Risk of hospitalization and mortality associated with uncontrolled blood pressure in patients with hypertension and COVID-19

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

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Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?

American Journal of Hypertension ◽

10.1093/ajh/hpt109 ◽

2013 ◽

Vol 26 (11) ◽

pp. 1328-1334 ◽

Cited By ~ 9

Author(s):

Xuefeng Liu ◽

Ping Song

Keyword(s):

Blood Pressure ◽

Racial Differences ◽

Mexican Americans ◽

The United States ◽

Linear Regression Models ◽

Uncontrolled Blood Pressure ◽

Hypertensive Patients ◽

Health And Nutrition ◽

Multistage Design ◽

Hispanic White

Abstract BACKGROUND Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS A total of 6,134 diagnosed hypertensive subjects aged ≥20 years were collected from the National Health and Nutrition Examination Survey 1999–2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37–0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35–0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40–0.96). Mexican Americans have a stronger associaton of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

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Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

BMC Nephrology ◽

10.1186/s12882-021-02418-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xin Li ◽

Xiaojing Wu ◽

Muyin Zhang ◽

Lili Xu ◽

Guohui Li ◽

...

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

High Altitude ◽

Kidney Injury ◽

Hypertensive Disorders Of Pregnancy ◽

Fetal Outcomes ◽

Uncontrolled Blood Pressure ◽

Logistic Regression Models ◽

Hypertensive Disorders ◽

Term Delivery

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

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Abstract 17130: Variables Associated With Uncontrolled Blood Pressure Early After Stroke

Circulation ◽

10.1161/circ.138.suppl_1.17130 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Saviour Achilike ◽

Austin Wang ◽

Gabretta Cooksey ◽

Evelyn Hinojosa ◽

Munachi Okpala ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Uncontrolled Blood Pressure ◽

Factors Associated ◽

Multivariable Analyses ◽

Medication Complexity ◽

Ischemic Attack

Introduction: Uncontrolled blood pressure (BP) is a major risk factor for recurrent stroke; however, up to 50% of stroke survivors have uncontrolled BP 6 months after stroke. Characterization of factors associated with uncontrolled BP early after stroke discharge (DC) may help to identify patients for BP interventions. Hypothesis: We sought to identify factors associated with uncontrolled BP in the first month after stroke discharge. We hypothesized that African American (AA) race, insurance status, medication complexity, and hospital BP prior to discharge would be associated with uncontrolled BP. Methods: We identified hypertensive patients with ischemic or hemorrhagic stroke or transient ischemic attack scheduled to follow-up in the stroke clinic 2 to 4 weeks after hospital DC. Office BP was obtained using BpTRU, an automated machine that averages five unattended BP measures. Uncontrolled BP was defined using 2017 American College of Cardiology Guidelines as BP ≥ 130/80 mmHg. We used univariate logistic regression to assess relationships between uncontrolled BP and selected variables. Variables with statistically significant associations in the univariate models and variables associated with uncontrolled BP in the literature were included in the multiple logistic regression model. Results: Of the 230 patients identified, 55.7% had uncontrolled BP at clinic follow-up. In univariate and multivariable analyses, AA race, young stroke (age < 50), and systolic BP (SBP) 24-hours prior to DC were significantly associated with uncontrolled BP early after stroke DC. BP medication complexity was not associated with uncontrolled BP in this study. Conclusions: AA race, young age, and elevate SBP in the 24 hours prior to of stroke DC were associated with uncontrolled BP early after stroke. These variables can be used to identify patients who may benefit from early interventions aimed at reducing the risk of uncontrolled BP after stroke and stroke recurrence.

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Abstract P112: Changes in Lifestyle Behavior to Reduce Uncontrolled Blood Pressure in the Faith Trial

Circulation ◽

10.1161/circ.131.suppl_1.p112 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Kristie J Lancaster ◽

