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Hypertension is a global health challenge, especially in low‐to‐middle‐income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed‐method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020–July 2021). Quantitative data included socio‐demographic characteristics and patient follow‐up rates. Qualitative data comprised focus group discussions (FGD) and in‐depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher‐level healthcare facilities, leading to substantial loss of follow‐up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient‐centered interventions are crucial steps. [ABSTRACT FROM AUTHOR]

The aim of this multi-country, cluster-randomized trial is to test the impact of pharmacy-based health promotion to reduce the blood pressure of individuals with hypertension over a 12-month period in Bangladesh and Pakistan. The trial will be implemented with two arms. In Bangladesh, the estimated sample size is around 3600 hypertensive patients. In Pakistan, we will select samples equivalent to 10% of the participants from Bangladesh, comprising 360 hypertensive patients from four pharmacies. Community pharmacies will be randomized into one of two parallel groups (allocation ratio 1:1). Pharmacy professionals in the treatment arm will provide their patients with educational training and counseling, as well as phone calls/mobile text messages and care coordination in the health sector, as part of the intervention. The study will be conducted in three phases: a baseline survey with intervention, a midline survey with intervention and follow-up, and an endline survey with impact evaluation. The primary outcome of the study will be BP. The secondary outcomes will be BP controlled to target, treatment adherence, quality of life, mortality or hospital admission rates resulting from hypertension and its related complications, incremental cost per health-related quality of life gained, knowledge on healthy lifestyle and dietary behavior, and change in the prevalence of current smoking status. [ABSTRACT FROM AUTHOR]

Sanju Bhattarai,1,2 Dikshya Wagle,2 Archana Shrestha,2– 4 Bjørn Olav Åsvold,1,5 Eva Skovlund,1 Abhijit Sen1,6 1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Institute of Implementation Science and Health, Kathmandu, Nepal; 3Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; 4Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, 06510, USA; 5Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 6Center for Oral Health Services and Research (Tkmidt), Trondheim, NorwayCorrespondence: Sanju Bhattarai, Email sanju.bhattarai@ntnu.noIntroduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale − 8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.Keywords: hypertension control, adherence, social support, Nepal

IntroductionHypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients.MethodsData were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network.ResultsThe group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p

The aim of this multi-country, cluster-randomized trial is to test the impact of pharmacy-based health promotion to reduce the blood pressure of individuals with hypertension over a 12-month period in Bangladesh and Pakistan. The trial will be implemented with two arms. In Bangladesh, the estimated sample size is around 3600 hypertensive patients. In Pakistan, we will select samples equivalent to 10% of the participants from Bangladesh, comprising 360 hypertensive patients from four pharmacies. Community pharmacies will be randomized into one of two parallel groups (allocation ratio 1:1). Pharmacy professionals in the treatment arm will provide their patients with educational training and counseling, as well as phone calls/mobile text messages and care coordination in the health sector, as part of the intervention. The study will be conducted in three phases: a baseline survey with intervention, a midline survey with intervention and follow-up, and an endline survey with impact evaluation. The primary outcome of the study will be BP. The secondary outcomes will be BP controlled to target, treatment adherence, quality of life, mortality or hospital admission rates resulting from hypertension and its related complications, incremental cost per health-related quality of life gained, knowledge on healthy lifestyle and dietary behavior, and change in the prevalence of current smoking status.

Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: Hypertension quality improvement programs reduce uncontrolled blood pressure (BP) but impact may differ by sex and age. Methods: This study examined uncontrolled BP, defined as a BP ≥ 140/90 mmHg, and therapeutic inertia, defined as absence of medication initiation or escalation during visits with uncontrolled BP, by sex and by age group (19–40, 41–65, 66–75, and 76+ years) during a 12 month follow-up period among 21, 861 patients with hypertension and ≥ two visits in primary care clinics enrolled in the American Medical Association (AMA) Measure Accurately, Act Rapidly, and Partner with Patients (MAP) BP hypertension quality improvement program. Results: The mean age was 64.8 years (standard deviation [SD 12.8]) and ranged from 19 to 87 years; 53.6% were female. In age groups 19–40, 41–65, 66–75, 76–87 years, uncontrolled BP at the first clinic visit was present in 51.5%, 42.5%, 37.5% and 36.6% of males, respectively, and in 40.0%, 38.0%, 36.0% and 39.6% of females, respectively. Based on vital signs at the first vs. last clinic visit, the proportion of patients with uncontrolled BP in age groups 19–40, 41–65, 66–75 years declined by 19.4%, 13.5%, 10.1% and 8.7% in males, respectively, and 14.4%, 12.5%, 9.3%, and 8.4%, among females, respectively. Therapeutic inertia ranged from 66.5% and 75.9% of clinic visits among males and females age 19–40 years, to 85.6% and 84.9% of clinic visits among males and females age 76–87 years, respectively. The proportion of clinic visits with therapeutic inertia was lower among males vs. females across all age groups until age 76–87 years. Conclusion: A quality improvement program improves BP control but declines in uncontrolled BP are larger and therapeutic inertia is lower for younger vs. older age groups and for males vs. females. More interventions are needed to reduce sex and age disparities in hypertension management.

