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FP-6

DISEQUILIBRIUM BETWEEN AT1R AND B2R ALTERS THE STRUCTURE AND THE INVASIVE CAPACITY OF HUMAN DERIVED TROPHOBLASTS

Alberto Leguina-Ruzzi, Jenny Corthorn, Liliana Garmendia, Eduardo Machuca, Gloria Valdes

Escuela de Medicina Pontificia Universidad Católica, Santiago, Chile.

Preeclampsia (PE) is initiated by a defective extravillous trophoblast (EVT) invasion. The local renin-angiotensin system (RAS) is enhanced in PE; its counter-regulatory kallikrein–kinin system is present in EVTs. In adition, angiotensin II (AII) inhibits EVT invasion via the AT1R, while bradykinin stimulates migration and invasion via the B2R. We postulate that submitting EVTs to AII stimulation and blockade of bradykinin B2R impairs trophoblast invasion. The aim of the present study was to evaluate the effect of a imbalance of the RAS and the kallikrein-kinin systems provoked by AII and B2R blockade by Bradyzide (BDZ) on the migratory phenotype and the invasive capacity of the validated EVT model of HRT8/SVneo cells. Immunoreactivity identified the receptor panel and MTS and Ki67 viability and proliferation. Filopodias were examined by phalloidin and invasion by the Transwell system. AT1, AT2, B1R and B2R were also identified by western blot. Cells were incubated 18 h with AII (10−7 M), BDZ (10−7 M) and losartan (5 × 10−5 M). Experiments were performed in duplicate ×3. Results are expressed as mean±SE; statistical analysis by one-way ANOVA and post-hoc tests. HTR-8/SVneo cells expressed LMWK, AT1, AT2, B1R and B2R. AII, AII+BDZ and losartan induced marked changes in filopodias (Figure 1). AII and AII+BDZ reduced the filopodias as compared to control (5.1±0.03 to 2.0±0.3 and 1.8±0.4 respectively; P<0.001). The invasion index decreased by BDZ and AII+BDZ from 1.0±0.0 to 0.6±0.1 and 0.3±0.5; P<0.05 and 0.001 respectively. Losartan reverted the effect of AII on the invasion index (0.7±0.0; P<0.001). This study demonstrates that disequilibrating AII/bradykinin alters the invasive capacity of HTR-8/SVneo cells. The reversal of the AII decreased invasion by losartan points to an AT1R effect. Further work is needed to validate these findings in EVT primary cultures and in animal models.

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Keywords:  Preeclampsia; Trophoblast Invasion; Angiotensin II; Bradykinin.

Late-Breaking Posters

LB-PO-01

ASSOCIATION BETWEEN SYMPATHETIC MODULATION, BLOOD PRESSURE AND CARDIAC HYPERTROPHY IN ANABOLIC STEROIDS USERS

R. S. Côrtes,1 L. F. Oliveira,1 F. L. Orsatti,1 G. R. Mota,1 M. Marocolo-Júnior,1 L. A. P. R. Resende,1 M. A. Vieira-Silva,1 E. A. M. R. Resende,2 V. J. Dias Da Silva,1O. Barbosa-Neto1

1 Institute of Natural and Biological Sciences, Federal University of Triângulo, Mineiro, Brazil and 2Institute of Health Sciences – Federal University of Triângulo, Mineiro, Brazil.

