Background and aim: Excess sodium consumption is a major risk factor for cardiovascular diseases including hypertension. Switching regular salt for reduced-sodium salt is shown to lower blood pressure and cardiovascular risk, however it is an underutilised intervention. An understanding of how reduced-sodium salt is perceived by consumers and healthcare professionals is required to scale-up use. This systematic review aims to summarise the findings of studies that assessed consumer and healthcare professional knowledge, attitudes, and behaviours about reduced-sodium salt.

Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Cochrane Central Register for Controlled Trials (CENTRAL), and Google Scholar (all years to 8 February 2024) were systematically searched to identify studies reporting quantitative or qualitative outcome measures about consumer and healthcare professional knowledge, attitudes, and behaviours relating to reduced-sodium salt use.

Results: Twenty-nine studies from 11 countries were included. Eighteen were intervention studies evaluating participants’ perceptions following a reduced-sodium salt intervention and 11 were descriptive studies examining perceptions of reduced-sodium salt among the general community and healthcare professionals. About half of studies (n=15) only measured one knowledge, attitude, or behaviour outcome. Among intervention studies, high overall acceptability was found in four out of five studies, but there were mixed findings on taste. Six out of seven intervention studies reported ≥30% of participants used or were willing to use reduced-sodium salt. Use of reduced-sodium salt was higher following interventions involving cost-subsidisation. Among descriptive studies, awareness of reduced-sodium salt was low among consumers compared to healthcare professionals (0-32% versus 71%). There was low use of reduced-sodium salt (ranging from 10-16%) in the general population. Low availability and higher costs compared to regular salt were identified as barriers to use.

Conclusions: Most studies found high overall acceptability and a willingness to use following exposure to a reduced-sodium salt intervention, despite some studies observing a taste difference. Greater awareness coupled with strategies to improve availability and affordability are of importance in scaling-up reduced-sodium salt use for the prevention and control of hypertension. More comprehensive assessment of knowledge, attitudes, and behaviours related to reduced-sodium salt is needed to inform and evaluate interventions.

Background and Aim:
There remains uncertainty about the short-term effects of blood pressure (BP) lowering drugs on cardiovascular events. We performed a meta-analysis of double-blind, short-term randomised trials to evaluate the effect of BP-lowering drugs on cardiovascular events compared to placebo.

Methods:
A systematic search for relevant trials was performed in the following databases: MEDLINE, Cochrane Central Register of Controlled Trials Library, and Epistemonikos. Trials satisfying the following criteria were included: (i) randomized, double-blind placebo-controlled trials of 2-26 weeks published in English language; (ii) adults (age ≥18 years) with hypertension (BP ≥140/90 mmHg or taking BP-lowering drugs); (iii) intervention: oral fixed dose of BP-lowering drug(s) as either monotherapy or combination therapy from five major classes (angiotensin converting enzyme, angiotensin-II receptor blockers, calcium channel blockers, beta-blockers, and diuretics); (iv) placebo comparator; (v) reported data on cardiovascular events; (vi). The primary outcome was major adverse cardiovascular events (MACE), defined as stroke, transient ischaemic attack (TIA), myocardial infarction, heart failure hospitalisation, angina or coronary revascularisation.

Results:
451 trials (93,121 participants [mean age 54 years, 56% males, mean follow-up 8 weeks], with a total of 250 cardiovascular event were included. There was no effect of the intervention compared to placebo on MACE (0.19% versus 0.43%; relative risk [RR] 0.89, 95% CI 0.69-1.14, p=0.35). There was a significant reduction in stroke (0.01% versus 0.05%; RR 0.37 [0.19-0.72]; p<0.001) and TIA (0.001% versus 0.01%; RR 0.26 [0.08-0.82]; p=0.02). Subgroup analysis suggested combination therapy provided the most benefit in stroke reduction (RR 0.21 [0.04-1.01], p=0.05), but benefits were observed across all anti-hypertensive groups for TIA outcomes. There were no between group differences in all-cause or cardiovascular mortality, myocardial infarction, heart failure, angina or coronary revascularisation.