PurposeThis study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension.MethodsThis cross-sectional study used data of 5163 adults with hypertension obtained from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as 9 hours. BP control was defined as average systolic BP 9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control.ConclusionSleep duration of

Vernando Yanry Lameky,1 Oci Tasijawa2 1Department of Nursing, Universitas Kristen Indonesia Maluku, Ambon, Maluku, Indonesia; 2Book Publisher, Ghema Berkat Abadi, Ambon, Maluku, IndonesiaCorrespondence: Vernando Yanry Lameky, Department of Nursing, Universitas Kristen Indonesia Maluku, Jl. Ot pattimaipauw, Ambon, Maluku, Indonesia, Email vernandoyanrylameky@gmail.com

Abstract Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician’s advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician’s advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician’s advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

BackgroundHypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population.ObjectiveWe sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications.MethodsWe performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as

Everlyne G Ogugu,1 Sheryl L Catz,1 Janice F Bell,1 Christiana Drake,2 Julie T Bidwell,1 James E Gangwisch3 1Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA; 2Department of Statistics, University of California Davis, Davis, CA, USA; 3Department of Psychiatry, Columbia University, New York City, NY, USACorrespondence: Everlyne G Ogugu, Betty Irene Moore School of Nursing, University of California Davis 2570 48th Street Sacramento, Sacramento, CA, 95817, USA, Email egogugu@ucdavis.eduPurpose: This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension.Methods: This cross-sectional study used data of 5163 adults with hypertension obtained from the 2015– 2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as < 6, 6 - < 7, 7– 9, and > 9 hours. BP control was defined as average systolic BP < 130mmHg and diastolic BP < 80mmHg.Results: Results from the fully adjusted models show that among all adults with hypertension, habitual sleep duration of < 6 hours night/main sleep period was associated with reduced odds of BP control (OR = 0.53, 95% CI: 0ss.37– 0.76, P = 0.001) when compared to 7– 9 hours. In the subpopulation of adults who were on antihypertensive medication, those with a sleep duration of < 6 hours had lower odds of BP control than those with a sleep duration of 7– 9 hours (OR = 0.53, 95% CI: 0.36– 0.77, P = 0.002). No significant differences were noted in all adults with hypertension and in the subpopulation of those on antihypertensive medication in BP control between the reference sleep duration group (7– 9 hours) and the 6 - < 7 or > 9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control.Conclusion: Sleep duration of < 6 hours is associated with reduced odds of hypertension control. These significant findings indicate that interventions to support adequate habitual sleep duration may be a promising addition to the current hypertension management guidelines.Keywords: hypertension, blood pressure control, hypertension control, sleep, sleep duration

Abstract Background Evidence-based task-strengthening strategies for hypertension (HTN) control (TASSH) are not readily available for patients living with HIV in sub-Saharan Africa where the dual burden of HTN and HIV remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of practice facilitation versus a self-directed control (i.e., receipt of TASSH with no practice facilitation) in reducing blood pressure and increasing the adoption of task-strengthening strategies for HTN control within HIV clinics in Nigeria. Prior to implementing the trial, we conducted formative research to identify factors that may influence the integration of TASSH within HIV clinics in Nigeria. Methods This mixed-methods study was conducted with purposively selected healthcare providers at 29 HIV clinics, followed by a 1-day stakeholder meeting with 19 representatives of HIV clinics. We collected quantitative practice assessment data using two instruments: (a) an adapted Service Availability and Readiness Assessment (SARA) tool to assess the capacity of the clinic to manage NCDs and (b) Implementation Climate Scale to assess the degree to which there is a strategic organizational climate supportive of the evidence-based practice implementation. The quantitative data were analyzed using descriptive statistics and measures of scale reliability. We also used the Consolidated Framework for Implementation Research (CFIR), to thematically analyze qualitative data generated and relevant to the aims of this study. Results Across the 29 clinics surveyed, the focus on TASSH (mean=1.77 (SD=0.59)) and educational support (mean=1.32 (SD=0.68)) subscales demonstrated the highest mean score, with good–excellent internal consistency reliability (Cronbach’s alphas ranging from 0.84 to 0.96). Within the five CFIR domains explored, the major facilitators of the intervention included relative advantage of TASSH compared to current practice, compatibility with clinic organizational structures, support of patients’ needs, and intervention alignment with national guidelines. Barriers included the perceived complexity of TASSH, weak referral network and patient tracking mechanism within the clinics, and limited resources and diagnostic equipment for HTN. Conclusion Optimizing healthcare workers’ implementation of evidence-based TASSH within HIV clinics requires attention to both the implementation climate and contextual factors likely to influence adoption and long-term sustainability. These findings have implications for the development of effective practice facilitation strategies to further improve the delivery and integration of TASSH within HIV clinics in Nigeria. Trial registration ClinicalTrials.gov , NCT04704336