Forty-five male with 29.8±0.5 year participated of this study: sedentary (n=15), anabolic steroids (AS) users (n=15) and nonusers (n=15). AS was determined by hormonal test. Heart rate variability (HRV), blood pressure (BP), electrocardiography and echocardiography analysis at rest were performed. The serum testosterone and estradiol levels were higher in AS users than in others groups. AS users presented a drastic reduction of luteinizing and follicle-stimulating hormone compared to nonusers and sedentary control. The mean BP was significantly higher in AS users (107.1±2.8 mm Hg) than nonusers (95.7±3.3 mm Hg; P<0.05) and sedentary subjects (91.2±2.1 mm Hg; P<0.001). The LF component of HRV (indicative of sympathetic modulation) were significantly higher in AS users (1711.0±133.6 ms2) in comparison of nonusers (711.7±66.7 ms2, P<0.001) and sedentary (802.7±95.0 ms2, P<0.001). In contrast, the HF band (indicative of parasympathetic modulation) was lower in AS users (647.7±266.6 ms2) than sedentary men (1265.7±248.8 ms2, P<0.001). In the AS users, the left ventricle (LV) posterior wall thickness (11.5±0.3 mm), the interventricular septal thickness (12.3±0.4 mm) and the relative diastolic wall thickness of LV (0.46±0.0%) were significantly higher compared to AS nonusers (8.7±0.2; 8.6±0.2 mm and 0.34±0.0%, P<0.05) and sedentary subject (7.7±0.2; 8.0±0.2 mm and 0.32±0.0%, P<0.05), respectively. Further analysis showed a significant correlation between LF oscillations of HRV and mean BP (r=0.46, P<0.002). In addition, a significant correlation occur between LF component of HRV and relative diastolic wall thickness (r=0.54, P<0.001). AS increases sympathetic modulation in young athletes. The increase in BP in AS users is associated with augmented sympathetic outflow, as well as the increased sympathetic modulation is associated with concentric cardiac hypertrophy. AS users had an autonomic dysfunction, which may constitute an important mechanism linking AS abuse to increase of cardiovascular risk, with more susceptible to the incident of sudden death.

Keywords:  Anabolic Steroids; Blood Pressure; Sympathetic Modulation; Heart Rate Variability

LB-PO-02

ENDOTHELIAL-DEPENDENT MICROVASCULAR DYSFUNCTION IN HYPERTENSIVE TYPE II DIABETIC PATIENTS WITHOUT SIGNIFICANT CORONARY ARTERY STENOSIS: EFFECTS ON MYOCARDIAL PERFUSION

Caterina Marciano, Maurizio Galderisi, Carmen D’ Amore, Paola Gargiulo, Laura Casaretti, Pasquale Perrone Filardi

AOU Federico II, Naples, Italy.

To assess coronary microvascular function and myocardial perfusion in hypertensive type 2 diabetic (DM 2) patients without Coronary Artery Disease (CAD).

Twenty hypertensive type 2 diabetic patients (10 men; age 62.5±10.7 year) underwent coronary angiography, single photon emission computed tomography (SPECT), transthoracic echocardiographic Coronary Flow Reserve (CFR) and Cold Pressor Test (CPT) within 1 week, and were compared to 19 age-matched hypertensive non-diabetic patients (10 men; age 59.2±9.8 year) who underwent coronary angiography, CFR and CPT. CFR reflects primarily endothelium-independent vasodilation, while CPT reflects endothelium-dependent vasodilation. All patients had no angiographically significant CAD.

CPT was significantly lower in hypertensive patients with DM 2 compared to hypertensive patients without DM 2 (1.42±0.22 vs 1.71±0.36; P=0.005); CFR was not significantly different in diabetic patients and non diabetics (2.46±0.76 vs 2.79±0.56; P=0.13). However, at SPECT only five hypertensive diabetic patients (3 of them with impaired FR) showed mild inducible ischemia (summed difference score >3 and <7), whereas normal perfusion at rest and pharmacological stress was observed in the remaining 15 hypertensive patients.

Additionally, there was a significant Pearson's correlation test between CPT and fasting glycemia in the same day (r=−0.345; P=0.03).

Hypertensive type 2 diabetic patients without CAD show significantly impaired endothelial function compared to hypertensive non diabetic patients without CAD, which correlates to fasting glycemia whereas no correlation was found between glycosylated hemoglobin and either CPT or CFR. However, myocardial perfusion is normal in the majority of them (15/20). These data should foster follow-up studies to evaluate the prognostic impact of impaired CFR and CPT in these patients.

Keywords:  Microvascular Function; Coronary Artery Disease; Type 2 Diabetes Mellitus; Myocardial Perfusion

LB-PO-03

REFRACTORY HYPERTENSION CHARACTERIZED BY INCREASED HEART RATE, CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS CONSISTENT WITH HEIGHTENED SYMPATHETIC TONE

Tanja Dudenbostel, Maria C. Acelajado, Eric Judd, Suzanne Oparil, David A. Calhoun

University of Alabama, Birmingham, AL.

Introduction:  Within the population of patients with resistant hypertension (RHTN), a subset has been identified who remain hypertensive despite maximal medical therapy, who we refer to as having refractory hypertension (RefHTN). RefHTN represents a unique phenotype with unexplained mechanisms of treatment failure. In a prior analysis, we excluded secondary causes of hypertension as mechanisms of RefHTN. The current study prospectively compared ambulatory blood pressure monitoring (ABPM) and vascular function in RefHTN subjects and controlled resistant hypertensive subjects.

