6^th World Congress on Hypertension and Public Health November 21- 22, 2018 | Paris, France

Biography:

Abstract:

Arterial Hypertension is an important cardiovascular risk factor. Patients on dialysis have an increase cardiovascular risk when compared with general population. The last  Brazilian census of Nephrology published in 2017 showed that arterial hypertension remains as the first cause of chronic kidney disease leading to dialysis in Brazil.

P.Medeiros el al analyzed 67 patients from a single center  and found that only 35,8% of patients on haemodialysis (HD) achievied the target blood pressure (BP), including here patients using at least one class of anti-hypertensive drug. In this study hypertension was definided as Systolic BP pre HD <140mmHg and Diastolic BP pre HD<90mmHg.

The CORDIAL study perfomed between 2010-2011 collected data from 1200 patients  and found a prevalence of hypertension of 87,4%. The definition of hypertension was the same as defined above plus the use of any anti-hypertensive drug.

There are still a lack of data about BP control in haemodialysis patients in Brazil but the data available show a high prevalence of hypertension on this population. Lowering blood pressure objecting blood pressure control should be pursue to reduce cardiovascular events and mortality in patients on dialysis.

Biography:

Rola Bou Serhal has completed her Research Master’s in Public Health, Epidemiology and Biostatistics branch from the Lebanese University. She holds a BS in Nursing from the Lebanese University too. She is a Clinical Research Assistant at the Clinical Research Center of Saint Joseph University (USJ). This is her first publication in a promising research career that she is building.

Abstract:

Background: Hypertension control reduces cardiovascular risk. Yet, lack of adherence to medication reduces this control. Therefore, tools to measure medication adherence are needed. A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8).

Objectives: The main objectives of this study were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors.

Methodology: A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake was estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence.

Results: A percentage of 54.9% had controlled hypertension and 82.4% were adherent by the new scale which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted non-adherence.

Conclusion: This study elaborated a validated, practical, and useful tool measuring adherence to medications in hypertensive patients.

Biography:

Laura Azevedo is a brazilian infectious diseases physician, completed her MSc of Public Health in Developing Countries at LSHTM and has recently started a PhD of economic evaluation of health interventions at University of São Paulo.  She works as medical coordinator in an emergency care unit and as data analysis supporter for the regional health care network. There, she works for SPDM, a health organization responsible for the management of all health care units of this district in the outskirts of the biggest city in Brazil - São Paulo.

Abstract:

The line of care for hypertensive and diabetics (LCHD) aims to be the guide of care in primary health care. Care systematization, cardiovascular risk classification and return flowchart require standards so that all the information is collected uniformly, whether in the reception, medical or nursing consultations or in attendance by the multiprofessional team.  The objective of this study was to present the forms of a LCHD. Experience report on the forms of a LCHD implemented in 2012 at the Vila Maria Vila Guilherme Health Network. The first version of the service form being capable of structuring the LCHD logic was developed in 2013. In 2015, it was revised and brought more objectivity maintaining the vital signs, anthropometric measurements, laboratory results, emergency or hospitalization care, diabetic foot evaluation and information on physical activities. In the same year, the need of sharing the management of care with the user, a singular therapeutic project form was developed, which symbolized a contract between the patient and the professional. At the end of 2017, in addition to contributing to the follow-up of the disease, ensure continuity of care and communication between the team, the return-on-consultation records stood out, since it was a priority to ensure compliance with the LCHD flowchart. More efficient attendances, more accurate monitoring of patients and to extract the characterization of the epidemiological profile are real contributions from LCHD's structured and constantly updated records. Although today, six years after its first version, difficulties in its fulfillment are found and these are essential for the execution of the LCHD.

