STEP to blood pressure management of elderly hypertension: evidence from Asia

Impact of the National Essential Public Health Service Package on Blood Pressure Control in Chinese People With Hypertension: Retrospective Population-Based Longitudinal Study

Background

The National Essential Public Health Service Package (NEPHSP) was launched in 2009 to tackle poor blood pressure control in Chinese people with hypertension; however, it's effect is still unclear.

Objective

In a retrospective population-based longitudinal study, we aimed to evaluate effect of the NEPHSP on blood pressure control.

Methods

A total of 516,777 patients registered in the NEPHSP were included. The blood pressure control data were assessed based on the Residence Health Record System dataset. We longitudinally evaluated the effects of the NEPHSP on blood pressure control by analyzing changes in blood pressure at quarterly follow-ups. Both the degree and trend of the blood pressure changes were analyzed. We conducted stratified analysis to explore effects of the NEPHSP on blood pressure control among subgroups of participants with specific characteristics.

Results

The mean baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 147.12 (SD 19.88) mm Hg and 85.11 (SD 11.79) mm Hg, respectively. The control rates of baseline SBP and DBP were 39.79% (205,630/516,777) and 69.21% (357,685/516,777). Compared to baseline, the mean SBP decreased in each quarter by 5.06 mm Hg (95% CI -5.11 to -5.00; P<.001), 6.69 mm Hg (95% CI; -6.74 to -6.63; P<.001), 10.30 mm Hg (95% CI -10.34 to -10.23; P<.001), and 6.63 mm Hg (95% CI -6.68 to -6.57; P<.001). The SBP control rates increased in each quarter to 53.12% (274,493/516,777; β coefficient=0.60, 95% CI 0.59-0.61; P<.001), 56.61% (292,537/516,777; β coefficient=0.76, 95% CI 0.75-0.77; P<.001), 63.4% (327,648/516,777; β coefficient=1.08, 95% CI 1.07-1.09; P<.001), and 55.09% (284,711/516,777; β coefficient=0.69, 95% CI 0.68-0.70; P<.001). Compared to baseline, the mean DBP decreased in each quarter by 1.75 mm Hg (95% CI -1.79 to -1.72; P<.001), 2.64 mm Hg (95% CI -2.68 to -2.61; P<.001), 4.20 mm Hg (95% CI -4.23 to -4.16; P<.001), and 2.64 mm Hg (95% CI -2.68 to -2.61; P<.001). DBP control rates increased in each quarter to 78.11% (403,641/516,777; β coefficient=0.52, 95% CI 0.51-0.53; P<.001), 80.32% (415,062/516,777; β coefficient=0.67, 95% CI 0.66-0.68; P<.001), 83.17% (429,829/516,777; β coefficient=0.89, 95% CI 0.88-0.90; P<.001), and 79.47% (410,662/516,777; β coefficient=0.61, 95% CI 0.60-0.62; P<.001). The older age group had a larger decrease in their mean SBP (β coefficient=0.87, 95% CI 0.85-0.90; P<.001) and a larger increase in SBP control rates (β coefficient=0.054, 95% CI 0.051-0.058; P<.001). The participants with cardiovascular disease (CVD) had a smaller decrease in their mean SBP (β coefficient=-0.38, 95% CI -0.41 to -0.35; P<.001) and smaller increase in SBP control rates (β coefficient=-0.041, 95% CI -0.045 to -0.037; P<.001) compared to the blood pressure of participants without CVD.

Conclusions

The NEPHSP was effective in improving blood pressure control of Chinese people with hypertension. Blood pressure control of older individuals and those with CVD need to be intensified.

