are video sharing websites a useful source of information on hypertension?
TRANSCRIPT
e14 Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e13–e17
Keywords: Blood pressure variability; coronary heart disease; stroke;
heart failure
FP-2
Are video sharing websites a useful source of information on
hypertension?
Nilay Kumar,2 Neetika Garg,1 Anand Venkatraman,3 Ambarish Pandey.4
1BIDMC, Boston, MA, United States; 2Cambridge Health Alliance,Cambridge, MA, United States; 3UAB, Birmingham, AL, United States;4UTSW, Dallas, TX, United States
Background/Objectives: Hypertension (HTN) is a prevalent and growing
public health problem in the US. Lifestyle changes and medication
adherence are crucial to the effective control of blood pressure. YouTube,
a video sharing website, likely influences health related behavior via
properties of interpersonal and mass communication. We sought to
ascertain if YouTube is a useful source of information on HTN and
perform a detailed content analysis of videos on HTN.
Methods: YouTube was searched using the terms ‘‘hypertension’’ and
‘‘high blood pressure’’. Videos in English dealing with systemic HTN
were included. Two physicians classified videos as ‘‘useful’’,
‘‘misleading’’ or ‘‘patient experiences’’. Videos were graded on an
Characteristics of videos by category
Variables Useful videos 112 (64%) Mislead
Number of views
Median (IQR)
3682 (746-16395)
Likes
Median (IQR)
8 (2-38)
Reliability score
Mean�SD
3.4 (�0.96)
Quality score
Mean�SD
3.32 (�0.89)
Number of days online
Median (IQR)
547 (272-990)
Views per day
Median (IQR)
6 (2-19)
Duration in minutes
Median (IQR)
4 (3-8)
Source
N (%)
University Channel/
Professional Organization
(UC/PO), Government
Organization/News
Agency (GO/NA), Health
information website
(HIW), Test preparation
website (TPW),
Physicians or other
healthcare workers (P/
HCW), Individual Users
(IU), Interquartile range
(IQR)
UC/PO: 22 (20%)
GO/NA: 5 (4%)
HIW: 33 (29%)
TPW: 11(10%)
P/HCW: 22 (20%)
IU: 19 (17%)
UC/PO:
GO/N
HIW
TPW
P/HC
IU: 4
Target audience
N (%)
Physicians: 31 (28%) Physic
Patients: 59 (53%) Patie
Unspecified: 22 (20%) Unspeci
Epidemiology 54 (36%)
Pathogenesis 69 (67%)
Prevention/Lifestyle
modification
75 (67%)
Symptoms 37 (33%)
Pharmacologic treatment 31 (28%)
Complications 57 (51%)
Alternative therapies 8 (7%)
Product advertisement 4 (4%)
objective, five-point, ordinal scale for quality and reliability. Other
variables of interest included target audience and source of upload, total
views, views per day and number of likes. Content on epidemiology,
pathogenesis, symptoms, lifestyle modification, treatment, advertisements
and alternative treatments was noted.
Results: First 8 pages for each search term (320 videos) were screened and
176 included in the final analysis. 112 (64%) videos were classified as
‘‘useful’’, 58 (33%) as ‘‘misleading’’ and 6 (3%) were ‘‘patient’s personal
experience’’. There was a high inter-observer agreement (k 0.81,
CI 0.83-0.91). Useful videos had the highest quality/reliability scores
and proportion videos covering epidemiology, pathogenesis, prevention,
pharmacologic treatments and complications. Median number of views,
views per day and likes was lowest for useful videos. University
channels/professional organizations (UC/PO), health information websites
(HIW) and physicians/healthcare workers (P/HCW) uploaded 69% of
useful videos while independent users (IU) uploaded 81% of misleading
videos. Two thirds of misleading videos advocated unproven alternative
therapies and more than half advertised questionable supplements not
supported by scientific evidence. Patients were the target audience for
53% of useful videos and 91% of misleading videos.