Background: Social determinants of health (SDOH) are associated with cardiovascular disease, but little is known about mechanisms underlying those relationships. We hypothesized that SDOH would be associated with uncontrolled hypertension (HTN) in adults with Medicaid. Methods: This was a retrospective analysis of adults in a Medicaid accountable care organization who had HTN diagnoses, received regular care at community health centers, and enrolled in a cohort study between December 2019 and December 2020. Baseline surveys collected demographics and SDOH, including food insecurity, unstable housing, cost-related medication underuse, and financial stress. Blood pressure (BP) measurements over 12 months after survey completion were obtained from the electronic health record. Participants were categorized as: uncontrolled HTN (mean systolic BP ≥ 140 mm Hg and/or mean diastolic BP ≥ 90 mm Hg), controlled HTN, or unknown HTN control (no BP documented). We examined the association of individual and cumulative (count, 0-4) SDOH with uncontrolled HTN and unknown HTN control using multivariable logistic regression adjusting for demographics, smoking, diabetes, and HTN medication. Results: Participants (n = 245) were mean (SD) age 51.3 (8.6) years, 66.1% female, 43.7% Hispanic, 34.3% White, and 18.0% Black. Overall, 58.0% had food insecurity, 38.0% had unstable housing, 29.4% had financial stress, and 20.0% reported cost-related medication underuse. BP was documented for 180 participants; 44 (24.4%) had uncontrolled HTN. In multivariable models, neither individual nor cumulative SDOH were associated with uncontrolled HTN or unknown HTN control. Conclusions: In a Medicaid-insured population receiving care at community health centers, adverse SDOH were prevalent but were not associated with HTN control. [ABSTRACT FROM AUTHOR]

Introduction: high blood pressure is a health problem in the Mexican population, there are social determinants that condition its development, so it is important that the doctor controls high blood pressure based on an adequate assessment, examination and clinical history; as well as proper use and management of clinical practice guidelines. Objective: to know in greater detail the characteristics of health professionals who could influence the control of hypertension. Material and methods: a descriptive study was carried out, the study population was the doctors of a health center in Mexico City, a 26-item questionnaire with closed and open questions was applied, through an in-depth interview directly. divided into 4 sections: i) identification and demographic factors; ii) academic training; iii) information sources and iv) prescription criteria. Results: with regard to hypertension, the age of the doctors appears to be a determining factor in its control: the degree of control can vary up to almost three times more depending on the age of these doctors, the influence of the number of patients seen would be less. However, deficiencies associated with age, such as lack of updating, could be compensated with specific training interventions by health administrations; alternatively, or complementary, clinical sessions and case discussion among colleagues could play a crucial role in this regard. Conclusions: the age of the doctors appears as a determinant in the control of arterial hypertension. [ABSTRACT FROM AUTHOR]

Family is the main support system in caring for its members, including the elderly with hypertension. Treatment of the disease in old people is through help from a spouse, child, or close relatives because they often live with their families. Therefore, this study aims to determine the form of family support in controlling hypertension among the elderly, including physiological, psychological, socio-cultural, and spiritual supports. The qualitative method was used with a descriptive phenomenological approach. The respondents consist of eight family members who cared for the elderly with uncomplicated hypertension during the past year. The themes found include responding to hypertension with traditional ingredients, the existence of quality time with the elderly, being free to select the activities they like, and prioritizing themselves to worship a lot. Based on the results, efforts are needed from community nurses to provide health promotion education on the importance of family support in controlling hypertension amond people. [ABSTRACT FROM AUTHOR]

BackgroundHypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients’ pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them.MethodsMEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsFrom 2584 identified records, 30 were included in the narrative synthesis. At entry, ‘health systems resources and processes’ and ‘knowledge and beliefs about hypertension’ dominated while ‘social relations and traditions’ and ‘comorbidities’ assume greater importance subsequently, with patients making ‘trade-offs’ with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters.ConclusionUnderstanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.

