ABSTRACT
CONTEXT: Uncontrolled hypertension can lead to an increased risk of cardiovascular disease, myocardial infarction, stroke, or death. Self-monitoring blood pressure (SMBP) programs have been associated with blood pressure (BP) reduction, particularly among rural, minority, and low-income individuals. There is limited literature about nonphysician SMBP programs. OBJECTIVES: To evaluate the effectiveness of an SMBP program designed to engage nonphysician team members in hypertension management within a federally qualified health center (FQHC). DESIGN: Self-monitoring blood pressure program activities were implemented using a Plan, Do, Study, Act model. The University of Washington Health Promotion Research Center evaluated processes and patient-level outcomes in a mixed-methods design. Quantitative analysis examined clinical outcomes related to hypertension, and qualitative analysis relied on interviews with clinical staff examining program implementation, adoption, and sustainability. SETTING: Family Health Centers (FHCs), a FQHC located in rural Washington, serving medically underserved populations. PARTICIPANTS: Two hundred five active SMBP patients out of 2600 adult patients (over 18 years old) who had a diagnosis of hypertension within the last 12 months. INTERVENTION: Patients with uncontrolled hypertension were given a BP cuff to log their daily BP. Patients met with community health workers (CHWs) and medical staff to review logs and set self-management goals over 3 to 4 months. MAIN OUTCOME MEASURE: Controlled BP measurements and factors to implementation and sustainment. RESULTS: Facilitators to implementation included expanded telehealth reimbursement during the COVID-19 pandemic, integration of CHWs, and linguistically adapted resources. Barriers included a lack of reimbursement for nonphysician time and BP monitors. Quantitative results demonstrated an effort to reach minoritized populations but did not show an improvement in BP outcomes. CONCLUSIONS: Family Health Center implemented an SMBP program adapted to meet the linguistic and social needs of their patients. The successful integration of CHWs and the need for reimbursement policies to support SMBP programs were key factors for implementation and sustainability.
Subject(s)
Hypertension , Humans , Hypertension/therapy , Washington , Female , Male , Middle Aged , Rural Population/statistics & numerical data , Program Evaluation/methods , Patient-Centered Care/standards , Adult , Safety-net Providers , Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Self Care/methodsABSTRACT
Unlabelled: User engagement with remote blood pressure monitoring during pregnancy is critical to optimize the associated benefits of blood pressure control and early detection of hypertensive disorders of pregnancy. In our study population of pregnant individuals, we found that connected blood pressure cuffs, which automatically sync measures to a monitoring platform or health record, increase engagement (2.13 [95% CI 1.36-3.35] times more measures per day) with remote blood pressure monitoring compared to unconnected cuffs that require manual entry of measures.
Subject(s)
Blood Pressure Determination , Humans , Pregnancy , Female , Adult , Blood Pressure Determination/instrumentation , Blood Pressure Determination/methods , Blood Pressure Determination/statistics & numerical data , Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Blood Pressure Monitoring, Ambulatory/standardsABSTRACT
CONTEXT: Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large. PROGRAM: The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions. IMPLEMENTATION: The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program. EVALUATION: A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure. DISCUSSION: Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.
Subject(s)
Rural Population , Telemedicine , Humans , South Carolina , Rural Population/statistics & numerical data , Female , Male , Adult , Middle Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Hypertension/epidemiology , Hypertension/diagnosis , Hypertension/prevention & control , Aged , Blood Pressure/physiology , Program Evaluation/methodsABSTRACT
Knowledge of the status of real-world home blood pressure (BP) measurements is crucial for establishing policies promoting hypertension treatment through home BP monitoring. However, only a few studies have investigated the status of home BP measurements in real-world settings. This study investigated the practice of Korean patients in measuring BP at home. This study recruited participants aged ≥20 years who were taking antihypertensives and conducted a questionnaire-based survey on home BP measurements. Of 701 participants recruited between August 2018 and April 2020, 673 were included in the analysis. Of these, 359 (53.3%) possessed home BP measurement devices. The devices used by 184 (51.3%) participants were validated, 110 (30.6%) were nonvalidated, and 65 (18.1%) had an unknown validation status. Only 18 patients (5.0%) with home BP devices were aware of the validation tests for home BP measurement devices. Of the 673 participants, 278 (41.3%) measured BP at home (77.4% of the patients owned home BP measurement devices). Among them, at least 74 (26.6%) performed proper measurements (at least once a month, at least twice a day or twice at a time, after at least 1 minute of rest, with at least a 1-min interval between each measurement, and 30 min after drinking coffee, exercising, or smoking). In conclusion, our community-based survey in the nonpresentive Korean population revealed a low rate of home BP measurement, a high rate of using nonvalidated devices, and a high rate of inappropriate measurements, suggesting that more efforts toward patient education regarding home BP measurements are needed.