Biography:

Joao Brocas is a Wearable’s Expert and a globally recognized top 100 Global Digital Health Influencer. His passion lies in helping others, sharing experiences, transferring knowledge, working collaboratively and passing on the latest innovation trends from the digital health world as a Thought Leader in wearable’s, digital health, IoT and healthcare innovation, including AI (artificial intelligence), robotics and ML (machine learning). He has explored the intersection of technology in modeling business models and shaping consumer behavior. Also, he analyses the impact of disruptive innovations and shares future trends in the marketplace.

Abstract:

The world has reached an unprecedented point in new digital technology developments, where novel wearable technologies will now be able to revolutionize everyday management of chronic disease. Cardiovascular disease is the world’s single biggest killer. As such, this is an area significantly appropriate for the introduction of remote monitoring medical wearable technologies. Joao Brocas, a recognized expert in digital technology, will explain how the modern consumer wants to interact with this dynamic new world, as well as what challenges and opportunities lie ahead and why this is one of the world’s most exciting area for consumer engagement. Joao will also highlight the revolutionary manner in how TLT’s new digital platform technology and the revolutionary ViCardio product will drive the future of this sector.

Biography:

Mafalda Castelão  is currently working in the Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.

Abstract:

Introduction: The world is in the grip of an obesity crisis, associated with a substantial increase in the prevalence of hypertension among youth. Obesity and elevated blood pressure (BP) in adolescents are both risk factors for cardiovascular disease that track into adulthood. New guidelines on pediatric hypertension were published that may change the previous diagnoses of hypertension.

Objective: The main objective of this study was to evaluate the prevalence of hypertension and the impact of the updated European guidelines on excess weight adolescents.

Methods: Retrospective cohort study (2011-2018) of overweight and obese adolescents, with BP measurements on at least three separate visits.

Results: Three hundred eleven (311) adolescents (48% male; 15.1±1.63 years old; BMI 32.2±5.85 kg/m²) were included. Hypertension was identified in 15% and 9% according to the 2009 and 2016 European Society of Hypertension (ESH) guidelines, respectively (p=.003). The prevalence of hypertension above the age of 16 was reduced by 76% (p<.001), mostly among males (p=.004). The estimates of high-normal BP decreased from 29% to 15% (p<.001), reclassifying as normotensive predominantly adolescents with a lower BMI (33.4±5.81 vs 35.7±7.22; p=.025). The overall prevalence of abnormal BP decreased by 45% (from 44% to 24%; p<.001), irrespective of gender, age or BMI.

Conclusions: The new ESH guidelines classified nearly half less adolescents with elevated BP and hypertension, with more than two thirds of the older adolescents reclassified as normotensive. Nevertheless, the prevalence of hypertension remained extremely high as compared to the healthy weight youth. Recognition of the premature beginning of cardiovascular disease among this at-risk population is a key public health target to reduce adult morbidity and mortality.

Biography:

Laura Azevedo is a brazilian infectious diseases physician, completed her MSc of Public Health in Developing Countries at LSHTM and has recently started a PhD of economic evaluation of health interventions at University of São Paulo.  She works as medical coordinator in an emergency care unit and as data analysis supporter for the regional health care network. There, she works for SPDM, a health organization responsible for the management of all health care units of this district in the outskirts of the biggest city in Brazil - São Paulo.

Abstract:

The hypertension line of care (HLC) contemplates the continual care and interconnects to the hypertension carriers on the health care system. Therefore, it is essential that the technical team have adherence to the line. Thus, health care managers proposed the production of an educational video (EV) about HLC for the professionals. The theoretical reference for the production of the EV about the HLC was the format of Fleming, Reynolds and Wallace. The EV production took place in June 2018 in the Rede Assistencial de Saúde Vila Maria and Vila Guilherme with institutional resources and the acquisition of the video software VideoScribe®. In pre-production, the script was written by two specialists, one in education and another in public health. It was based on the story of a fictional character, 64 years old Dona Joana, who after moving from her home has a headache and seeks the health service, initiating the investigation of hypertension. It is narrated her attendance in the center of specialty, in the hospital and her return to the basic unit of origin that accompanies her continuously. An experienced nurse, a reference to HLC, analyzed the script. The video production and audio recording were done. In post-production the EV was released, with 4:11, on Youtube® (https://www.youtube.com/watch?v=ZwXV0RaY4mo) with the option of automatic subtitles on a variety of languages, counting 600 views since the publication. It is possible to make an EV with few resources and contribute in a simple and effective way with the qualification of the professionals for the integral care of the patients with hypertension.