Abstract Background The role of socioeconomic status (SES) on hypertension prevalence and hypertension control has gotten much attention but with conflicting results. This paper aimed to quantify the association of SES with both hypertension prevalence and hypertension control rate in Nanjing, China. Methods A community-based cross-sectional study was conducted using multistage random sampling on 60,283 adults aged more than 18 years between March 2017 and June 2018. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or self-reported diagnosis of hypertension or respondent's report of taking antihypertensive medications. The controlled hypertension was defined by systolic BP

Purpose: Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper.Methods: We video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings.Results: Home BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing.Conclusions: Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits. [ABSTRACT FROM AUTHOR]

We investigated the control rate of hypertension across months of year and hours of day in a real-world database. The study participants were hypertensive patients from 142 community health centers across 16 districts in Shanghai, China, who measured their blood pressure with an automatic office blood pressure measurement platform between 2018 and 2023. The 343,400 hypertensive patients included 53.7% of women, and had average age of 70.2 (±8.1) years (range 50-90 years). For months of year, the control rate of hypertension was lowest in February and highest in August (51.9% vs 71.8%). For hours of day, the control rate of hypertension was lowest at 7:00 AM and highest at 12:00 PM (52.1% vs 76.0%). When the months of year and hour of day were considered together, the control rate was lowest at 7 AM in February (42.1%), and highest at 12 PM in July (86.8%). In 8516 patients who had uncontrolled blood pressure in the early morning and had their blood pressure also measured around noon, 45.7% had masked uncontrolled morning hypertension, with higher rates in spring and summer, and in women, those aged 50-69 years, and non-diabetic patients. The control rate of hypertension varies greatly across months of year and hours of day, suggesting that the evaluation of blood pressure control has to take into full consideration the measurement time in terms of months and hours., (© 2024. The Author(s).)

Hypertension in Mexico has a prevalence of 32% and is the second most widespread cause of consultation in primary care. Only 40% of patients in treatment have a blood pressure (BP) below 140/90 mmHg. This clinical trial aimed to compare the effectiveness of the combination of enalapril and nifedipine versus the empirical treatment for hypertension in patients with uncontrolled BP in a primary care center in Mexico City. Participants were randomized to treatment with enalapril and nifedipine (combination group) or to continue with the empirical treatment. Outcome variables were BP control, therapeutic adherence, and adverse effects at 6 months of follow-up. At the end of the follow-up period, BP control (64% versus 77%) and therapeutic adherence (53% versus 93%) showed an improvement from the baseline values in the group that received the combination treatment. BP control (51% versus 47%) and therapeutic adherence (64% versus 59%) in the group who received the empirical treatment did not show improvement from the baseline to follow-up. Combined treatment was 31% more efficacious than conventional empirical treatment (odds ratio = 3.9), which yielded an incremental clinical utility of 18% with high tolerability extent among patients in primary care in Mexico City. These results contribute to the control of arterial hypertension.

Abstract Among ethnic minority groups in Europe, blood pressure (BP) control is often suboptimal. We aimed to identify determinants of suboptimal BP control in a multi‐ethnic population. We analyzed cross‐sectional data of the Healthy Life in an Urban Setting (HELIUS) study, including 3571 participants aged 18‐70 with prescribed antihypertensive medication, of various ethnic backgrounds (500 Dutch, 1052 African Surinamese, 656 South‐Asian Surinamese, 637 Ghanaian, 433 Turkish, and 293 Moroccan) living in Amsterdam, the Netherlands. 53.3% of the population had suboptimal BP control, defined as BP ≥140/90 mmHg despite prescribed antihypertensives. Using multivariate logistic regression analysis, female sex (OR 0.50, 95%CI 0.43‐0.59), being married (0.83, 0.72‐0.96), smoking (0.78, 0.65‐0.94), alcohol intake (0.80, 0.66‐0.96), obesity (1.67, 1.35‐2.06), cardiovascular disease (CVD) history (0.56, 0.46‐0.68), non‐adherence to antihypertensives (1.26, 1.00‐1.58), and family history of hypertension (1.19, 1.02‐1.38) were identified to be independently associated with suboptimal BP control in the total population. In the ethnic‐stratified analysis, factors associated with better BP control were female sex (all ethnic groups), smoking (Turks), and CVD history (Dutch, South‐Asian Surinamese, and African Surinamese), whereas factors associated with suboptimal BP control were older age (Turks), obesity (Dutch, African Surinamese, Ghanaian, and Turks), and non‐adherence to antihypertensives (Dutch). In conclusion, our analysis identifies several key determinants that are independently associated with suboptimal BP control in a multi‐ethnic population, with some important variations between ethnic groups. Targeting these determinants may help to improve BP control.