Methods:  From 2009 to present, refractory subjects were identified in a referral hypertension clinic using the following criteria: uncontrolled blood pressure (BP) on 5 or more antihypertensive medications (including chlorthalidone and spironolactone) after ≥3 visits within a minimum 6-month follow-up period. All subjects underwent measurement of 24-h BP, heart rate (HR); pulse wave analysis (PWA); augmentation index (AIx75); aortic pulse pressure (APP); pulse wave velocity (PWV); arterial flow-mediated dilation (FMD) and echocardiography.

Results:  Baseline characteristics were similar between both groups; although, refractory patients tended to be younger (48 vs. 55 years). ABPM confirmed a significant difference in systolic (141±17.8 vs. 171±21.6 mm Hg, P<0.001) and diastolic BP (72.1±9 vs. 95±13.8 mm Hg, P<0.001) in the controlled vs. refractory groups. Average 24-h HR was higher in subjects with RefHTN (77.8±7.6 vs. 69±7.4, P=0.039) despite being on more β-blockers. PWV was greater (9.5±1.9 vs. 11.7±2.6 m/s, P=0.03), as was AIx75 (17.8±12.1 vs. 27.5±10.5, AP 11.3±10.7 vs. 18.3±13.5 mm Hg (P=0.041), and APP (40.7±15.7 vs. 61±27.9, P<0.001). Brachial artery FMD was reduced in patients with RefHTN (6.6% vs. 9.4%). Echocardiography showed left ventricular hypertrophy in both groups.

Conclusion:  Subjects with RefHTN have increased arterial stiffness, central blood pressure, left ventricular hypertrophy and decreased FMD compared to subjects with controlled RHTN. The higher HR and increased arterial stiffness are consistent with higher sympathetic activity suggesting that increased adrenergic output contributes importantly to antihypertensive treatment failure.

Keywords:  Vascular Resistance; Difficult-to-Control Hypertension; Sympathetic Activity; Endothelial Dysfunction

LB-PO-04

IMPACT OF MEASUREMENT SITE, AGE, AND BLOOD PRESSURE ON VARIATION IN PULSE WAVE VELOCITY

Kunal Gawri, Sheikh M. Faheem, Siva Yedlapati, Peter M. Osmond, Joseph L. Izzo

SUNY-Buffalo School of Medicine, Buffalo, NY.

Background:  Pulse wave velocity (PWV) is a lumped parameter representing arterial stiffness that is dependent on arterial size and wall properties and is affected by aging and hypertension. Carotid-femoral (cfPWV) is most commonly used but relationships of other PWV values to aging and hypertension are less well described.

Methods:  We studied normotensive and hypertensive subjects supine with an oscillometric BP cuff (Omron) and a Colin VP2000 that yielded heart-carotid (hc), heart-femoral (hf), femoral-ankle (fa), cf, and brachial-ankle (ba) PWV values. The strength of association among PWV variables, age and BP was assessed by standard Pearson regression coefficients and by ranking the slopes of the corresponding regression equations.

Results:  Ranges in 98 subjects were: age 17–83 years; systolic BP (SBP) 87-220 and diastolic BP (DBP) 51–143 mm Hg. Means(SD) of the 5 PWVs were (in cm/s): hc 770(337), hf 941(352), cf 1180(542), fa 917(175), and ba 1288(349); all PWV values were highly inter-correlated (P<0.000 each). The table (Table 1) demonstrates r-values for each PWV variable with age and individual BP components [SBP, pulse pressure (PP), mean arterial pressure (MAP), and DBP]. The slope of the age-relationship was highest for cfPWV (20 cm/s/year) and lowest for faPWV (4.5 cm/s/year), with other values intermediate (hf>hc>baPWV). The slopes of the PWV-blood pressure relationships always followed the same rank order: cf>ba>hf>hc>faPWV. For SBP, cfPWV was 14 and faPWV was 5.2 cm/s/ mm Hg.

