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Using the JASH abstract supplement issue to teach new advances in clinical hypertension to internal medicine residents
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Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e53–e58
Methods: The MMAS-8 is a self-reported scale shown to be a reliable and validated assessment tool to evaluate medication adherence. SPRINT includes administration of the MMAS-8 at the baseline visit along with the 12 month and 48 month follow-up visits in order to evaluate the relationship between self-reported antihypertensive medication regimen adherence and actual systolic blood pressure (SBP) control. In order to evaluate this relationship, we performed a cross-sectional analysis of the SPRINT baseline data set. The outcome of interest was baseline SBP control, defined as a categorical variable: SBP 160 mm Hg (severely uncontrolled). The predictor of interest was baseline MMAS-8 score as a categorical variable: 7.75 (high adherence). Baseline demographic and risk factors were assessed using bivariate analyses. Multivariable ordinal logistic regression was then used to analyze the adjusted association between SBP and medication adherence. Finally, we evaluated whether significant interactions were present in the multivariate model for age (75 and <75 years old), chronic kidney disease (CKD), race, and number of antihypertensive medications prescribed. Results: There was a significant relationship between blood pressure control and medication adherence in the bivariate analysis (p 0.0142). This relationship remained significant after adjustment in the multivariate analysis (p 0.0378). However, there were not significant interactions for age (p 0.0830), CKD (p 0.6076), presence of race (p 0.4835), or number of antihypertensive medications (p 0.3893). Conclusions: Subjects’ self-reported medication adherence, measured via MMAS-8 scores, was significantly correlated with measured systolic blood pressure control at baseline in the SPRINT cohort. This association was not impacted by several key covariates, including number of antihypertensive medications prescribed. These data were consistent with prior reports that the MMAS-8 questionnaire is a valid tool that can be useful in identifying non-adherent subjects at high risk for worse SBP control. Keywords: Adherence; risk; control
P-77 Using the JASH abstract supplement issue to teach new advances in clinical hypertension to internal medicine residents Bruce Johnson. Virginia Tech Carilion School of Medicine, Roanoke, VA, United States Objectives: Identify current topics of investigation in hypertension from submissions to the national meeting Give perspective and background to topics of investigation Encourage audience participation in learning topics Methods: Being responsible for teaching sessions in clinical hypertension, especially for residents, is a mixed blessing. Hypertension is a frequent topic for discussion in clinic and on wards, in both formal and informal settings. Residents may have an adequate knowledge base in pharmacology but do not always know current topics in investigation since such topics are not regularly encountered in typical clinical activities. Once topics are chosen to present to residents, it can be challenging to use principles of audience participation with this audience. The author developed a method to present topics of current investigation in clinical hypertension. The method utilizes audience participation and gives an opportunity to add perspective and background to better integrate the topics into resident practice. Briefly, the resident audience was split into equal small groups. Each small group was given 2-4 abstracts taken from the May 2013 supplement of the JASH; this supplement includes most research abstracts presented at the annual ASH meeting. The abstracts were oriented around a topic of investigation at the meeting; topics varied from home blood pressure monitoring to interprofessional hypertension management to sympathetic renal denervation and others. Each small group was given about 15 minutes to review the abstracts and prepare a 2-minute summary for presentation to the whole audience. After each brief presentation, the author spent 5 minutes embellishing on the topic, hopefully providing additional information and perspective. Conclusions: Most residents in the audience participated in the small groups. By having one member of each small group make a brief
summation of the abstracts, residents seemed more attentive, perhaps out of respect for their colleagues. Each small group also had a sense of investment in the topic. By including many topics, the session, which lasted just over an hour, was fast paced and engaging. The background and perspective presented by the author focused on those issues that are active in our setting (e.g., home blood pressure monitoring) or of significant future relevance to the field (e.g., biomarkers). Evaluations of the session were generally supportive with endorsement of the method of audience participation but concern regarding superficiality in covering some topics. There was almost universal recognition that this method indeed touched on current topics of investigation in clinical hypertension. Keywords: Teaching; teaching hypertension; audience participation P-78 Beta blocking agents and statins correlated negatively to quality of life in drug-treated hypertensive patients Ilkka M. Kantola, Martti Merikari, Jerry Tervo, Lauri Koskio, Jussi Haijanen, Henrika Hermansson, Taru