The role of non-drug methods of increasing adherence to the treatment of patients with arterial hypertension in a polyclinic

Introduction. Arterial hypertension (AH) is one of the important high-risk factors for the development of heart diseases, but its diagnosis and treatment does not require high technologies and substantial costs. However, the asymptomatic course of AH combined with a low level of medical literacy contributes to low adherence to treatment.Aim. To study the indirect impact of remote blood pressure monitoring (RBPM), the introduction of educational materials (EMs) in comparison with self-monitoring of blood pressure (SMBP) on adherence of patients with AH to outpatient treatment.Materials and methods. 60 subjects with an established fact of partial or complete refusal to use antihypertensive therapy were enrolled in the study and randomized into four equal and comparable groups: 1 – SMBP, 2 – RBPM, 3 – SMBP + EMs, 4 – RBPM + EMs. The impact of using RBPM was assessed by comparing blood pressure values in groups 1 and 2; the impact of EM – by comparing the results of questionnaire surveys in groups 1 and 2 and groups 3 and 4.Results and discussion. Additional training of patients with AH contributed to a twofold increase in adherence in using SCAD and RBPM. The average systolic blood pressure in groups 1 and 2 was 134 mm Hg, in groups 3 and 4 – 129 mm Hg; diastolic blood pressure in groups 1 and 2 – 78.5 mm Hg, in groups 3 and 4 – 77.5 mm Hg.Conclusion. The maximum impact on adherence to AH treatment can be achieved with the introduction of a set of measures. However, the introduction of RBPM has a number of limitations associated with the additional economic burden and the lack of an approved methodology. However, the provision of treatment and prevention facilities with EMs does not require additional development of methodology and is significantly cheaper than the cost of modern blood pressure monitors.

Post-operative blood pressure and 3-year major adverse cardiac events in Chinese patients undergoing PCI

Background There is no clear evidence for the target value of blood pressure control after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure after PCI and major adverse cardiac events (MACE) during 3-year follow-up. Methods This study is a prospective study. We included the patients who were diagnosed with acute coronary syndrome and underwent PCI stent implantation operation. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. MACE is defined as acute myocardial infarction, recurring chest pain, heart failure, stroke, revascularization and cardiac death. Results A total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure of patients after PCI and MACE events within 3 years and the inflection point is 121. On the left side of the inflection point, the effect size and 95% CI are 1.09 and 1.01–1.18, respectively (P = 0.029). The impact size and 95% CI at the right inflection point were 1.00 and 0.98–1.02(P = 0.604), respectively. Conclusion There is a curvilinear relationship between systolic blood pressure and prognosis of patients after PCI. Under the premise of ensuring the safety of patients, maintaining lower blood pressure after surgery is beneficial to improve the prognosis of patients.

T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications

Development of complications in type 1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN, respectively. This tool was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.

P124 Chronotype and OSA combine to modify risk of hypertension

Introduction There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population. Methods Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension. Results After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004). Discussion Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.

Post-Operative Blood Pressure in 24 Hours and 3-Year Major Adverse Cardiac Events in Chinese Patients Undergoing PCI

Background: There is no clear evidence for the target value of blood pressure control within 24 hours after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure within 24 hours after PCI and major adverse cardiac events (MACE) during 3-year follow-up. Methods: This study is a prospective study. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure within 24 hours after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. Results: A total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure within 24 hours of patients after PCI and MACE events within 3 years and the inflection point is 134. On the left side of the inflection point, the effect size and 95% CI are 1.22 and 1.04-1.43, respectively (P=0.017). The impact size and 95% CI at the right inflection point were 0.96 and 0.83-1.11, respectively (P=0.604). Conclusion: There is a non-linear relationship between systolic blood pressure and the occurrence of MACE events in 3 years, and its inflection point is 134mmHg. In the case of ensuring patient safety, we should control the patient's systolic blood pressure within 24 hours after surgery.

T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications

Development of complications in type-1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN respectively.This tool (https://ptran25.shinyapps.io/Diabetic_Peripheral_Neuropathy_Risk) was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.

Adherence To Antihypertensive Medications Among Primary Care Centre Attendees in Trinidad: A Cross-Sectional Study

Objective: To determine the adherence levels to antihypertensive medications and its associated factors among primary care attendees in Trinidad. Methods: A cross-sectional study was carried out whereby an interviewer-administered questionnaire was administered to public primary care attendees throughout Trinidad. Non-pregnant hypertensive adults, attending chronic disease clinic on anti-hypertensive medications for at least 1 year were eligible. Results: Of 225 participants (92% response rate), 58% displayed a low level of adherence to anti-hypertensive medications and 73.3% had uncontrolled hypertension, both independent of age, gender, and ethnicity. Experiencing adverse effects to prescribed medications (P=0.003) and self-reported use of herbal/alternative treatment (P=0.024) for hypertension were significantly associated with higher rates of low adherence. Having too many pills to take and fear about the potential effects of these medications on the body were both correlated with low adherence (P< 0.001) Obtaining antihypertensive medications from a national chronic disease assistance program was inversely correlated with low adherence (P= 0.03). There were no statistically significant associations between adherence and average systolic blood pressure (P= 0.20), home self-monitoring (P= 0.75), daily dosing frequency (P= 0.53), or daily number of pills (P= 0.68) Conclusion: Most primary care hypertensive patients who attended chronic disease clinics at primary care health centers around Trinidad were found to have uncontrolled hypertension along with low adherence to antihypertensive medications. Education, screening for herbal use, and improvements to the existing national medication program, are discussed as interventions to improve adherence in this setting. Keywords: Hypertension, Adherence, Antihypertensive medications, Primary Care

Comparative Study of Road Traffic Accident Victims Transferred by Air and Ground Emergency to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018

Background: Prehospital emergency department provides land, air, boat, and rail ambulance care. This study aimed to compare the situation of air and ground emergency casualties in road traffic accidents transferred to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018. Materials and Methods: The present study is a retrospective descriptive-analytical study. All road traffic accident victims transferred to Shahid Beheshti Medical Center in Qom by prehospital emergency land or air staff from 2015 to 2018 at 6 to 20 o’clock were included in this study (census method). The exclusion criteria included burns, death, transmission during cardiopulmonary resuscitation or by urban ambulances, and information deficiencies. We used a researcher-made checklist to examine victims’ age, sex, type of transmission, type of accident, type of trauma, distance, initial vital signs, time intervals, and day of the accident. SPSS software version 16 was used to analyze the data. Data were compared in two groups with the t test and the Chi-square test. Results: A total of 2057 casualties were included in the study: 566 casualties were transferred by air emergency and 1491 by ground emergency. The mean age of air emergency casualties was significantly lower than the ground emergency (P=0.008). Trauma to the neck, chest, abdomen and lower back was significantly higher in air emergency casualties, but hand and foot trauma were more common in ground emergency casualties. Most air missions took place on holidays or weekends, while most ground missions were done during weekdays (P<0.001). The mean distance of the air emergency missions was more than Beheshti Medical Center (P<0.001). Compared with ground emergency casualties, air emergency casualties had average systolic blood pressure, lower level of consciousness, and higher heart rate and respiration (P<0.001). The mean duration of transfer from the accident scene to the medical center in the air emergency was significantly shorter (P<0.001). Conclusion: Air emergency casualties were usually accompanied by more critical vital signs and severe injuries to the neck, chest, abdomen, and back. This study can provide clinical triage criteria that focus on key environmental factors and reduced transport time. Further studies are needed to investigate the consequences of traffic accident casualties at the medical center to determine which subgroups will benefit most from using air emergency.

The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.