- Email: [email protected]
Refractory and resistant hypertension: different aspects of a similar disease?
e68
Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e63–e72
populations are needed to adequately address the high burden of hypertension in Portugal. Methods: A retrospective analysis of patient-based electronic medical records was conducted during the year of 2013. To examine the effect of regular General practitioner (GP) management and control on BP across at least two annual visits. A subgroup of patients with elevated BP and age 18 years old, were selected in a total of 2.639 millions patients (58,1 % women). Hypertension was defined as Systolic BP and or Diastolic BP 140/90 mmHg. Results: The mean value for SBP was 130,8 83,4 mmHg (men 133,9 82,9, and women 129,083,7) and DBP 75,3 12,8 mmHg ( men 76,3 12,7 women 74,7 12,8). The overall prevalence of hypertension was 29,1% (men 26,0% and women 31,8%) . Among those patients under hypertensive treatment, the control rates were 33,9% (men 31,4% and women 35,8%). The main classes of antihypertensive prescribed were tiazide diuretics 27,2% (men 23,7% and women 29,7%), b-blockers 27,0% (men 26,5% and women 27,4%), calcium channel blockers 20,2% (men 21,1% and women 19,5%) and blockers of Renin Angiotensin Aldosterone System (RAAS) 80,8% (men 84,8% and women 77,9%). Conclusions: The prevalence of hypertension was lower than the results of PAP and PHYSA syudies. Arterial blood pressure control was optimum in only three out of ten in the subgroup of Portuguese patients aged 18 years or older. Blood pressure control assessement was significantly better in women. A more intensive approach in the management of the BP in primary care is required to ensure that more patients achieve BP control targets. Keywords: hypertension; epidemiology; study
P-107 Refractory and resistant hypertension: different aspects of a similar disease? Rodrigo Modolo, Ana Paula de Faria, Andrea Rodrigues Sabbatini, Alessandra Ritter, Natalia Ruggeri Barbaro, Natalia Batista Correa, Veridiana Brunelli, Heitor Moreno. University of Campinas, Campinas, Brazil Resistant hypertension (RH) is defined as BP levels that remain uncontrolled despite the use of 3 anti-hypertensive drugs, or controlled requiring the use of at least 4 drugs. Recently a new definition for a more extreme phenotype of RH (uncontrolled BP using at least 5 drugs) has emerged - the refractory hypertension. Although characteristics of the resistant hypertensive population are well established, little is known of this newly described subgroup. The aim of this study was to characterize subjects with refractory hypertension among RH and identify factors associated with it. For that, 116 subjects with true resistant hypertension were enrolled from a specialized RH Clinic and divided into two groups according to the new definition: RH (n¼80), and refractory hypertension (RfH, n¼36). Subjects were submitted to echocardiography, 24h-ABPM and office BP measurements and biochemical analyses. There were no difference between groups regarding age, gender and biochemical parameters. RfH subgroup had higher left ventricular mass index (LVMI, 12746 vs. 11234 g/m2, p¼0.04), presence of WCE (67% vs. 39%, p¼0.01) and were more likely black (61% vs. 26%, p<0.001) compared with their counterparts. Logistic regression analysis demonstrated that: (1) WCE (OR¼3.23, 95% confidence interval-95%CI 1.12-9.27, p¼0.03), (2) black race (OR¼6.67, 95%CI 1.99-16.16, p<0.001) and (3) left ventricular mass index (OR¼1.02, 95%CI 1.01-1.03, p¼0.04) were independent predictor of refractoriness. In conclusion, refractory and resistant hypertension present different patients characteristics, prevailing black race with higher LVMI and WCE. These phenotypic aspects can be useful in order to better understanding this harder-to-treat subgroup. Keywords: Resistant hypertension; refractory hypertension; left ventricular hypertrophy
P-108 Should patients with hypertension be screened for psychological distress? Nwakike Ojike,1 Sunil Penesetti,1 Azizi Seixas,1 Seithikurippu Pandi-Perumal,1 Samy I. McFarlane,2 Gbenga Ogedegbe,1 Girardin Jean-Louis.1 1Center for Healthful Behavior Change New York University School of Medicine, New York, NY, United States; 2Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, United States Introduction: Growing evidence supports a link of major depressive disorder and anxiety to cardiovascular disease outcome. The study evaluated whether individuals with hypertension are more likely to experience psychological distress. Methods: Data analysis was performed using the National Health Interview Survey (NHIS) dataset data (2004-2013), which applies a stratified multistage sample survey of the resident civilian non-institutionalized population. Respondents provided sociodemographic and physician-diagnosed chronic