Effectiveness of the intelligent hypertension excellence centers (iHEC) therapy model in the blood pressure management of older hypertensive patients: a randomized controlled trial

Intelligent hypertension excellence centers (iHEC) may improve blood pressure (BP) management in older hypertensive patients. However, this has not yet been rigorously evaluated, so we conducted a prospective randomized open-label clinical trial to verify this hypothesis. Older patients with hypertension were recruited between January and June 2022. The control group received conventional treatment and visited doctors in clinic. The intervention group received the iHEC therapy model, including remote BP management, online consultation, and follow-up services with support from the internet. Both groups received 12 months follow-up. Finally, 540 older patients with hypertension participated in the study; of these, 517 completed the follow-up. The average age was 71.4 ± 3.7years, 81 patients with frailty (15.7%). When follow-up was terminated, the SBP of the intervention group was 4.2 mmHg lower than that of the control group (95% CI, 2.0 to 6.4, P < 0.001), and the overall BP control rate in the intervention group was higher than that in the control group (60.2% vs. 48.1%, P < 0.05). During follow-up, the new-onset rate of excessive BP lowering in the intervention group was lower than that in the control group (3.8% vs. 9.0%, P < 0.05). Patients with a median age or above and high school education or above had higher numbers of online consultations and home BP measurements (P < 0.05).Our study confirmed those who received the iHEC therapy model achieved better BP reduction, higher rates of BP control, and alleviated the risk of excessive BP reduction.

Pilot Study of Intelligent Office Blood Pressure Measurement Model in Shanghai, China, 2022

Introduction

An intelligent office blood pressure measurement (IOBPM) model for community-based hypertension management was piloted in Shanghai, China, to overcome the conventional blood pressure management (CBPM) model's deficiencies.

Methods

We selected adults aged 35-89 years who were being treated and managed for hypertension in two community health centers for the IOBPM and CBPM models. The IOBPM model consisted of two or three consecutive blood pressure (BP) measurements using a pre-programmed and validated automatic device. The BP data for the CBPM model were obtained from the routine follow-up records of hypertensive patients and derived from the Shanghai Non-communicable Diseases Management Information System. Subjects in the IOBPM model were selected by a simple random sampling method, and propensity score matching was used to select a comparable control population from the CBPM model based on important covariables. The BP levels, end-digit preferences, frequency distribution, and BP control were compared between the two models.

Results

We selected 2,909 patients for the IOBPM model and 5,744 for the CBPM model. The systolic BP in the CBPM model was 12.3 mmHg lower than in the IOBPM model. In the CBPM model, there were statistically significant end-digit preferences (P < 0.001), with zero being the most reported end-digit (23.3% for systolic BP and 27.7% for diastolic BP). There was no significant end-digit preference in the IOBPM model. Certain BP values below 140/90 mmHg in the CBPM model were more frequent, while the IOBPM model showed a normal distribution. The BP control in the CBPM model was significantly higher than the IOBPM model (P < 0.001).

Conclusion

The IOBPM model appears to overcome the deficiencies of the CBPM model, leading to more accurate and reliable BP measurements.

Hypertension in frail older adults: current perspectives

Hypertension is one of the most common chronic diseases in older people, and the prevalence is on the rise as the global population ages. Hypertension is closely associated with many adverse health outcomes, including cardiovascular disease, chronic kidney disease and mortality, which poses a substantial threat to global public health. Reasonable blood pressure (BP) management is very important for reducing the occurrence of adverse events. Frailty is an age-related geriatric syndrome, characterized by decreased physiological reserves of multiple organs and systems and increased sensitivity to stressors, which increases the risk of falls, hospitalization, fractures, and mortality in older people. With the aging of the global population and the important impact of frailty on clinical practice, frailty has attracted increasing attention in recent years. In older people, frailty and hypertension often coexist. Frailty has a negative impact on BP management and the prognosis of older hypertensive patients, while hypertension may increase the risk of frailty in older people. However, the causal relationship between frailty and hypertension remains unclear, and there is a paucity of research regarding the efficacious management of hypertension in frail elderly patients. The management of hypertension in frail elderly patients still faces significant challenges. The benefits of treatment, the optimal BP target, and the choice of antihypertensive drugs for older hypertensive patients with frailty remain subjects of ongoing debate. This review provides a brief overview of hypertension in frail older adults, especially for the management of BP in this population, which may help in offering valuable ideas for future research in this field.