Biography:

Mawar Shashi has experience of 18 years in various positions, presently she is working as a Lecturer at college of Nursing, AIIMS New Delhi and a lifetime member of Trained Nurses Association of India, Nursing Research Society of India, Indian Association of Neonatal Nurses and Indian Association of Preventive and social medicine.

She participated as co-ordinator, Panelist, and Resource person at various National and International forums. She is a Master trainer for Global Funded project for Aids, Tuberculosis and Malaria- AIDS and Tuberculosis, Advanced trauma care for Nurses etc. She has some national and international publications and paper presentations.

Abstract:

Introduction: Hypertension exerts a substantial public health burden on cardiovascular health status and health care system in India. It has been estimated that among adults>50 years of age, the lifetime risk of developing hypertension approaches 90%. BP is frequently underdiagnosed and undertreated among elderly therefore a community based screening followed by a nurse-led BP control program was taken up.

Methods: A cross sectional survey was done to assess the prevalence of hypertension among 1386 elderly. Quasi experimental design was created to assess the effectiveness of nurse-led program on management of hypertension. Purposive sampling adopted to enroll 378 hypertensive patients. Study group and control group were divided on the basis of blocks. Community based nurse-led program is a holistic program covering life style modification, stress management, dietary modification, physical activity and medication adherence.

Results: Overall prevalence of hypertension was 34.6% with 31% among males and 36% among females. Mean age was 64.5 years. Both groups were homogenous with respect to all risk factors at baseline. There was a significant difference in SBP at 6 months p=0.04 (95%, CI: 0.04-4.01) and one year p<0.001 (95%, CI: 2.4-5.9) among study group subjects. Mean BP reduced by 6 mmHg at the end of one year among study group. Significant difference in total cholesterol, TGL and VLDL levels was also found. Mean reduction of 13.1 mg/dl in total cholesterol among study group p=0.003 (95%, CI: 2.3-11.6)

Conclusion: Community based nurse-led program is effective in managing BP.

Biography:

Foroohar Foroozan is system software and signal processing scientist at Analog Devices Inc. (ADI) leading the algorithm design for vital signs and in-home monitoring systems for the healthcare business unit in Toronto. The mission of this technology development group is to deliver the embedded platform, cloud, and analytics technologies required to meet the ADI IoT product and service ambitions. She is also collaborating with the Echo2Bits healthcare team for Point-of-Care ultrasound imaging systems. She was a postdoctoral fellow at Sunnybrook Research Institute working on 3D super-resolution ultrasound imaging for brain vascular mapping from 2012 to 2013 with a PCT patent pending. She was also a lecturer at the University of Ontario Institute of Technology, teaching both graduate courses from 2011 to 2012. She received her PhD degree in computer science from Lassonde School of Engineering, York University, Toronto, Canada in 2011. Her area of interest is in signal processing and algorithms in biomedical systems with focus on body area sensors for vital signs systems, in-home monitoring systems for assisted living and biomedical imaging. Dr. Foroozan’s work on compact ultrasound imaging system was awarded at the Sunnybrook-Schulich Innovation program in 2014, with a PCT patent. She is a member of the Professional Engineering Society of Ontario (PEng.) and a senior member of the IEEE.