Table 1. 
 hcPWVhfPWVcfPWVfaPWVbaPWV
Age0.740.850.770.540.71
SBP0.670.730.640.730.83
PP0.500.570.530.430.61
MAP0.700.710.600.800.82
DBP0.640.630.510.780.73

Conclusions:  We conclude that: (i) despite strong positive correlations among PWV indicators, sensitivity to age is greatest in proximal arteries (hc, hf, and cf) and lowest in distal arteries (fa and ba); (ii) PWV values are also sensitive to BP, especially those representing the lower aorta and muscular arteries; SBP is more closely related to PWV than MAP, PP or DBP; and (iii) cfPWV has the highest overall sensitivity to age and BP but also the highest variability; limited sensitivity of faPWV to either age or BP limits its value.

Keywords:  Pulse Wave Velocity; Age; Blood Pressure; Arterial Stiffness

LB-PO-05

EFFICACY AND SAFETY OF AVANAFIL, A NEXT GENERATION PDE5 INHIBITOR (PDE5i), IN MEN WITH ERECTILE DYSFUNCTION (ED) AND HYPERTENSION (HTN)

Alok Gupta,1 Irwin Goldstein,2 Andrew McCullough,3 Karen DiDonato,4 Wesley Day4

1Pennington Biomedical Research Center; 2Alvarado Hospital; 3Albany Medical Center and 4VIVUS, Inc.

Introduction:  Prevalence of ED in men with untreated or treated HTN is high. PDE5is, which have mild vasodilatory properties, are first-line treatment for ED. Avanafil is a highly specific PDE5i with rapid absorption (Tmax30–45 min) and a relatively short half-life (3–5 h). Outcomes from randomized, placebo-controlled, double-blind phase 2 (TA-05) and phase 3 (TA-301; TA-302) trials demonstrate improved erectile function (EF) in men with mild to severe ED both with or without diabetes (DM).

Objective:  Evaluate efficacy and safety of avanafil in participants with a past medical history (PMH) of HTN versus those with no history of HTN (NHTN) using an integrated analysis (IA) of TA-05, TA-301 and TA-302.

Methods:  Patients were randomized to placebo or avanafil (50−200 mg). Improvement in EF was assessed with Sexual Encounter Profile question 3 (SEP3; Did your erection last long enough for you to have successful intercourse?).

Results:  Baseline: mean age (57 year; range 23–88); PMH of HTN (43%); DM (31%); antihypertensive treatment (39%; 6% with α-blockers). Improvements resulting in successful intercourse were observed across all avanafil doses [LS mean change from baseline, HTN vs NHTN: 10% vs 13% (placebo); 34% vs 37% (avanafil 100 mg); 37% vs 39% (avanafil 200 mg)]. Adverse events (AEs) were generally mild to moderate in severity, with no significant differences observed (including symptomatic hemodynamic changes (dizziness, syncope) between the treatment groups, despite α-blocker therapy. Treatment-emergent AEs (TEAEs) and discontinuations due to AEs were similar and no drug-related serious AEs (SAEs), were reported for either cohort.

Table 1. 
% AEsPast Medical History of HTNNo History of HTN
  Avanafil, mg Avanafil, mg
 Placebo (n=156)50 (n=62)100 (n=164)200 (n=161)Placebo (n=193)50 (n=155)100 (n=185)200 (n=191)
TEAEs2427363727334436
Drug-related TEAEs3710166121819
SAEs03332011
Drug-related SAEs00000000
Discontinuation due to AE12222122

LB-PO-06

EFFICACY AND SAFETY OF DUAL RENIN-ANGIOTENSIN-SYSTEM BLOCKADE – A METAANALYSIS OF RANDOMIZED TRIALS

Harikrishna Makani,1 Sripal Bangalore,2 Kavit A. Desouza,1 Arpit Shah,1 Franz H. Messerli1

1St. Luke's Roosevelt Hospital Center, New York, NY and 2New York University School of Medicine, New York, NY.

Introduction:  Combination of an angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB) or direct renin inhibitors (DRI) (dual renin-angiotensin-system (RAS) blockade) have been proposed to provide more complete RAS and aldosterone inhibition. However, the long term efficacy and safety of such an approach is not well defined.

Methods:  PubMed/EMBASE/CENTRAL databases were searched for prospective randomized controlled trials (RCTs) from 1990 to December 2011 comparing dual RAS blockers with RAS blocker monotherapy (ACEi, ARB or DRI). Trials of total sample size of at least 50 reporting long-term (≥1 year) outcomes or adverse events (hyperkalemia, hypotension, renal failure or withdrawal due to drug related adverse events) were included in the analysis. Analysis was stratified by heart failure (HF) vs non-HF cohorts.