Antoinette M Schoenthaler ◽

William Chaplin ◽

Gbenga Ogedegbe

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Medication Adherence ◽

Lifestyle Modification ◽

Intervention Group ◽

Black Americans ◽

Control Group ◽

Lifestyle Behaviors ◽

Uncontrolled Blood Pressure ◽

Faith Based

Introduction: Modifying lifestyle behaviors is a key method for controlling hypertension. This strategy is extremely important for hypertensive Black Americans, as they are more likely to have uncontrolled blood pressure (BP), have a higher risk of complications, and poorer outcomes. To address this need, we conducted a cluster-randomized controlled trial to reduce BP through lifestyle modification that was delivered by lay health advisors in Black churches. The Faith-based Approaches in the Treatment of Hypertension (FAITH) trial was designed to evaluate the effectiveness of a 12-week faith-based lifestyle intervention and subsequent 3-month motivational interviewing vs. health education control on BP reduction among hypertensive Black adults. This study examines the change in lifestyle behaviors during the trial from baseline to 6 months. Methods: We recruited 373 Black Americans with uncontrolled hypertension from 32 urban churches. BP was considered to be uncontrolled if systolic BP (SBP)≥140 mmHg or diastolic BP (DBP)≥90 mmHg, or DBP≥130 mmHg or DBP≥80 mmHg for participants with self-reported diabetes or kidney disease The primary outcome was within-participant change in BP from baseline to 6 months. Lifestyle data collected included the NCI fruit/vegetable intake screener and % calories from fat screener, the International Physical Activity Questionnaire (IPAQ), medication adherence, and measured height and weight. Results: Participants’ mean age was 63.4 y, 76.4% were female, and 96.1% reported being of African descent. The mean BMI was 32.1 kg/m2. At 6 months, the intervention was associated with significant reduction in SBP but not DBP compared with the control group (-16.0 mmHg vs -10.3 mmHg, p=0.017). There was no significant change in number of servings of fruits and vegetables consumed, minutes walked per day, or weight for either group. However, the intervention group had a slight but significantly greater decrease of 1.08 % calories from fat over time compared with the control (p=0.018), but that change was not related to change in SBP. Most notably, there was a significant months x treatment interaction on medication adherence the intervention group had a greater decrease in non-adherence score than the control (-0.84 vs -0.30, p=0.28). This improvement in adherence was related to decrease in SBP (p=0.019). Conclusion: Community-based lifestyle modification program led to significantly reduced systolic BP; and this intervention effect was mediated by improved medication adherence. However, the 12-week intervention resulted in little change in key diet and physical activity behaviors found in other trials to positively affect BP.

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Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽

10.1161/hyp.78.suppl_1.p132 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Zahra Abuzaid ◽

Sara Almuslem ◽

Farah Aleisa

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Recurrent Stroke ◽

Uncontrolled Hypertension ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Event ◽

Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

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Initial left-ventricular mass predicts probability of uncontrolled blood pressure in arterial hypertension

Journal of Hypertension ◽

10.1097/hjh.0b013e328343ce32 ◽

2011 ◽

Vol 29 (4) ◽

pp. 803-808 ◽

Cited By ~ 20

Author(s):

Raffaele Izzo ◽

Giovanni de Simone ◽

Richard B Devereux ◽

Renata Giudice ◽

Marina De Marco ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Left Ventricular Mass ◽

Left Ventricular ◽

Uncontrolled Blood Pressure ◽

Ventricular Mass

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Plenary III-03: Adherence to Home Blood Pressure Monitoring in Patients with Uncontrolled Blood Pressure

Clinical Medicine & Research ◽

10.3121/cmr.2010.943.plenary-iii-03 ◽

2010 ◽

Vol 8 (3-4) ◽

pp. 209-209

Author(s):

S. Tiwana ◽

T. Kerby ◽

S. Asche ◽

N. Schneider ◽

M. Maciosek ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Uncontrolled Blood Pressure

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Oxygen Reactivity in Diabetes Mellitus: Effect of Hypertension and Hyperglycaemia

Clinical Science ◽

10.1042/cs0860689 ◽

1994 ◽

Vol 86 (6) ◽

pp. 689-695 ◽

Cited By ~ 26

Author(s):

V. Patel ◽

S. M. B. Rassam ◽

H. C. Chen ◽

E. M. Kohner

Keyword(s):

Blood Pressure ◽

Laser Doppler Velocimetry ◽

Vascular Reactivity ◽

Retinal Blood Flow ◽

Retinal Circulation ◽

Uncontrolled Blood Pressure ◽

Oxygen Breathing ◽

Oxygen Reactivity ◽

Retinal Photographs ◽

Vascular Autoregulation

1. Laser Doppler velocimetry and computerized image analysis of retinal photographs were used to define retinal vascular autoregulation to 60% oxygen breathing. This normally causes vasoconstriction in the retinal circulation. Normotensive and hypertensive diabetic subjects were studied under conditions of relative normoglycaemia (< 10 mmol) and hyperglycaemia (> 15 mmol) together with control subjects. 2. Retinal blood flow was significantly higher in diabetic subjects when hypertensive and hyperglycaemic than in the same diabetic subjects when normotensive. 3. In the normotensive non-diabetic subjects the oxygen reactivity was 41.16 ± 14.09%. It was significantly reduced in normotensive ‘hyperglycaemic’ diabetic subjects (21.75 ± 15.56%), hypertensive diabetic subjects with controlled blood pressure and ‘normoglycaemia’ (30.49 ±14.20%), hypertensive diabetic subjects with controlled blood pressure and ‘hyperglycaemia’ (18.36 ±11.42%), hypertensive diabetic subjects with uncontrolled blood pressure and ‘normoglycaemia’ (26.91 ±13.43%) and hypertensive diabetic subjects with uncontrolled blood pressure and ‘hyperglycaemia’ (17.17 ±13.24%) (means±SD, all P values <0.05). 4. In conclusion, retinal vascular reactivity is impaired in diabetic subjects both when they are normotensive and when they are hypertensive. Hyperglycaemia, to a degree commonly encountered in clinical practice, impairs retinal vascular autoregulation even further.

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