Abstract The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p

Background: The role of socioeconomic status (SES) on hypertension prevalence and hypertension control has gotten much attention but with conflicting results. This paper aimed to quantify the association of SES with both hypertension prevalence and hypertension control rate in Nanjing, China.Methods: A community-based cross-sectional study was conducted using multistage random sampling on 60,283 adults aged more than 18 years between March 2017 and June 2018. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or self-reported diagnosis of hypertension or respondent's report of taking antihypertensive medications. The controlled hypertension was defined by systolic BP < 140 mmHg and diastolic BP of < 90 mmHg among the subjects that self-reported exhibiting hypertensive and taking antihypertensive medications. The associations between SES with hypertension prevalence and hypertension control were quantified using generalized mixed model regression analysis and reported as odds ratios (ORs) and 95% confidence interval (CI).Results: There was a high prevalence of subjects with primary educational level (49.6%) or unemployed and retired (49.5%) or lower annual household income level (44.9%) in each SES group, respectively. After adjustments for potential confounding factors, there were higher odds of hypertension among those with primary educational level (OR = 1.56), but lower odds for controlled BP (OR = 0.51). Higher odds of hypertension could be found among unemployed and retired, and higher odds of controlled BP was observed in the mental laborers or students (OR = 1.30), compared with the other categories, respectively. The lower-income group was more likely to be hypertensive (OR = 1.35) and less likely to have controlled hypertension (OR = 0.73).Conclusion: Socioeconomic status played an important role in hypertension prevalence and hypertension control among adults in Nanjing, China. Strategies for hypertension prevention and control should especially focus on people in the vulnerable lower SES groups. [ABSTRACT FROM AUTHOR]

Background: Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients' pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them. Methods: MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: From 2584 identified records, 30 were included in the narrative synthesis. At entry, 'health systems resources and processes' and 'knowledge and beliefs about hypertension' dominated while 'social relations and traditions' and 'comorbidities' assume greater importance subsequently, with patients making 'trade-offs' with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters. Conclusion: Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem. [ABSTRACT FROM AUTHOR]

Background To examine the associations between urbanization and hypertension, stage II hypertension, and hypertension control. Methods Data on 16,360 US adults aged 18 years or older from the 2013–2018 National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg or use of medication for hypertension), stage II hypertension (BP ≥140/90 mm Hg), and hypertension control (BP <130/80 mm Hg among hypertensives) by urbanization, classified by levels of metropolitan statistical areas as large MSAs (population ≥1,000,000), medium to small MSAs (population 50,000–999,999), and non-MSAs (population <50,000). Results All prevalence ratios (PRs) were compared with large MSAs and adjusted for demographics and risk factors. The PRs of hypertension were 1.07 (95% confidence interval (CI) = 0.99–1.14) for adults residing in medium to small MSAs and 1.06 (95% CI = 0.99–1.13) for adults residing in non-MSAs. For stage II hypertension, the PRs were higher for adults residing in medium to small MSAs 1.21 (95% CI = 1.06–1.36) but not for adults residing in non-MSAs 1.06 (95% CI = 0.88–1.29). For hypertension control, the PRs were 0.96 (95% CI = 0.91–1.01) for adults residing in medium to small MSAs and 1.00 (95% CI = 0.93–1.06) for adults residing in non-MSAs. Conclusions Among US adults, urbanization was associated with stage II hypertension. [ABSTRACT FROM AUTHOR]

Abstract Background Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. Methods Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. Discussion Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. Trial registration ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018. Protocol version and date Version 1, date: 21 August, 2019.

Background The control of hypertension is low in low‐ and middle‐income countries like India. We evaluated the effects of a nurse‐facilitated educational intervention in improving the control rate of hypertension among school teachers in India. Methods and Results This was a cluster‐randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse‐facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed‐effects logistic regression models. Two months after a 3‐month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06–3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08–2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, −7.2 to −1.1) than in the usual care group. Conclusions A nurse‐facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension. Registration URL: https://www.ctri.nic.in; Unique Identifier: CTRI/2018/01/011402.