Conclusions: YouTube contains a large number of videos on HTN of
which approximately two thirds were useful, however these were least
ing videos 58 (33%) Patient’ personal experience
6 (3%)
p value
8543 (2067-29926) 14268 (5584-65238) 0.0353
20 (8-59) 53 (5-87) 0.0096
0.64 (�0.81) 1.17 (�1.60) <0.0001
1.09 (�0.80) 1.17 (�0.98) <0.0001
574 (300-1045) 585 (373-931) 0.8839
11 (5-31) 29 (26-41) 0.0162
5 (2-10) 5 (3-8) 0.9786
0 (0%)
A: 2 (3%)
: 5 (9%)
: 1 (2%)
W: 3 (5%)
7 (81%)
UC/PO: 1 (17%)
GO/NA: 1 (17%)
HIW: 0 (0%)
TPW: 0(0%)
IP/HCW: 0(0%)
IU: 4(66%)
<0.001
ians: 1 (2%) Physicians: 0 (0%) <0.001
nts: 53 (91%) Patients: 6 (100%)
fied: 4 (7%) Unspecified: 0 (0%)
2 (3%) 0(0%) <0.001
7 (12%) 0(0%) <0.001
6 (10%) 3 (50%) <0.001
4 (7%) 0 (0%) <0.001
1 (2%) 0 (0%) <0.001
8 (14%) 1 (17%) <0.001
39 (67%) 2 (33%) <0.001
31 (54%) 1 (17%) <0.001
e15Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e13–e17
likely to be viewed. Consumers must be aware of spurious online
content that could pose safety risks. Universities/Professional organiza-
tions should take a greater role in uploading reliable information for
patients.
Keywords: Hypertension; High Blood Pressure; YouTube; Internet
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Blood pressure classification and cardiovascular risk factors in
children with and without ADHD
Ibrahim F. Shatat,3 Kimberly Lewis,2 Doaa Al Qaoud,3 Carol Wagner,3
Susan Hailpern,1 Brent Egan.2 1Independent Consultant, Saratoga, CA,
United States; 2MUSC, Charleston, SC, United States; 3MUSC Children’s
Hospital, Charleston, SC, United States
Background: It is estimated that 8% of children ages 4-17 in the US carry
the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and a
significant portion of them take medications to treat their ADHD
symptoms. Previous NHANES analyses showed 2-3% of children in the
US suffer from hypertension. The prevalence of hypertension and
cardiovascular risk factors in children with ADHD on CNS stimulant
treatment vs no treatment compared to their healthy counterparts is not
well described.
Aim: Using the NHANES database, we examine demographic and
cardiovascular risk factors of 4,907 children with and without the diagnosis
of ADHD.
Results: 383 (10.7%) of children carried the diagnosis of ADHD; of
whom 111 (3.4%) were on CNS stimulant medications, and (272) 7.3%
were not. Mean age was 15 years. Children with ADHD on stimulant
medication were significantly younger, male, and white (p¼0.001).
BMI Z score, GFR, total cholesterol levels, the prevalence of albuminuria
and poverty were not significantly different. 160 (2.7%) children were
hypertensive and 637 (12.4%) were prehypertensive. The prevalence of
hypertension and/or prehypertension was not different between the
groups with ADHD on CNS treatment vs. no treatment and without
ADHD. Systolic BP percentiles were not significantly different between
the three groups, 40.87%, 37.53%, and 38.46, respectively. Heart Rate
(HR) was significantly higher in the ADHD group on stimulants vs. the
group without ADHD groups; 81.7 BPM and 76.8 BPM, respectively
(p¼0.006).
Conclusion: The prevalence of hypertension and/or prehypertension
is comparable between children with ADHD on stimulant treatment
vs. no treatment and is comparable to children without ADHD.
Children with ADHD on stimulant treatment have significantly
higher HR.