Kantola, Pekka M€akela, Simo Rehunen, Juha Varis. Turku University Hospital, Turku, Finland The objective of the study was to clarify quality of life in Finnish drugtreated hypertensive patients. SF-36 questionnaire was filled out by 174 hypertensive patients (66 females and 108 males, aged 64.5 (8.5) years). All of them used at least one antihypertensive agent. Their mean 24-hour ambulatory systolic blood pressure was 132.1 (12.6) mmHg and diastolic blood pressure 76.6 (7.2) mmHg and LDL-cholesterol 2.6 (0.7) mmol/l. 38 of them had diabetes mellitus. The mean (SD) SF-36 questionnaire scores were (maximum 100): Physical functioning 78.4 (19.9), role-physical 71.0 (37.1), bodily pain 67.5 (20.4), general health 61.4 (18.6), vitality 65.6 (19.8), social functioning 89.4 (18.0), role-emotional 76.5 (35.4), mental health 80.5 (17.1) and reported health transition 3.2 (0.8). The mean (SD) of all the scores was 74.1 (18.4). All different scores correlated significantly (p<0.001) to each other. The use of beta blocking agents correlated negatively to most of the quality of life parameters. Also the use of statin medication correlated negatively to role-physical, general health and vitality. According to our results the SF-36 scores of the Finnish drug-treated hypertensive patients did not differ markedly from the American healthy population of the same age and the scores of hypertensive patients used in validation of SF-36 questionnaire. The patients in our study were quite well treated and their hypertension and antihypertensive treatment did not affect negatively on their quality of life. However, the use of beta blocking agents and statins seemed to decrease quality of life. According to the reported health transition item quality of life had not changed markedly compared to the previous year. Keywords: Quality of life; antihypertensive medication P-79 Nebivolol and valsartan alone and in combination: effects on 24-hour ambulatory cardiac work and blood pressure-heart rate variability Safi U. Khan, Osman Saleem, Peter J. Osmond, Joseph L. Izzo. University at Buffalo, Buffalo, NY, United States Beta-blockers are standard antihypertensive drugs indicated for treatment of heart diseases but little is known about their effects on cardiac workload in the ambulatory setting. We compared the effects of nebivolol (N), angiotensin receptor blocker valsartan (V) and combined N/V on 24-hour ambulatory central rate-pressure product (ACRPP) and its variability. Subjects with hypertension (SBP >140 or DBP>90, n¼26) were studied in a 3-way, double-blind, forced-titration, randomized crossover study. After 4 weeks of each drug (V 320, N 40, or N/V 320/40 mg daily), ambulatory pulse wave analysis (IEM MobilOGraph) was performed every 20 min for 24-hours with primary (ACRPP) and secondary endpoints (time of day, heart rate, etc.) analyzed by sequential paired t-analyses (N+V vs V; N
Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e53–e58
Methods: The MMAS-8 is a self-reported scale shown to be a reliable and validated assessment tool to evaluate medication adherence. SPRINT includes administration of the MMAS-8 at the baseline visit along with the 12 month and 48 month follow-up visits in order to evaluate the relationship between self-reported antihypertensive medication regimen adherence and actual systolic blood pressure (SBP) control. In order to evaluate this relationship, we performed a cross-sectional analysis of the SPRINT baseline data set. The outcome of interest was baseline SBP control, defined as a categorical variable: SBP 160 mm Hg (severely uncontrolled). The predictor of interest was baseline MMAS-8 score as a categorical variable: 7.75 (high adherence). Baseline demographic and risk factors were assessed using bivariate analyses. Multivariable ordinal logistic regression was then used to analyze the adjusted association between SBP and medication adherence. Finally, we evaluated whether significant interactions were present in the multivariate model for age (75 and <75 years old), chronic kidney disease (CKD), race, and number of antihypertensive medications prescribed. Results: There was a significant relationship between blood pressure control and medication adherence in the bivariate analysis (p 0.0142). This relationship remained significant after adjustment in the multivariate analysis (p 0.0378). However, there were not significant interactions for age (p 0.0830), CKD (p 0.6076), presence of race (p 0.4835), or number of antihypertensive medications (p 0.3893). Conclusions: Subjects’ self-reported medication adherence, measured via MMAS-8 scores, was significantly correlated with measured systolic blood pressure control at baseline in the SPRINT cohort. This association was not impacted by several key covariates, including number of antihypertensive medications prescribed. These data were consistent with prior reports that the MMAS-8 questionnaire is a valid tool that can be useful in identifying non-adherent subjects at high risk for worse SBP control. Keywords: Adherence; risk; control
