Background: Whether time-in-target range (TTR) for systolic blood pressure (SBP) associates with adverse kidney and cardiovascular events remains incompletely understood. Methods: This study included participants in 2 clinical trials that compared intensive (<120 mm Hg) and standard (3.3 mg/dL, sustained eGFR 40%. Adverse cardiovascular events included myocardial infarction, stroke, heart failure, and cardiovascular death. Adjusted Cox proportional hazards regression models were used to estimate the association between SBP-TTR and kidney and cardiovascular events. Results: Participants with higher TTR were younger and less likely to have preexisting cardiovascular disease. Compared with participants with TTR of 0%, the risk of adverse kidney events was lower for participants with TTR of >0% to 43% (hazard ratio [95% CI], 0.57 [0.42–0.76]; P <0.001), 43% to <70% (0.57 [0.42–0.78]; P =0.001), 70% to <100% (0.53 [0.38–0.74]; P <0.001), and 100% (0.33 [0.20–0.57]; P 0% to 43% (0.66 [0.52–0.83]; P =0.001), 43% to <70% (0.70 [0.55–0.90]; P =0.005), 70% to <100% (0.65 [0.50–0.84]; P =0.001), or 100% (0.56 [0.39–0.80]; P =0.001) compared with those with TTR of 0%. Conclusions: Higher SBP-TTR associates with lower risks of adverse kidney and cardiovascular events in adults with hypertension. SBP-TTR may be a potential therapeutic target and quality metric.

Background: The aim of this study is to identify potential barriers to conducting and publishing pharmacy residency research. Methods: A cross-sectional study surveyed pharmacy residents in Saudi Arabia from August to September 2020. The online survey assesses residents’ characteristics, residency research experience, barriers to completion, and challenges in publishing. A Likert scale assessed factors and barriers to conducting and publishing research during residency. Descriptive statistics were performed for binary variables, with Likert scale responses visualized using Gannt charts. Results: A total of 69 residents completed the survey, of whom 63.5 percent were female, and the median age was 28 years. More than half of the residents were in R2 (56.5 %), followed by R1 (24.6 %) and R3 (4.4 %). Half of residents had prior research experience, while 84.1 % had prior research training in workshops or courses. Cohort study design was the most common type of residency research project conducted. According to residents, the main barriers to conducting research were a lack of allocated time for research during rotations (81.7 %) and a lack of a realistic timeline determined by the SCFHS to finish the research project (66.2 %). Regarding barriers to publishing research, the majority of residents reported lack of time to work on the publication process (78.6 %), lack of previous publication experience (60 %), and lack of guidance from mentors (55.7 %) as the most important barriers. Conclusion: Pharmacy residents face barriers to conducting research during their residency program, including limited allocated time during rotations, a lack of realistic timelines, and data collection limitations. Additionally, they face challenges in publishing their research due to a lack of experience, mentorship, and guidance. Future research should consider seeking the perspective of residency program directors and preceptors on research barriers and evaluating the publication rate of residents’ projects.

The high prevalence of prediabetes and diabetes mellitus and its secondary complications in Saudi Arabia is a major healthcare concern. Evidence suggests that despite evidence-based efficacy and safety, metformin is underutilized in prediabetic obese patients. Thus, the aim of this study was to investigate the use of metformin in prediabetic obese patients in the Qassim region of Saudi Arabia. Prediabetic patients' electronic health records were accessed and screened from 2017 to 2021. The inclusion criteria were patients with obesity (BMI ≥ 35) diagnosed with prediabetes, and who received metformin. Patients with chronic kidney disease and those using metformin for other diseases were excluded. The first major endpoint of this study was the rate of metformin use among obese, prediabetic individuals. The second major endpoint was the factors associated with metformin prescribing in our cohort. Descriptive statistics were used to report the primary and secondary outcomes. Data are presented as percentages, means, standard deviations (SDs), medians, and interquartile ranges, as appropriate. All analyses were conducted using Stata version 16.1. A total of 304 prediabetic patients were included in this study after screening the records of 1,789 patients. The average age was found to be 40, and the majority were female (72%). The average BMI was found to be 39.4 kg/m², while the average HbA1c was 5.8%. In the entire sample, only 25 (8.22%) obese patients received metformin for diabetes prevention. Among obese patients with a BMI ≥ 30, 19 patients (8.7%) received metformin. Metformin users had higher odds of being on statins (OR 2.72, 95% CI 1.01 to 7.36; p = 0.049). According to the study, metformin is not frequently prescribed to prediabetic obese individuals in the Qassim region of Saudi Arabia. This prevention strategy is a missed opportunity in the management of prediabetes in high-risk patients. Future studies are needed to investigate the root causes of the underuse of metformin and potential interventions to promote evidence-based practice in Saudi Arabia.

Objective: To indirectly compare glucagon like peptide-1 receptor agonists (GLP-1RA) cardiovascular outcome trials (CVOTs) using network meta-analysis (NMA). Methods: We searched Medline to retrieve CVOTs that involved GLP-1RA. We conducted NMAs using binomial likelihood logit link model for the following outcomes: CV death, myocardial infarction (IM), stroke, and death from any cause. After running both fixed effects and random effects models for each outcome, we identified the best fit model that has the smallest deviance information and the average posterior residual deviance. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA-NMA) in reporting this NMA. Results: After screening, a total of seven GLP-1RA CVOTs were included. The NMA results showed that oral semaglutide was statistically better than exenatide (HR 0.47, CI: 0.21-0.99), dulaglutide (HR 0.46, CI: 0.20-0.97), albiglutide (HR 0.45, CI: 0.19-0.97), and lixisenatide (HR 0.43, CI: 0.19-0.92) in reducing CV death events. No significant differences were detected between most of the treatments regarding reducing death from any cause, MI and stroke events. The ranking results showed that oral semaglutide had the highest probability to be ranked first (>90%) in reducing CV death and death from any cause. Moreover, once weekly semaglutide had the highest probability to be ranked first in reducing MI and stroke events. Conclusion: The indirect comparison of GLP-1RAs using CVOTs data showed that oral semaglutide is preferred over most of the GLP-1RAs in reducing CV death and death from any cause events. The ranking probability showed that once weekly semaglutide and oral semaglutide are the most likely to be ranked first in reducing the outcomes of interest. Disclosure: O. Alfayez: None. O. Alkhezi: None. A.R. Almutairi: None.