Abstract P220: Perception of Blood Pressure Control and Satisfaction with Hypertension Care in the Rural Setting

Background: National Health and Nutrition Examination Survey (NHANES) data indicate only 50% with hypertension (HTN) have controlled blood pressure (BP) yet limited data are available regarding patient’s knowledge of and satisfaction with their BP control.

Methods: We utilized MyHealthStory, an online health information exchange portal to identify a rural, diverse HTN population. Adult patients (≥ 18 yrs) were recruited from existing federally-qualified health center (FQHC) sites. The survey was sent via email to 5000 patients who voluntarily shared email addresses through MyHealthStory. Equal numbers of men and women of any race/ethnicity with a diagnosis of HTN and who consented to receive information about research in MyHealthStory were targeted. We developed the 21 question survey using Qualtrics. The first 300 patients who completed the survey were included. We compared a) patient-reported BP control (BP ≥ 140/90; or <140/90) and patient-reported satisfaction with BP control (yes=happy, no=unhappy) and b) patient reported BP control and perception of BP control (well controlled, uncontrolled); using McNemar’s test for paired nominal data.

Results: Here we report data from the 238 completed surveys received from Caucasians (n=184, 61% female) and African Americans (n=54, 83% female). Among 117 Caucasians reporting BP, 51% (n=60) reported uncontrolled BP, 52% (n=61) reported perception of well controlled BP (p=0.49). A total of 77% (n=46) of patients who had uncontrolled BP reported satisfaction with their HTN care compared to 96% in those who had controlled BP ( P <0.0001). Among 32 African Americans reporting BP, only 13% (n=4) reported controlled BP but 31% (n=10) reported perception of well controlled BP (p=0.034). Among the 4 African Americans whose BP was controlled, all 4 reported satisfaction with their HTN care, while among the 28 patients who reported uncontrolled BP, 23 (82%) reported satisfaction with their HTN care ( P <0.0001).

Conclusions: Among hypertensive individuals, our survey data suggest there is a substantial disconnection between reported BP control, perception of BP control and satisfaction with HTN treatment, suggesting need for improvement in patient education surrounding HTN treatment and BP control.

Ethanol influences on Bax associations with mitochondrial membrane proteins in neonatal rat cerebellum

These studies investigated interactions taking place at the mitochondrial membrane in neonatal rat cerebellum following ethanol exposure and focused on interactions between proapoptotic Bax and proteins of the permeability transition pore (PTP), voltage-dependent anion channel (VDAC) and adenine nucleotide translocator (ANT) of the outer and inner mitochondrial membranes, respectively. Cultured cerebellar granule cells were used to assess the role of these interactions in ethanol neurotoxicity. Analyses were made at the age of maximal cerebellar ethanol vulnerability (P4), compared to the later age of relative resistance (P7), to determine whether differential ethanol sensitivity was mirrored by differences in these molecular interactions. We found that, following ethanol exposure, Bax proapoptotic associations with both VDAC and ANT were increased, particularly at the age of greater ethanol sensitivity, and these interactions were sustained at this age for at least 2 h postexposure. Since Bax:VDAC interactions disrupt protective VDAC interactions with mitochondrial hexokinase (HXK), we also assessed VDAC:HXK associations following ethanol treatment and found such interactions were altered by ethanol treatment, but only at 2 h postexposure and only in the P4, ethanol-sensitive cerebellum. Ethanol neurotoxicity in cultured neuronal preparations was abolished by pharmacological inhibition of both VDAC and ANT interactions with Bax but not by a Bax channel blocker. Therefore, we conclude that, at this age, within the constraints of our experimental model, a primary mode of Bax-induced initiation of the apoptosis cascade following ethanol insult involves interactions with proteins of the PTP complex and not channel formation independent of PTP constituents.

Ethanol influences on Bax translocation, mitochondrial membrane potential, and reactive oxygen species generation are modulated by vitamin E and brain-derived neurotrophic factor

BACKGROUND

This study investigated ethanol influences on intracellular events that predispose developing neurons toward apoptosis and the capacity of the antioxidant α-tocopherol (vitamin E) and the neurotrophin brain-derived neurotrophic factor (BDNF) to modulate these effects. Assessments were made of the following: (i) ethanol-induced translocation of the pro-apoptotic Bax protein to the mitochondrial membrane, a key upstream event in the initiation of apoptotic cell death; (ii) disruption of the mitochondrial membrane potential (MMP) as a result of ethanol exposure, an important process in triggering the apoptotic cascade; and (iii) generation of damaging reactive oxygen species (ROS) as a function of ethanol exposure.

METHODS

These interactions were investigated in cultured postnatal day 8 neonatal rat cerebellar granule cells, a population vulnerable to developmental ethanol exposure in vivo and in vitro. Bax mitochondrial translocation was analyzed via subcellular fractionation followed by Western blot, and mitochondrial membrane integrity was determined using the lipophilic dye, JC-1, that exhibits potential-dependent accumulation in the mitochondrial membrane as a function of the MMP.

RESULTS

Brief ethanol exposure in these preparations precipitated Bax translocation, but both vitamin E and BDNF reduced this effect to control levels. Ethanol treatment also resulted in a disturbance of the MMP, and this effect was blunted by the antioxidant and the neurotrophin. ROS generation was enhanced by a short ethanol exposure in these cells, but the production of these harmful free radicals was diminished to control levels by cotreatment with either vitamin E or BDNF.

CONCLUSIONS

These results indicate that both antioxidants and neurotrophic factors have the potential to ameliorate ethanol neurotoxicity and suggest possible interventions that could be implemented in preventing or lessening the severity of the damaging effects of ethanol in the developing central nervous system seen in the fetal alcohol syndrome (FAS).

Effect ofbax deletion on ethanol sensitivity in the neonatal rat cerebellum

The developing cerebellum is highly sensitive to ethanol during discrete neonatal periods. This sensitivity has been linked to ethanol-induced alterations in molecules of the Bcl-2 survival-regulatory gene family. Ethanol exposure during peak periods of cerebellar sensitivity, for example, results in increased expression of proapoptotic proteins of this family, while overexpression of the antiapoptotic Bcl-2 protein in the nervous system protects against ethanol neurotoxicity. For the present study, neonatal mice with a targeted deletion of the proapoptotic bax gene were used to determine whether elimination of this protein would mitigate ethanol toxicity. bax knock-out and wild-type mice pups were exposed to ethanol via vapor inhalation during the maximal period of neonatal cerebellar ethanol sensitivity and cerebellar tissue was subsequently assessed for Purkinje and granule cell number and ethanol-mediated generation of reactive oxygen species (ROS). The results revealed that: (1) ethanol exposure during the peak period of cerebellar vulnerability resulted in substantial loss of Purkinje cells in wild-type animals, but not in bax knock-outs; (2) granule cells in the bax gene-deleted animals were not similarly protected from ethanol effects; and (3) levels of ROS following acute ethanol exposure were appreciably enhanced in the wild-type animals but not in the bax knock-outs. These results imply that Bax is important to ethanol-induced Purkinje cell death during critical neonatal periods, but that ethanol effects on granule cells may function at least partially independent of this apoptosis agonist. Amelioration of ethanol-mediated increases in ROS production in the knock-outs may contribute to the observed effects.