bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.