Conclusions:
This meta-analysis of placebo-controlled RCTs demonstrated reduced stroke and TIA events with BP-lowering drugs even at short-term follow up. These findings suggest BP lowering treatment should be initiated as soon as possible in at risk individuals because even 8 weeks of treatment can significantly reduce the risk of stroke/TIA.

Background. The Australian healthcare system is under pressure to more effectively prevent and manage risk factors for chronic disease, including hypertension. A community-led approach to co-design solutions can appropriately address local needs. This study aimed to empower local communities by 1) understanding their perceived barriers to preventing and reducing hypertension, and 2) co-designing an intervention to improve hypertension outcomes.
Methods. Design Thinking methodology guided involvement with community members (adults with known or suspected hypertension) in northwest Tasmania, where there is a high prevalence of hypertension. Face-to-face focus groups and interviews (n=81) were held to understand community perspectives. Fifteen co-design workshops (n=114) explored local priorities and whether measurement of automated office blood pressure (AOBP) aligned with expectations as a community intervention. Inductive and deductive thematic analysis was applied.
Results. Key messages emerged within four overarching themes. Participants referred to hypertension as ‘a silent killer.’ They had good knowledge about hypertension causes, but much less about management after diagnosis. Better BP measurement was a high priority with strong sentiment that AOBP should be measured in the community (e.g. men’s sheds, community centres), general practice waiting rooms and pharmacies. In all settings, they wanted appropriately trained people undertaking AOBP measurement, with information provided immediately on interpretation of the AOBP results and next steps for lowering risk from hypertension.
Conclusions. This study shows strong community preference toward co-designing solutions to use AOBP in community settings, and also including general practice and pharmacy. This could offer a solution to improve quality of BP measurement in Australia.

Background and aim:
Launched in 2017, the India Hypertension Control Initiative (IHCI) is India's largest public sector hypertension program, guided by WHO HEARTS package. It emphasizes evidence-based treatment and ensuring access to essential medications. All implementing the IHCI follow drug-specific pathways, with Calcium Channel Blockers (CCBs), Angiotensin Receptor Blockers (ARBs), and Diuretics as first, second, and third-line treatments, respectively. Notably, one state has chosen Angiotensin Converting Enzyme Inhibitors (ACEIs) as the second-line option instead of ARBs. To aid nationwide scaling, interventions such as a forecasting tool and procurement policy reforms were introduced. We conducted a comprehensive secondary data analysis to assess the temporal and spatial distribution of antihypertensive drugs availability according to treatment protocols across 21 Indian states during 2022-2023.

Methods:
We extracted data on drug availability (measured in patient days) from monthly state reports under the IHCI framework and manually entered it into MS Excel for compilation and analysis. The analysis examined temporal trends in drug supply, focusing on near-term adequacy, shortages, and the duration of shortages during the 2022-23 fiscal year. Near-term adequacy was defined as having '30 or more patient days of stock,' while a shortage was defined as having 'fewer than 30 patient days of stock.'

Results:
Our analysis revealed variability in drug availability across states and drug classes. Twelve states maintained near-term adequacy of antihypertensive drugs throughout the year. However, five states experienced shortages of CCBs, and four states faced shortages of ARBs for at least six months. For Diuretics, only eight states achieved near-term adequacy for the entire year. Additionally, six states consistently ensured the availability of all protocol drugs, whereas five states faced prolonged shortages of at least two drug classes

Conclusions:
Two-thirds of Indian states successfully maintained adequate availability of first and second-line protocol drugs, indicating the effectiveness of IHCI strategies. However, states facing prolonged shortages need a detailed review of their procurement processes. Best practices from states with sufficient drug availability needs to be documented and disseminated to enhance drug accessibility nationally and inform hypertension programs globally. Periodic analyses are recommended for targeted programmatic and administrative interventions.