Effectiveness of the knowledge, attitude, practice intervention model in the management of hypertension in the elderly

This study illustrated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for community hypertension in the elderly by the community physician-led, describing the study design and baseline data. The aim of the study was to compare the changes in the elderly hypertensive population before and after the KAP intervention model by managing the elderly hypertensive patients for a period of 1 year. Basic information and risk factors affecting blood pressure control based on baseline data of recruited elderly hypertensive patients. The management approach consists of two parts: (1) the unified management of the community physician to whom the patient belongs; and (2) the management of the contracted patient by the community physician. The aim was to demonstrate the anti-hypertensive effectiveness (control rate, blood pressure reduction, and pulse pressure), the distribution of blood pressure types, and the change of the KAP in elderly hypertensive patients before and after the intervention. The KAP intervention model was administered to 2660 elderly hypertensive patients in a 1-year period. The blood pressure control rate improved by 54.03%. Mean values of overall systolic and diastolic blood pressure decreased by 16.00 and 5.31 mmHg, respectively. The proportion of isolated systolic hypertension (ISH) and systolic-diastolic hypertension (SDH) decreased by 29.14% and 24.81%, respectively. The KAP compliance improved significantly. These results suggest that the community physician-led KAP intervention model is effective in the management of hypertension in the elderly.

Association between the geriatric nutritional risk index and the risk of stroke in elderly patients with hypertension: A longitudinal and cohort study

Objective

We aimed to investigate the association between the GNRI and the risk of stroke in elderly patients with hypertension.

Methods

A total of 5312 elderly hypertensive patients free of history of stroke were included. Multivariate Cox models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs) for stroke and its subtypes.

Results

The average time of follow-up was 3.8 years, and the median time was 3.2 years. We identified 640 individuals with stroke, of whom 526 had an ischemic stroke (IS) and 114 had a hemorrhagic stroke (HS). After adjusting for confounding variables, compared with participants in the lowest quartile of the GNRI, those in the third and fourth quartiles were associated with a decreased risk of stroke (adjusted HR 0.72, 95% CI 0.58-0.90, and adjusted HR 0.58, 95% CI 0.46-0.74, respectively, P for trend < 0.001). Similar results were found for IS and HS. Moreover, there were L-shaped associations of GNRI with new-onset HS (P for non-linearity = 0.034). Multiple sensitivity analyses and stratified analyses did not materially change the results.

Conclusions

In summary, we found that a lower GNRI was associated with a higher risk of incident stroke in elderly hypertensive patients. Additional prospective data collection is required to confirm our findings.

Clinical impact of blood pressure on cardiovascular death in patients 80 years and older following acute myocardial infarction: a prospective cohort study

Numerous trials have shown that lowering blood pressure (BP) reduces cardiovascular risk and mortality, yet data about the impact of BP on cardiovascular death risk in patients aged ≥80 years with acute myocardial infarction (AMI) are sparse. This study explored the prognostic value of BP for cardiovascular death during the first 48 h after admission following AMI among patients aged ≥80 years. A total of 1005 patients ≥80 years with AMI were enrolled. Average BP parameters, including systolic, diastolic, and pulse BP, over the first 48 h after admission were calculated. The end point was cardiovascular death. Receiver operating curve (ROC) analysis was used to identify whether BP was relevant to cardiovascular death. The relationship between BP levels and cardiovascular death was evaluated by Cox regression models. ROC analysis showed that average diastolic blood pressure (aDBP), but not systolic and pulse BP, was relevant to cardiovascular death, and the optimal cutoff was 65 mmHg. During the 2.9-year follow-up, patients who died from a cardiovascular cause had lower aDBP levels than those who did not (p = 0.002). Patients with aDBP <65 mmHg had a 1.5-fold higher incidence of cardiovascular death than those with aDBP ≥65 mmHg (35.9% vs. 24.0%; p < 0.001). In multivariable regression analysis, low aDBP remained a strong and independent predictor of cardiovascular death (adjusted hazard ratio 1.907; 95% CI 1.303-2.792). aDBP was independently associated with cardiovascular death in patients aged ≥80 years with AMI, suggesting that aDBP may be a useful index to predict worse outcome in these patients.