Subject(s)
Antihypertensive Agents , Blood Pressure Monitoring, Ambulatory , Hypertension , Humans , Hypertension/drug therapy , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Male , Female , Republic of Korea/epidemiology , Middle Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Antihypertensive Agents/therapeutic use , Aged , Surveys and Questionnaires , Adult , Blood Pressure/physiology , Blood Pressure/drug effects , Blood Pressure Determination/methods , Blood Pressure Determination/statistics & numerical dataABSTRACT
CONTEXT: Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES: To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN: A prospective case series study. SETTING: Five FQHCs. PARTICIPANTS: The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION: SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE: Systolic blood pressure and diastolic blood pressure. RESULTS: Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS: Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.
Subject(s)
Hypertension , Telemedicine , Humans , Telemedicine/statistics & numerical data , Prospective Studies , Female , Male , Middle Aged , Hypertension/therapy , Massachusetts , Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Adult , Self Care/methods , Blood Pressure/physiologyABSTRACT
BACKGROUND: Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings. METHODS: This was a retrospective cross-sectional analysis of patients 5-22 years old who underwent 24-h ABPM between 2003-2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action. RESULTS: 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action. CONCLUSIONS: While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Hypertension , Humans , Female , Male , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Cross-Sectional Studies , Adolescent , Child , Retrospective Studies , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Hypertension/physiopathology , Young Adult , Child, Preschool , Antihypertensive Agents/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Blood Pressure/physiology , Counseling/statistics & numerical data , Masked Hypertension/diagnosis , Masked Hypertension/physiopathology , Masked Hypertension/epidemiologyABSTRACT
Cerebral microbleeds (CMBs) can be understood as a type of target organ damage caused by hypertension. We aimed to explore the association of the CMB burden with morning blood pressure (BP) variability in patients with hypertension. We divided patients with hypertension into two groups: a group with 1-10 CMBs and a group with more than 10 CMBs. The duration, grade, medication, and control of hypertension were recorded in all patients. Morning home BP measurements were performed every 3 days for a month. A total of 791 patients were recruited. Full factor model analysis showed that higher morning home diastolic BP variability (standard deviation [SD], OR = 1.080, 95% CI: 1.024-1.140, P = .005; coefficient of variation [CV], OR = 1.076, 95% CI: 1.028-1.128, P = .002) was associated with more than 10 CMBs. Morning home systolic and diastolic blood pressure variability (SD, CV, average real variability) in more than 10 non-lobar CMBs group was significantly higher than that in 1-10 non-lobar CMBs group (P < .05).The multivariate analysis showed higher morning home diastolic blood pressure variability (SD, OR = 1.124, 95% CI: 1.031-1.224, P = .008; CV, OR = 1.099, 95% CI: 1.019-1.186, P = .015; average real variability, OR = 1.055, 95% CI: 0.995-1.120, P = .075) was associated with more than 10 non-lobar CMBs. There was no significant relationship between morning home systolic blood pressure variability and more than 10 non-lobar CMBs (P > .05). Higher morning home diastolic blood pressure variability was associated with more than 10 CMBs and more than 10 non-lobar CMBs.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Cerebral Hemorrhage , Circadian Rhythm , Hypertension , Humans , Female , Male , Hypertension/physiopathology , Hypertension/diagnosis , Hypertension/epidemiology , Blood Pressure/physiology , Middle Aged , Circadian Rhythm/physiology , Aged , Cerebral Hemorrhage/physiopathology , Cerebral Hemorrhage/epidemiology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Antihypertensive Agents/therapeutic use , Risk FactorsABSTRACT
No consensus has emerged among different guidelines concerning how many blood pressure (BP) measurements should be performed at office visits in the diagnosis of hypertension. The purpose of this study was to examine the compatibility of various multiple average office BP measurements and 24-h BP monitoring (ABPM) in patients followed up in the posthoc analysis of the Cappadocia hypertension cohort. A total 1158 office BP measurements by 207 patients were examined. The results were then classified as G1 (average of the 1st and 2nd BP), G2 (average of the 2nd and 3rd), G3 (average of the 2nd, 3rd, and 4th), G4 (average of the 2nd, 3rd, 4th, and 5th), and G5 (average of all five measurements). Compatibility between the average values in the groups and concomitant 24-h ABPM data was examined. While a significant difference was observed between daytime 24-h ABPM SBP and G1 (p = .002), no difference was found in the other groups. Office DBP approached the daytime 24-h ABPM values as the number of measurements in the five groups increased, although average office DBP data in all groups were higher than daytime 24-h ABPM DBP (p = .000 for all). In light of our study results, we recommend that three office BP measurements be performed and that the average of the 2nd and 3rd measurements be used for SBP, while in terms of DBP, we recommend that as many measurements as possible be taken without the 1st value being included in the average.