Objective: Determine sex differences in hypertension control by age group in a diverse cohort of adults age 45–84 years at baseline followed for an average of 12 years. Methods: The Multi-Ethnic Study of Atherosclerosis enrolled 3213 men and 3601 women from six communities in the U.S. during years 2000–2002 with follow-up exams completed approximately every two years. At each exam, resting blood pressure (BP) was measured in triplicate, and the last two values were averaged. Hypertension was defined as a BP ≥ 140/90 mmHg and/or use of antihypertensive medications. Hypertension control was defined as a BP < 140/90 mmHg and in separate analyses as < 130/90 mmHg. Generalized linear mixed effects models with a binomial function were used to calculate the odds of hypertension control by age group (45–64,75–74, 75+) at a given exam and by sex, while accounting for the intra-individual correlation, and adjustment for demographics, co-morbidities, smoking, alcohol use, education and site among participants with hypertension at any of the first five exams. Results: At baseline, mean age was 64.1 (9.1 [SD]) years, 48.0% were men, and race/ethnicity was Non-Hispanic white in 34.1%, 10.1% Chinese, 35.1% Non-Hispanic Black and 20.7% Hispanic. Average SBP was lower while average DBP was higher among men vs. women at each exam. Adjusted odds ratios of hypertension control defined as BP < 140/90 mmHg among men vs. women was 0.89 (95% CI 0.67, 1.19) for age 45–64 years, 1.37 (95% CI 1.04, 1.81) for age 65–74 years and 2.08 (95% CI 1.43, 3.02) for age 75+ years. When defined as < 130/80 mmHg, adjusted odds of hypertension control among men vs. women was 0.60 (OR 0.60; 95% CI 0.46, 0.79) at age 45–64 years, 1.01 (OR 1.01; 95% CI 0.77, 1.31) at age 65–74 years and 1.71 (95% CI 1.19, 2.45) at age 75+ years. Conclusion: Sex disparities in hypertension control increase with advancing age and are greatest among adults age 75+ years.

Background: Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population. Objective: We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications. Methods: We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as

Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].

Aim: To examine the changes in prevalence, awareness, treatment and control of hypertension between 1998 and 2016 in ≥15-year-old South African men and women and the sociodemographic characteristics associated with those changes. Methods: In nationally representative surveys in 1998 and 2016, multi-stage sampling was used to select, interview and collect blood pressure and anthropometric measurements in ≥15-year-old adults. Logistic regression analyses evaluated the independent effects of selected sociodemographic characteristics on hypertension management. Results: Among 13,217 participants in 1998 and 7830 in 2016 (59–60% women in both surveys), hypertension prevalence increased from 27% to 45% in men and 31% to 48% in women. Hypertension increased equally in participants with and without obesity and in daily cigarette smokers vs. their counterparts. Prevalence of awareness among participants with hypertension increased from 7% to 18% (men) and from 17% to 29% (women). Among those aware, hypertension treatment improved markedly from 8% to 85% (men) and from 12% to 82% (women). Hypertension control among those on treatment increased from 17% to 26% (men) and from 21% to 30% (women). Increasing age and survey year were consistently associated with higher prevalence, awareness, treatment and control of hypertension. The richest vs. poorer women, and lower vs. higher educated women were more likely to be treated for hypertension. Conclusions: The high and rising hypertension burden together with suboptimal awareness and control levels warrant greater attention to curb hypertension-related morbidity and mortality in South Africans. Novel strategies involving community-based or workplace hypertension programmes may overcome some barriers to optimal care.

Introduction: Hypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients., Methods: Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network., Results: The group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p  <0.05; OR = 1.33; p  < .05, respectively) compared to those whose social position throughout life varied the most. No statistical differences were found in the relations between single lifetime social position variables, and hypertension control in the three time points analyzed., Discussion: These findings warrant further research to deeper our understanding on the role of a multidimensional and cumulative approach of social position in hypertension control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Barradas, Lucumi, Mentz and Agudelo.)

Introduction: Achieving hypertension control is beneficial regardless of age. Fixed-combination pills have the potential of increasing adherence to treatment, improving the benefit/risk ratio, and simplifying therapy, with resulting convenience especially in the elderly. Aim: We examined real-world antihypertensive treatment adherence and hypertension control rates in a cohort of Italian elderly individuals, enrolled in a prospective, pragmatic awareness-raising campaign on blood pressure (BP). Methods: 13196 treated hypertensive elderly (mean age 73.2±7.5 years, 55.5% women) were recruited through opportunistic sampling, answered a brief questionnaire on antihypertensive therapy, and were followed-up for 6 months, when BP was measured as per routine care. Controlled hypertension was defined as BP < 140/90 mmHg. Real-world treatment adherence and hypertension control rates were evaluated at 6 months according to different treatment patterns (fixed-dose versus free combinations), using Yates correction for continuity to assess likelihood estimates for differences between treatments. Results: 10551 participants (80%) were on a single-pill therapy and 3445 were on a fixed combination therapy of two (24.8%) or three (1.3%) drugs. Individuals on a fixed combination therapy were more adherent to treatment than the counterparts (p < 0.001). Full adherence increased with the number of drugs/pill among single-pill users (47.5%, 68.5%, and 100% with 1, 2, or 3 drugs/pill; p < 0.001). Hypertension control rates were 70% and 65.2% (p = 0.001) according to fixed or free combinations of two drugs and 71% and 63.9% (p = 0.321) for fixed or free combinations of three drugs. Conclusions: Real-world data suggest that simplified treatment strategies and use of fixed combinations improve adherence to antihypertensive therapy and BP control in the elderly. [ABSTRACT FROM AUTHOR]