conditions. Hypertension was self-reported and the Kessler-6 (K6) scale was used to assess psychological distress; a score 13 indicated distress. The hypothesized relationship was tested using a multivariate logistic regression model. Results: Among the participants (N¼403,621), 51% were female; overall the mean age (SEM) was 35.30.02 years) and mean BMI was 27.50.01 Kg/m2. In the entire sample, the prevalence of hypertension was 28.4%. Hypertension was present among 9.7% of those reporting daily exercise, compared to 18.1% among those who did not (p<0.01). Hypertension was present among 7.5% of alcohol abstainers and 23.3% among current or former alcohol users. The mean age of participants with hypertension was 59.70.05 years versus 42.50.05 years for those without the condition. Hypertensives were characterized by a higher prevalence of dyslipidemia (51.4% versus 11.8%, p<0.01), diabetes mellitus (6.7% versus 3.8%, p<0.01), and weak/failing kidney (4.7% versus 0.8%, p<0.01). Multivariate logistic regression, adjusting for cardiovascular risk factors: age, race, BMI, diabetes, physical activity, sleep duration, marital status, educational level, and poverty status, indicated that individuals with hypertension were 30% more likely to experience psychological distress (OR ¼ 1.30, 95% CI¼1.16-1.46, p<0.01). There was significant interaction between psychological distress and race (b¼0.09, p<0.01). Conclusion: Results of this study characterized factors associated with the presence of hypertension. Consistent with our hypothesis, individuals with hypertension were more likely to experience psychological distress. Therefore, individuals with hypertension should be screened for the presence of psychological distress. Support: This work was supported by funding from the NIH (R01MD007716), the NINDS (U54NS081765), and the NHLBI (K24HL111315). Keywords: Hypertension; Psychological distress
P-109 Race and age group differences in wellness evaluation among individuals with hypertension Nwakile Ojike,1 Sunil Penesetti,1 Andrea Grant,3 Ferdinand Zizi,1 Seithikurippu Ratnas Pandi-Perumal,1 Gbenga Ogedegbe,1 Samy McFarlane,2 Girardin Jean-Louis.1 1New York University Medical Center, New York, NY, United States; 2SUNY Downstate Medical Center, New York, NY, United States; 3VA New York Healthcare System, New York, NY, United States Background: Despite expanding coverage under the Patient Protection and Affordable Care Act (PPACA) of 2010, health utilization and wellness
Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e63–e72
populations are needed to adequately address the high burden of hypertension in Portugal. Methods: A retrospective analysis of patient-based electronic medical records was conducted during the year of 2013. To examine the effect of regular General practitioner (GP) management and control on BP across at least two annual visits. A subgroup of patients with elevated BP and age 18 years old, were selected in a total of 2.639 millions patients (58,1 % women). Hypertension was defined as Systolic BP and or Diastolic BP 140/90 mmHg. Results: The mean value for SBP was 130,8 83,4 mmHg (men 133,9 82,9, and women 129,083,7) and DBP 75,3 12,8 mmHg ( men 76,3 12,7 women 74,7 12,8). The overall prevalence of hypertension was 29,1% (men 26,0% and women 31,8%) . Among those patients under hypertensive treatment, the control rates were 33,9% (men 31,4% and women 35,8%). The main classes of antihypertensive prescribed were tiazide diuretics 27,2% (men 23,7% and women 29,7%), b-blockers 27,0% (men 26,5% and women 27,4%), calcium channel blockers 20,2% (men 21,1% and women 19,5%) and blockers of Renin Angiotensin Aldosterone System (RAAS) 80,8% (men 84,8% and women 77,9%). Conclusions: The prevalence of hypertension was lower than the results of PAP and PHYSA syudies. Arterial blood pressure control was optimum in only three out of ten in the subgroup of Portuguese patients aged 18 years or older. Blood pressure control assessement was significantly better in women. A more intensive approach in the management of the BP in primary care is required to ensure that more patients achieve BP control targets. Keywords: hypertension; epidemiology; study
