years of age, undergoing ambulatory BP monitoring from 2019 to 2021; data were recorded in an instrument containing sociodemographic, clinical, and therapeutic characteristics. The data were analyzed with the SPSS 25 program.

Results:

A total of 440 blood pressure monitoring (ABPM) records were obtained, of which, 80.4% of the records were found to be compatible with a diagnosis of arterial hypertension. The distribution of the profiles included: normal dipper (55.2%), attenuated dipper (non-dipper) (23.6%), inverted dipper (13.6%) and extreme dipping (1.4%). Most of the overweight and obese patients presented arterial hypertension in the ABPM records, with 41.1% being overweight patients and 25.2% obese. Regarding the arterial hypertension profiles, there were no statistically significant differences in relation to overweight and obesity.

Conclusions:

Among the BP profiles measured by ABPM in the population studied, the most prevalent was the normal dipper profile, followed by non-dipper, inverted dipper, and extreme dipper. There was a tendency for the overweight and obese population to present abnormal circadian BP profiles more frequently; however, in our study these results were not statistically significant.
P062 INITIAL EXPERIENCE WITH 24-HOURS AMBULATORY BLOOD PRESSURE MONITORING IN KEFFI NASARAWA STATE
Authors: Musango Dennis Anthony , Ebom Augustine
Published: September 2024

Objective:

In the last 30 years or so, the techniques for measuring blood pressure to ascertain wether an individual bas hypertension or not have undergone substantial change. The traditional method of taking blood pressure in the clinic is very useful especially on the population basis but provides poor estimate of risk in an individual subject. Ambulatory blood pressure measurement has been developed to estimate the true blood pressure of an individual over prolonged periods. There is paucity of report on the experience with this technology in Nigeria. We are therefore reporting on our initial experience with ambulatory blood pressure monitoring at cardiac unit of the department of medicine, of the federal medical center keffi.

Methods:

All the procedures where carried out with Schiller BR - 102 Plus ambulatory pressure monitors and analysis done with Schiller SDS- 200 Computer system.

Results:

We report different forms of abnormalities: poor blood pressure control, non- keeping patterns, White cost effects, normal blood pressure patterns, blood pressure patterns in autonomic dysfunction etc.

Conclusion:

Ambulatory blood pressure monitoring is a useful tool in blood pressure management especially in specialized units.
P068 IDENTIFYING THRESHOLD BIAS IN RECORDED BLOOD PRESSURE
Authors: Foti Kathryn , Zhao Di , Marklund Matti , Pathiravasan Chathurangi , Choudhury Sohel , Amin Robed , Bhuiyan Mahfuzur Rahman , Jubayer Shamim , Miller Edgar R. , Appel Lawrence J. , Matsushita Kunihiro
Published: September 2024

Background and Objective:

Even when blood pressure (BP) is measured accurately, BP may be misrecorded. “Threshold bias” occurs when BP measurements are intentionally or unintentionally recorded at values just below BP control goals and may occur due to incentives to improve BP control or to avoid medication titration. Our objectives were to 1) examine the potential for threshold bias in datasets with and without a BP control goal from two countries and 2) propose a method for detecting threshold bias.

Methods:

We examined the distribution of recorded BP measurements among individuals taking antihypertensive medication in clinical practice or trials with a BP goal <140/90 mmHg and population-based surveillance studies without a BP goal from Bangladesh and the US. Then, we explored whether surveillance data could be used as a reference to evaluate the likelihood of threshold bias in clinical data. We calculated the ratio of BP measurements recorded 10 mmHg below versus above thresholds of interest (i.e., the “threshold ratio,” or number of systolic BP [SBP] measurements 130-139 mmHg over 140-149 mmHg) and used bootstrapping to determine the probability of observing ratios that may indicate threshold bias. We compared the “threshold ratio” from clinical data to the probabilities determined from surveillance data.

Results:

Visually, we observed a cluster of measurements below SBP 140 mmHg in the clinical but not the surveillance datasets from Bangladesh and the US (Figure). Based on 10,000 random draws of 100 observations in the Bangladesh surveillance dataset, the probability of observing a “threshold ratio” of 3.56 in the clinical dataset was <2%, indicating a high probability of threshold bias. Using the same procedure in the US surveillance dataset, the probability of observing a “threshold ratio” of 2.26 in the clinical dataset was <10%, indicating potential concern.

Conclusions: Threshold

bias may be an underrecognized but common problem in clinical settings with a BP goal. Our proposed approach to detecting threshold bias should be tested in other settings.