Background Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment, and control among community residents of rural areas of Peravia in Dominican Republic (DR), followed by an assessment of CI in their primary care clinics (PCCs). Methods We interviewed 827 adults from 8 rural communities of Peravia. Demographics, medical history, health care information, and blood pressure (BP) were obtained. We reviewed the community PCC visits of patients with known hypertension or a BP ≥140/90, abstracting medical history and the physician's action toward uncontrolled BP. Results Of those interviewed, 57% (95% CI: 53%–60%) had hypertension, with 63% (95% CI: 59%–68%) of those aware of their diagnosis. Among individuals with hypertension, 60% (95% CI: 56%–65%) were receiving pharmacological treatment, and only 35% (95% CI: 31%–40%) were controlled. Characteristics associated with awareness were female sex, age >55 years, diabetes, private insurance, and having at least 1 health care visit within the past year. Of the 507 PCC patients reviewed, 340 (67%) had uncontrolled BP. Of these, 220 had no clinical action to address the uncontrolled BP, corresponding to a CI rate of 65%. Conclusions Among rural communities in the DR, undiagnosed hypertension remains common, especially in individuals who are younger, uninsured, or with limited access to health care. For those seen in PCCs, therapeutic intensification to achieve controlled BP is infrequently done. Strategies to address population awareness and CI are needed to improve hypertension control. [ABSTRACT FROM AUTHOR]

Objectives: To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow‐up, treatment and control gaps in low‐income urban Medellin, Colombia. Methods: We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap‐associated factors. Results: Hypertension prevalence was 43.5% (95% CI 41.2–45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9–38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6–17.6) of aware hypertensive patients presented a follow‐up gap, 93.4% (95% CI 90.9–95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7–43.3) were not compliant. The latter was strongly associated with follow‐up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9–43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non‐pharmacological advice. Overall, 60.4% (95% CI 57.0–63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension. Conclusions: We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control. [ABSTRACT FROM AUTHOR]

Among ethnic minority groups in Europe, blood pressure (BP) control is often suboptimal. We aimed to identify determinants of suboptimal BP control in a multi‐ethnic population. We analyzed cross‐sectional data of the Healthy Life in an Urban Setting (HELIUS) study, including 3571 participants aged 18‐70 with prescribed antihypertensive medication, of various ethnic backgrounds (500 Dutch, 1052 African Surinamese, 656 South‐Asian Surinamese, 637 Ghanaian, 433 Turkish, and 293 Moroccan) living in Amsterdam, the Netherlands. 53.3% of the population had suboptimal BP control, defined as BP ≥140/90 mmHg despite prescribed antihypertensives. Using multivariate logistic regression analysis, female sex (OR 0.50, 95%CI 0.43‐0.59), being married (0.83, 0.72‐0.96), smoking (0.78, 0.65‐0.94), alcohol intake (0.80, 0.66‐0.96), obesity (1.67, 1.35‐2.06), cardiovascular disease (CVD) history (0.56, 0.46‐0.68), non‐adherence to antihypertensives (1.26, 1.00‐1.58), and family history of hypertension (1.19, 1.02‐1.38) were identified to be independently associated with suboptimal BP control in the total population. In the ethnic‐stratified analysis, factors associated with better BP control were female sex (all ethnic groups), smoking (Turks), and CVD history (Dutch, South‐Asian Surinamese, and African Surinamese), whereas factors associated with suboptimal BP control were older age (Turks), obesity (Dutch, African Surinamese, Ghanaian, and Turks), and non‐adherence to antihypertensives (Dutch). In conclusion, our analysis identifies several key determinants that are independently associated with suboptimal BP control in a multi‐ethnic population, with some important variations between ethnic groups. Targeting these determinants may help to improve BP control. [ABSTRACT FROM AUTHOR]

The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p <.001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care. [ABSTRACT FROM AUTHOR]