Results:  Twenty-eight RCTs with 58 849 patients (mean age 60 years, 72% men) and mean duration of 53 weeks were included. Comparing dual RAS blockers with RAS blocker monotherapy there was no significant difference in all-cause mortality (relative risk 0.98; 95% CI: 0.89–1.08) and cardiovascular mortality (RR 0.94; 95% CI: 0.86–1.03). These outcomes were similar between the HF and non-HF cohorts. There was 19% reduction in hospitalization for heart failure with dual RAS blockers compared to monotherapy (P<0.0001), mainly attributed to HF cohort (RR 0.78, 95% CI: 0.70–0.87) with no difference in the non-HF cohort (RR 1.11, 95% CI, 0.36–3.47). There was 66% increase in the risk of hyperkalemia (P<0.00001), 74% increase in the risk of hypotension (P<0.00001), 49% increase in the risk of renal failure (P=0.009) and 28% increase in the risk of withdrawal due adverse events (P<0.00001) with dual RAS blockers compared to monotherapy. HF cohort was at significantly increased risk of renal failure (P=0.0004) with dual RAS blockade (RR 2.19, 95% CI: 1.82–2.65) compared to non-HF cohort (RR 1.02, 95% CI: 0.70–1.49).

Conclusion:  Dual RAS blockade does not reduce mortality but is associated with significant excess risk of adverse events such as hyperkalemia, hypotension and renal failure. The risk benefit ratio argues against the use of dual RAS blockade for non HF patients and indicates that it should be used with caution, if at all, for HF patients.

Keywords:  Renin-Angiotensin-System Inhibitors; Safety; Efficacy

LB-PO-07

RESISTANT HYPERTENSION GOAL ATTAINMENT IMPROVED THROUGH A CLINICAL PHARMACY SPECIALIST HYPERTENSION CLINIC

Joel C. Marrs,1,2 Sarah L. Anderson,1,2 Rebecca L. Hanratty2,3

1University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO; 2Denver Health & Hospital Authority, Denver, CO and 3University of Colorado School of Medicine, Aurora, CO.

This retrospective observational cohort study evaluated blood pressure (BP) goal attainment before and after referral to clinical pharmacy specialists (CPS) among patients with resistant hypertension (HTN) in a community health clinic. Secondary endpoints included mean changes in BP and evaluation of antihypertensive medication utilization. Patients were referred to the CPS hypertension clinic from January 1, 2011 through December 31, 2011 if they were prescribed 3 or more antihypertensive medications and were not at their BP goal. Medical records for adults seen in the CPS HTN clinic during this study period were reviewed for baseline and post-intervention variables. Patient demographics, laboratory data including basic metabolic panels, BP, and antihypertensive use, were collected. Eighty-seven patients were seen in the CPS HTN clinic in 2011. The average BP at the first visit in the CPS HTN clinic was 146/86±20/13 mm Hg compared to 138/80±17/11 mm Hg at the last visit (P<0.0001). Blood pressure goal attainment had improved to 43.7% by the end of 2011 compared to baseline (P=0.0261). Most patients (46/87) had diabetes mellitus and/or chronic kidney disease and a BP goal of <130/80 mm Hg and the mean number of antihypertensive medications was 3.65 in this group compared to a mean of 3.37 in the <140/90 mm Hg group (P=0.0551). Eighteen (21%) patients were prescribed chlorthalidone, 9 (15%) were prescribed spironolactone, and 6 (10%) were prescribed a mixed alpha-beta blocker. A CPS HTN clinic focused on patients with resistant hypertension is an effective way to improve BP goal attainment in this high-risk population. This approach can increase the utilization of recommended antihypertensive medications such as chlorthalidone, spironolactone, and mixed alpha-beta blockers.

Keywords:  Resistant Hypertension; Clinical Pharmacy Specialist; Blood Pressure Goal Attainment

LB-PO-08

RENAL ASPECTS OF STATIN TREATMENTS FOR HYPERCHOLESTEROLEMIA IN THE PATIENTS WITH WELL-CONTROLLED BLOOD PRESSURE – ATORVASTATIN REDUCED ALBUMINURIA BUT ROSUVASTATIN DID NOT

Fumitoshi Satoh, Ryo Morimoto, Masataka Kudo, Yoshitsugu Iwakura, Yoshikiyo Ono, Sadayoshi Ito

Tohoku University Hospital, Sendai, Japan.