P-77 Using the JASH abstract supplement issue to teach new advances in clinical hypertension to internal medicine residents Bruce Johnson. Virginia Tech Carilion School of Medicine, Roanoke, VA, United States Objectives: Identify current topics of investigation in hypertension from submissions to the national meeting Give perspective and background to topics of investigation Encourage audience participation in learning topics Methods: Being responsible for teaching sessions in clinical hypertension, especially for residents, is a mixed blessing. Hypertension is a frequent topic for discussion in clinic and on wards, in both formal and informal settings. Residents may have an adequate knowledge base in pharmacology but do not always know current topics in investigation since such topics are not regularly encountered in typical clinical activities. Once topics are chosen to present to residents, it can be challenging to use principles of audience participation with this audience. The author developed a method to present topics of current investigation in clinical hypertension. The method utilizes audience participation and gives an opportunity to add perspective and background to better integrate the topics into resident practice. Briefly, the resident audience was split into equal small groups. Each small group was given 2-4 abstracts taken from the May 2013 supplement of the JASH; this supplement includes most research abstracts presented at the annual ASH meeting. The abstracts were oriented around a topic of investigation at the meeting; topics varied from home blood pressure monitoring to interprofessional hypertension management to sympathetic renal denervation and others. Each small group was given about 15 minutes to review the abstracts and prepare a 2-minute summary for presentation to the whole audience. After each brief presentation, the author spent 5 minutes embellishing on the topic, hopefully providing additional information and perspective. Conclusions: Most residents in the audience participated in the small groups. By having one member of each small group make a brief
summation of the abstracts, residents seemed more attentive, perhaps out of respect for their colleagues. Each small group also had a sense of investment in the topic. By including many topics, the session, which lasted just over an hour, was fast paced and engaging. The background and perspective presented by the author focused on those issues that are active in our setting (e.g., home blood pressure monitoring) or of significant future relevance to the field (e.g., biomarkers). Evaluations of the session were generally supportive with endorsement of the method of audience participation but concern regarding superficiality in covering some topics. There was almost universal recognition that this method indeed touched on current topics of investigation in clinical hypertension. Keywords: Teaching; teaching hypertension; audience participation P-78 Beta blocking agents and statins correlated negatively to quality of life in drug-treated hypertensive patients Ilkka M. Kantola, Martti Merikari, Jerry Tervo, Lauri Koskio, Jussi Haijanen, Henrika Hermansson, Taru Kantola, Pekka M€akela, Simo Rehunen, Juha Varis. Turku University Hospital, Turku, Finland The objective of the study was to clarify quality of life in Finnish drugtreated hypertensive patients. SF-36 questionnaire was filled out by 174 hypertensive patients (66 females and 108 males, aged 64.5 (8.5) years). All of them used at least one antihypertensive agent. Their mean 24-hour ambulatory systolic blood pressure was 132.1 (12.6) mmHg and diastolic blood pressure 76.6 (7.2) mmHg and LDL-cholesterol 2.6 (0.7) mmol/l. 38 of them had diabetes mellitus. The mean (SD) SF-36 questionnaire scores were (maximum 100): Physical functioning 78.4 (19.9), role-physical 71.0 (37.1), bodily pain 67.5 (20.4), general health 61.4 (18.6), vitality 65.6 (19.8), social functioning 89.4 (18.0), role-emotional 76.5 (35.4), mental health 80.5 (17.1) and reported health transition 3.2 (0.8). The mean (SD) of all the scores was 74.1 (18.4). All different scores correlated significantly (p<0.001) to each other. The use of beta blocking agents correlated negatively to most of the quality of life parameters. Also the use of statin medication correlated negatively to role-physical, general health and vitality. According to our results the SF-36 scores of the Finnish drug-treated hypertensive patients did not differ markedly from the American healthy population of the same age and the scores of hypertensive patients used in validation of SF-36 questionnaire. The patients in our study were quite well treated and their hypertension and antihypertensive treatment did not affect negatively on their quality of life. However, the use of beta blocking agents and statins seemed to decrease quality of life. According to the reported health transition item quality of life had not changed markedly compared to the previous year. Keywords: Quality of life; antihypertensive medication P-79 Nebivolol and valsartan alone and in combination: effects on 24-hour ambulatory cardiac work and blood pressure-heart rate variability Safi U. Khan, Osman Saleem, Peter J. Osmond, Joseph L. Izzo. University at Buffalo, Buffalo, NY, United States Beta-blockers are standard antihypertensive drugs indicated for treatment of heart diseases but little is known about their effects on cardiac workload in the ambulatory setting. We compared the effects of nebivolol (N), angiotensin receptor blocker valsartan (V) and combined N/V on 24-hour ambulatory central rate-pressure product (ACRPP) and its variability. Subjects with hypertension (SBP >140 or DBP>90, n¼26) were studied in a 3-way, double-blind, forced-titration, randomized crossover study. After 4 weeks of each drug (V 320, N 40, or N/V 320/40 mg daily), ambulatory pulse wave analysis (IEM MobilOGraph) was performed every 20 min for 24-hours with primary (ACRPP) and secondary endpoints (time of day, heart rate, etc.) analyzed by sequential paired t-analyses (N+V vs V; N