P-107 Refractory and resistant hypertension: different aspects of a similar disease? Rodrigo Modolo, Ana Paula de Faria, Andrea Rodrigues Sabbatini, Alessandra Ritter, Natalia Ruggeri Barbaro, Natalia Batista Correa, Veridiana Brunelli, Heitor Moreno. University of Campinas, Campinas, Brazil Resistant hypertension (RH) is defined as BP levels that remain uncontrolled despite the use of 3 anti-hypertensive drugs, or controlled requiring the use of at least 4 drugs. Recently a new definition for a more extreme phenotype of RH (uncontrolled BP using at least 5 drugs) has emerged - the refractory hypertension. Although characteristics of the resistant hypertensive population are well established, little is known of this newly described subgroup. The aim of this study was to characterize subjects with refractory hypertension among RH and identify factors associated with it. For that, 116 subjects with true resistant hypertension were enrolled from a specialized RH Clinic and divided into two groups according to the new definition: RH (n¼80), and refractory hypertension (RfH, n¼36). Subjects were submitted to echocardiography, 24h-ABPM and office BP measurements and biochemical analyses. There were no difference between groups regarding age, gender and biochemical parameters. RfH subgroup had higher left ventricular mass index (LVMI, 12746 vs. 11234 g/m2, p¼0.04), presence of WCE (67% vs. 39%, p¼0.01) and were more likely black (61% vs. 26%, p<0.001) compared with their counterparts. Logistic regression analysis demonstrated that: (1) WCE (OR¼3.23, 95% confidence interval-95%CI 1.12-9.27, p¼0.03), (2) black race (OR¼6.67, 95%CI 1.99-16.16, p<0.001) and (3) left ventricular mass index (OR¼1.02, 95%CI 1.01-1.03, p¼0.04) were independent predictor of refractoriness. In conclusion, refractory and resistant hypertension present different patients characteristics, prevailing black race with higher LVMI and WCE. These phenotypic aspects can be useful in order to better understanding this harder-to-treat subgroup. Keywords: Resistant hypertension; refractory hypertension; left ventricular hypertrophy
P-108 Should patients with hypertension be screened for psychological distress? Nwakike Ojike,1 Sunil Penesetti,1 Azizi Seixas,1 Seithikurippu Pandi-Perumal,1 Samy I. McFarlane,2 Gbenga Ogedegbe,1 Girardin Jean-Louis.1 1Center for Healthful Behavior Change New York University School of Medicine, New York, NY, United States; 2Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, United States Introduction: Growing evidence supports a link of major depressive disorder and anxiety to cardiovascular disease outcome. The study evaluated whether individuals with hypertension are more likely to experience psychological distress. Methods: Data analysis was performed using the National Health Interview Survey (NHIS) dataset data (2004-2013), which applies a stratified multistage sample survey of the resident civilian non-institutionalized population. Respondents provided sociodemographic and physician-diagnosed chronic conditions. Hypertension was self-reported and the Kessler-6 (K6) scale was used to assess psychological distress; a score 13 indicated distress. The hypothesized relationship was tested using a multivariate logistic regression model. Results: Among the participants (N¼403,621), 51% were female; overall the mean age (SEM) was 35.30.02 years) and mean BMI was 27.50.01 Kg/m2. In the entire sample, the prevalence of hypertension was 28.4%. Hypertension was present among 9.7% of those reporting daily exercise, compared to 18.1% among those who did not (p<0.01). Hypertension was present among 7.5% of alcohol abstainers and 23.3% among current or former alcohol users. The mean age of participants with hypertension was 59.70.05 years versus 42.50.05 years for those without the condition. Hypertensives were characterized by a higher prevalence of dyslipidemia (51.4% versus 11.8%, p<0.01), diabetes mellitus (6.7% versus 3.8%, p<0.01), and weak/failing kidney (4.7% versus 0.8%, p<0.01). Multivariate logistic regression, adjusting for cardiovascular risk factors: age, race, BMI, diabetes, physical activity, sleep duration, marital status, educational level, and poverty status, indicated that individuals with hypertension were 30% more likely to experience psychological distress (OR ¼ 1.30, 95% CI¼1.16-1.46, p<0.01). There was significant interaction between psychological distress and race (b¼0.09, p<0.01). Conclusion: Results of this study characterized factors associated with the presence of hypertension. Consistent with our hypothesis, individuals with hypertension were more likely to experience psychological distress. Therefore, individuals with hypertension should be screened for the presence of psychological distress. Support: This work was supported by funding from the NIH (R01MD007716), the NINDS (U54NS081765), and the NHLBI (K24HL111315). Keywords: Hypertension; Psychological distress
P-109 Race and age group differences in wellness evaluation among individuals with hypertension Nwakile Ojike,1 Sunil Penesetti,1 Andrea Grant,3 Ferdinand Zizi,1 Seithikurippu Ratnas Pandi-Perumal,1 Gbenga Ogedegbe,1 Samy McFarlane,2 Girardin Jean-Louis.1 1New York University Medical Center, New York, NY, United States; 2SUNY Downstate Medical Center, New York, NY, United States; 3VA New York Healthcare System, New York, NY, United States Background: Despite expanding coverage under the Patient Protection and Affordable Care Act (PPACA) of 2010, health utilization and wellness