This study aimed to know the profile of the hypertensive population, using drug therapy, not responsive to antihypertensive treatment. We interviewed 37 people diagnosed with systemic arterial hypertension even when they were treated. Patient data were collected through a questionnaire to assess the profile of people who have high blood pressure, even using antihypertensive. The results showed that the most common causes were sedentary lifestyle (35.1%), alcohol use, smoking and forgetfulness of medication use (29.7%). When analyzing the questionnaire, the participants' low schooling was diagnosed, since 56.7% were literate, 41.5% had elementary education, and 51.3% received less than a minimum wage. In conclusion, this study suggests the main influencing factors for the non-control of systemic arterial pressure, allowing to elaborate better strategies to combat systemic arterial hypertension

Background: Hypertension is a significant global public health problem and an important risk factor for cardiovascular diseases. We aimed to determine treatment and control rates of hypertension and to explore related risk factors by urban and rural areas. Methods: A cross-sectional survey of 14,956 participants (≥ 15 years) was conducted in Jilin Province, China from July 2014 to December 2015 using questionnaire forms and physical measurements. Results: Total rates of hypertension treatment, control, and controlled blood pressure among treated subjects were 31.7%, 8.8%, and 27.9% in the Jilin Province. Rates of hypertension treatment, control, and controlled blood pressure among treated subjects were 35.9%, 13.7%, and 38.3% in urban areas and 28.4%, 5.0%, and 17.5% in rural areas, respectively. Higher treatment of hypertension was associated with older age, female sex, other races (except Han), and higher body fat percentage in both areas. Among urban residents, higher education was additionally associated with higher treatment of hypertension; among rural residents, a family history of coronary artery disease and unemployment were associated with higher treatment of hypertension. Higher control of hypertension was associated with unemployment, married status, higher education, healthy body mass index, lower abdominal waist circumference, non-smoking status, and lower visceral adiposity index in urban residents; higher control of hypertension was associated with younger age in rural residents. Conclusion: Treatment and control rates of hypertension in urban and rural areas were lower than the national average; blood pressure control in patients taking antihypertensive drugs needs further improvement.

Purpose: Since the publication of the 2017 ACC/AHA hypertension guideline, few studies have analyzed the epidemiology and management of hypertension across many heterogeneous subgroups in the US. Materials and Methods: We analyzed the data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. Participants greater than 20 years of age, who had valid blood pressure measurements, were included in the study. A comprehensive analysis of 14 population subgroups was done to systematically examine how hypertension awareness, treatment, and control varied by subpopulations. Results: Our study included 45,557 participants with a mean age of 47.1 years, 48.3% were male and 51.7% were female. 47.8% participants had hypertension, of which 59.9% were aware of their diagnosis. Among the participants who were aware of their hypertension, 90.3% were prescribed medication(s) to lower blood pressure, of which 39.2% had achieved control. Multivariate analysis showed age, gender, Race/ethnicity, annual family income, education level, BMI, waist to height ratio, diabetes, and previous cardiovascular events to be independent risk factors for hypertension. Lower likelihoods of awareness and treatment were associated with male sex, younger age, Mexican ethnicity, participants without health insurance, absence of previous cardiovascular events, diabetes, obesity, or smoking. Overall, hypertension control rate was suboptimal across most of subgroups (

Systemic Arterial Hypertension is a chronic disease that can lead to the appearance of cardiovascular, cerebrovascular and renal alterations, making it a relevant public-health problem. The aim of this study was to evaluate the adherence to the treatment of arterial hypertension by people diagnosed in the municipality of Jales, State of São Paulo. A structured questionnaire was developed about the drug treatment of hypertension, adoption of dietary care and practice of physical activity. Subsequently, an interview was conducted with 120 hypertensive patients registered in the program HIPERDIA. The data were arranged in spreadsheets and analyzed using descriptive statistics. The majority of the respondents (73.3%) were women; 62.5% were married; their average age was 66.5 years; and 70.9% had been suffering from hypertension for more than six years. The main drugs used were Losartan, Hydrochlorothiazide, Atenolol, Enalapril and Propanolol, and 63.4% of the individuals used polytherapy. The results also revealed that 22.5% had stopped taking the medication at some time and 10.8% had already changed the dosage without medical indication. Regarding the non-drug therapy, 51.7% of the interviewees stated they did not have food restrictions and 81.6% did not practice physical activity. Thirty percent (30%) of the respondents associated the disease with some symptom and 18.4% believed hypertension is curable. In conclusion, the patients' knowledge about HAS is satisfactory, although many did not adhere to the treatment. Therefore, the role of health professionals is necessary to raise awareness in the patient about the importance of knowing their pathology, its possible complications, forms of prevention and treatment. [ABSTRACT FROM AUTHOR]