are video sharing websites a useful source of information on hypertension?

2
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 1 BIDMC, Boston, MA, United States; 2 Cambridge Health Alliance, Cambridge, MA, United States; 3 UAB, Birmingham, AL, United States; 4 UTSW, 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 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 Characteristics of videos by category Variables Useful videos 112 (64%) Misleading videos 58 (33%) Patient’ personal experience 6 (3%) p value Number of views Median (IQR) 3682 (746-16395) 8543 (2067-29926) 14268 (5584-65238) 0.0353 Likes Median (IQR) 8 (2-38) 20 (8-59) 53 (5-87) 0.0096 Reliability score MeanSD 3.4 (0.96) 0.64 (0.81) 1.17 (1.60) <0.0001 Quality score MeanSD 3.32 (0.89) 1.09 (0.80) 1.17 (0.98) <0.0001 Number of days online Median (IQR) 547 (272-990) 574 (300-1045) 585 (373-931) 0.8839 Views per day Median (IQR) 6 (2-19) 11 (5-31) 29 (26-41) 0.0162 Duration in minutes Median (IQR) 4 (3-8) 5 (2-10) 5 (3-8) 0.9786 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: 0 (0%) GO/NA: 2 (3%) HIW: 5 (9%) TPW: 1 (2%) P/HCW: 3 (5%) IU: 47 (81%) UC/PO: 1 (17%) GO/NA: 1 (17%) HIW: 0 (0%) TPW: 0(0%) IP/HCW: 0(0%) IU: 4(66%) <0.001 Target audience N (%) Physicians: 31 (28%) Physicians: 1 (2%) Physicians: 0 (0%) <0.001 Patients: 59 (53%) Patients: 53 (91%) Patients: 6 (100%) Unspecified: 22 (20%) Unspecified: 4 (7%) Unspecified: 0 (0%) Epidemiology 54 (36%) 2 (3%) 0(0%) <0.001 Pathogenesis 69 (67%) 7 (12%) 0(0%) <0.001 Prevention/Lifestyle modification 75 (67%) 6 (10%) 3 (50%) <0.001 Symptoms 37 (33%) 4 (7%) 0 (0%) <0.001 Pharmacologic treatment 31 (28%) 1 (2%) 0 (0%) <0.001 Complications 57 (51%) 8 (14%) 1 (17%) <0.001 Alternative therapies 8 (7%) 39 (67%) 2 (33%) <0.001 Product advertisement 4 (4%) 31 (54%) 1 (17%) <0.001 e14 Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e13–e17

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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

FP-3

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

FP-4

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

FP-5

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