Abstract:

Problem: Continuously monitoring the Blood Pressure (BP), specially for people of advanced age and those who are at a high risk of developing cardiac disease is very important. Currently, continuous BP measurements, including nocturnal, require surgical insertion of an intra-arterial monitor, only occurring in an ICU environment. Non-invasive BP measurements are limited to cumbersome products requiring deliberate inflation & producing only spot measurements, often negatively impacted erroneous procedures during measurement. Medical providers, patients and pharma need continuous, real life measurements without expensive, bulky invasive equipments.  In this work, 24H unobtrusive monitoring of cardiovascular health is implemented using wrist-based Photoplethysmography (PPG) signals, in which we produce 24H BP graphs and Personal Health Maps (PHM).

Methodology: We suggest PHM for each patient to provide at a glance the position of the patient in the Health Space 24H. The algorithm is based on Fuzzy clustering, where each patient is assigned with a different level of membership in different pathological and healthy conditions. The PHM shows the trace of a patient’s PPG pulse shape during day and night in one glance. In one study in Calcutta hospital, 30 hypertensive and diabetic patients were monitored at home 24H both with an Ambulatory Blood Pressure Monitoring (ABPM) device which records the BP every 15 min together with a continuous PPG  recordings in order to estimate the BP and Cardiac Output  (CO) continuously. In a second clinical trial, we compared our Hemodynamics prediction to that of a continuous Hemodynamics CNAP device, during Hemodialysis in Fresenius Kidney Center, in St. Louis hospital. Using 2-4 light wavelengths allowed us also to interrogate the capillary bed at different penetration levels to estimate features related to the microcirculation.

Findings: We implemented Fuzzy clustering algorithm to cluster the pulse shapes in the feature space. We discovered that different health conditions fell into different clusters and it changes during 24H.

Conclusions & Significance: We showed that different health conditions can be defined by the PPG pulse shape clustering, which also generates a continuous Health space. Cluster centroids that represent various pulse shapes belong to different health conditions. This provides a powerful tool to monitor progress or deterioration of a patient in a quantitative way. It is quite crucial for people suffering from hypertension to monitor their BP continuously and get timely medical intervention, so that serious cardiovascular complications shall be prevented. This method can also solve the problem of nocturnal cardiac monitoring at home.

Biography:

Wafaa Abdel-Rehim works as assistant professor of biochemistry, Medical Research Institute, Alexandria University, Egypt. I have published more than 20 papers in reputed journals, including Journal of Cellular Biochemistry in 2017 and Biological Chemistry in 2016.  

Abstract:

Background: klotho is recognized as an anti-aging protein, protects the cardiovascular system through endothelium – derived NO. Klotho deficiency disturbs endothelial integrity, but the molecular mechanism is not fully clarified.

Objective: To observe the relationship between klotho protein and biochemical marker of oxidative stress, endothelial dysfunction and arterial aging in non-treated and ACEI-treated patients with essential hypertension (EH).

Subjects& Methods: 80 subjects with essential hypertension, divided into two groups the first didn’t receive any hypertensive treatment (n=40) while the other (n=40) received angiotensin converting enzyme inhibitors (ACEIs), and 20 age and sex matched controls were included in the study. Serum levels of nitric oxide (NO), malondialdehyde (MDA), vascular endothelial growth factor-A (VEGF-A) and klotho protein were measured. Carotid Intima- Media Thickening (IMT) were determined by ultrasonography for all participants.

Results: Mean values of MDA, VEGF-A and IMT revealed significant increment while those of NO and Klotho showed significant reduction in non-treated EH patients compared to controls. Mean levels of MDA, VEGF-A and IMT showed significant reduction while those of NO and Klotho exhibited significant elevation in ACEI- treated patients compared to corresponding values of non-treated ones. Significant negative correlation between serum MDA concentration and NO levels and positive correlation between klotho level and NO were observed in the present study. 

Conclusion: soluble klotho may become an important target in vascular medicine, mainly in situations where senescence and stress is responsible for accelerated vascular damage as in hypertension. The addition of exogenous klotho may prevent the oxidative stress that induces premature senescence.