Backgrounds and Aims:  Albuminuria is an independent risk factor of cardiovascular complication of hypertensive patients. Several clinical trials have reported inconsistent findings for the effects of atorvastatin (ATV) and rosuvastatin (RSV) on renal function. The aim of this study was to investigate the effects of these two statins on glomerular filtration rate (GFR) and albuminuria respectively, and determine which is better.

Methods:  To clarify renal effects of statin in the patients with well-controlled blood pressure who needed lipid lowering therapy, 10 mg of atorvastatin and 2.5–5 mg of rosuvastatin were medicated to 102 patients (male/female, 52/50) and 153 patients (male/female, 55/98) respectively.

Results:  Oral treatment with ATV and RSV significantly reduced lipid profiles (LDL cholesterol, non-HDL cholesterol and triglyceride) at 24 weeks after treatment. Estimated GFR (eGFR) in both statins did not change significantly (66.6±2.6 to 64.7±2.9 ml/min/1.73 in ATV group versus 69.1±1.5 to 67.9±1.4 ml/min/1.73 in RSV group). In ATV group, urine albumine excretion (UAE) was significantly decreased from 95.1±29.6 to 50.1±11.8 mg/g Cr, but in RSV group, UAE did not change significantly. There were no significant changes in systolic/diastolic blood pressure (135.6±2.06/79.7±1.39 to 135.1±2.44/78.7±1.52 mm Hg in ATV group versus 125.4±1.50/74.7±1.44 to 126.0±1.42/73.6±1.04 mm Hg in RSV group) and HbA1c of the patients with both statin treatment.

Conclusions:  These results indicated that low dose of atorvastain might have more beneficial effects on renal function in the patients with well-controlled blood pressure.

Keywords:  Urine Albumin Excretion; Hypertensioin; Statin; Kidney

LB-PO-09

BLOOD PRESSURE CHANGES WITH ISHIB IMPACT CARDIOVASCULAR RISK REDUCTION TOOLKIT INTERVENTION AND EDUCATION

E. Saunders,1,2 W. Johnson,1,2 D. Monroe,1,2 F. T. Shaya3

1University of Maryland School of Medicine, Baltimore, MD; 2International Society on Hypertension in Blacks (ISHIB) and 3University of Maryland School of Pharmacy, Baltimore, MD.

Study Purpose:  Hypertension control remains at very low levels, and more markedly so within minority groups, despite the effectiveness of treatments available to patients. The purpose of this study is to assess the impact of a targeted intervention, based on ISHIB TLC and Consensus Statement and IMPACT tools, on blood pressure control in hypertensive patients, with other morbidities.

Methods:  Adult patients with hypertension were recruited from community based primary care physician offices. The inclusion criteria were uncontrolled hypertension and age 18–70. Patients were randomized to an intervention group who undertook monthly education sessions and to a control group who followed usual care. Clinical assessments, including blood pressure measurements were taken at baseline, one, three and 6 months follow ups. Initial exploratory analyses were conducted and multiple regression models were used to assess the effect of the ISHIB intervention on change of systolic (SBP) and diastolic (DBP) blood pressure at 1 month and at 3 months.

Results:  We show preliminary results: most of the 43 enrolled patients, about half in the intervention group, were African American (90.77%), females (66%), and the mean age was 55. Most patients completed one (38) and three (33) months of follow-up. The study is ongoing and will record follow-up at 6 months. The average SBP reductions were larger at 1 month (−5.00) at 1 month, and even larger at 3 months (−10) in patients who received the interventions as compared to those who received usual care. The presence of diabetes attenuated the impact of the intervention on blood pressure drop (OR 0.85, P 0.004).

Conclusions:  There is a strong indication that increased knowledge and awareness provided by ISHIB intervention coincide with a bigger blood pressure drop, which also continues from 1 month to 3 months post-baseline. Next phase will be to assess the sustainability of the blood pressure drop beyond the 3 months and at six months follow-up and assess the goal of achieving hypertension control.

Keywords:  Hypertension; Patient Education; Patient Disease Process Awareness

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