Keywords: Pediatrics; ADHD; Hypertension
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Effect of ZS-9, a novel selective cation trap, on urinary potassium
and sodium excretion when used for the treatment of hyperkalemia
in patients with chronic kidney disease
Bhupinder Singh,y,3 Stephen R. Ash,2 Philip Lavin,1 Alex Yang,4
Henrik S. Rasmussen.5 1Boston Biostatistics Research Foundation,
Framingham, MA, United States; 2Indiana University Health Arnett,
Lafayette, IN, United States; 3Southwest Clinical Research Institute, Tempe,
AZ, United States; 4Xelay Acumen, Belmont, CA, United States; 5ZSPharma, Coppell, TX, United States
Hyperkalemia is associated with significant mortality and limits use of
life-saving renin-angiotensin-aldosterone (RAAS) inhibitors, yet
prevalent treatments are poorly tolerated and not always effective. The
nonselective organic resin sodium polystyrene sulfonate (SPS) is the
only approved hyperkalemia therapy in the U.S. However, its efficacy
has been questioned and its use has been associated with sodium (Na+)
loading and decreases in serum calcium and magnesium. ZS-9 is an
inorganic, nonsystemic cation exchanger designed to preferentially
entrap excess potassium (K+). In a Phase 2 trial in 90 patients with
chronic kidney disease (CKD) and hyperkalemia, ZS-9 led to a rapid
and sustained decrease in serum K+ vs placebo, with acceptable safety
(Ash et al. ASN 2013). Here we present results for urinary K+ and
Na+ excretion. Eligible patients (estimated glomerular filtration rate:
30-60 mL/min/1.73 m2; serum K+: 5-6 mEq/L) received ZS-9 10g
(N¼24) or placebo (N¼30) as an oral suspension 3X daily for an initial
2 days (and up to 2 more days if serum K+ �5.0 mEq/L), with regular
meals (8am, 12pm, 6pm) as in-patients (no patients on ZS-9 10g required
treatment beyond 2 days). Twenty-four hour urine samples were
collected at baseline and during treatment. RAAS inhibitors were
continued during the study. In the placebo and ZS-9 10g groups,
18 (60%) and 20 (83%) patients, respectively, were on RAAS inhibitors.
At baseline, 24-hour urine K+ and Na+ were not significantly different
between groups (Table). Urinary K+ excretion increased by +31% with
placebo and decreased by -23% with ZS-9 10g (p¼0.002 vs placebo)
in 48 hr. Urinary Na+ excretion increased in 48 hr in both groups
(placebo, +52%; ZS-9 10g, +26%), but was not significantly different
between groups. There were no cases of significant hypocalcemia
(�8 mg/dL), hypomagnesemia (�1.2 mmol/L), or hypokalemia
(�3.0 mEq/L), including in patients on RAAS inhibitors. Consistent
with its reductions in serum K+, ZS-9 10g significantly decreased urinary
K+ excretion by 23% in CKD patients treated for hyperkalemia, the
majority of whom were on RAAS inhibitors. ZS-9 10g had no clinically
relevant effect on urinary Na+ excretion.
Keywords: Hyperkalemia; Chronic Kidney Disease; Urinary Sodium
Excretion; ZS-9
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Prognostic value of clinic and ambulatory blood pressure
measurements for predicting the risk of developing diabetes
Ramon C. Hermida, Diana E. Ayala, Artemio Mojon, Jose R. Fernandez.
University of Vigo, Vigo, Spain
Progression to target organ damage and cardiovascular (CVD) risk are
more closely associated with ambulatory (ABPM) than with clinic blood
pressure (BP) measurements. Independent prospective studies have also
found the sleep-time BP mean determined by ABPM is a better predictor
of CVD risk than the awake or 24h BP means. Nighttime hypertension
and non-dipper BP patterning are highly prevalent in diabetes and they
have been consistently associated with the increased CVD risk of these
patients. However, whether elevated ABPM provides prognostic
value for predicting the development of diabetes has scarcely
been investigated. We evaluated 2656 subjects without diabetes,
1292 men/1364 women, 50.6�14.3 years of age, with baseline
ambulatory BP ranging from normotension to sustained hypertension.
At baseline and annually (or more frequently if hypertension treatment
was adjusted based on ABPM) thereafter, ambulatory BP and physical