Subject(s)
Blood Pressure Determination , Blood Pressure Monitoring, Ambulatory , Blood Pressure , Hypertension , Office Visits , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Female , Male , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/standards , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Middle Aged , Office Visits/statistics & numerical data , Blood Pressure Determination/methods , Blood Pressure Determination/standards , Blood Pressure/physiology , Aged , AdultSubject(s)
Blood Pressure Monitoring, Ambulatory , Hypertension , Humans , India/epidemiology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Hypertension/epidemiology , Hypertension/diagnosis , Bias , Male , Female , Blood Pressure/physiologyABSTRACT
BACKGROUND: Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. LOCAL PROBLEM: At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. INTERVENTIONS: A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. RESULTS: A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). CONCLUSION: Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.
Subject(s)
Hypertension, Pregnancy-Induced , Mobile Applications , Postpartum Period , Humans , Female , Mobile Applications/standards , Mobile Applications/statistics & numerical data , Pregnancy , Adult , Postpartum Period/physiology , Hypertension, Pregnancy-Induced/physiopathology , Hypertension, Pregnancy-Induced/diagnosis , Blood Pressure Determination/methods , Blood Pressure Determination/standards , Blood Pressure Determination/statistics & numerical data , Blood Pressure Determination/instrumentation , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitoring, Ambulatory/standardsSubject(s)
Humans , Heart Failure/physiopathology , Hypertension , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Heart Ventricles , Cardiovascular Diseases , Heart Failure/drug therapy , Heart Failure/epidemiology , Heart Failure/prevention & control , Blood Pressure Monitoring, Ambulatory/trendsABSTRACT
Objetivo: Representantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos. Materiales y métodos: Estudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores. Resultados: Un total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤135/85mmHg se recomienda pautar una nueva cita telemática en 3-6meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥135/85mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma. Conclusiones: La teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.(AU)
Aim: Members of the working groups on hypertension or cardiovascular disease of the Spanish Societies of Primary Care Physicians (PCPs) [SEMERGEN], Family and Community Medicine [semFYC] and General and Family Physicians [SEMG], conducted a Delphi study to validate with a panel of PCPs with expertise in hypertension several recommendations to optimize teleconsultation in hypertensive patients. Materials and methods: Delphi study based on an online questionnaire with 59 recommendations based on the available evidence and the clinical experience of the authors. Results: 118 PCPs participated in two rounds of the questionnaire (98.3% of the invited physicians), reaching consensus in 53/62 statements (85%). The Primary Care team must proactively select the hypertensive patients suitable for telematic consultation and contact them to set up an appointment. Telematic consultation must begin explaining the reason and aims pursued, continuing with anamnesis, which must explore signs and symptoms of disease worsening, current treatments and level of adherence. In patients with a home blood pressure measurement (HBPM) ≤135/85mmHg, it is recommended to schedule a new telematic appointment in 3-6months. On the contrary, asymptomatic patients with a HBPM ≥135/85mmHg should undergo ambulatory blood pressure monitoring, treatment modification or, in case of warning signs or symptoms, referral to a face-to-face visit or to emergency department. Conclusions: Teleconsultation can complement face-to-face consultation, constituting an additional tool for the appropriate follow-up of hypertensive patients.(AU)
Subject(s)
Humans , Male , Female , Arterial Pressure , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Hypertension/diagnosis , Hypertension/therapy , Telemedicine , Spain , Primary Health Care , Surveys and Questionnaires , 28599 , First Aid , Cardiovascular DiseasesABSTRACT
BACKGROUND: High day-to-day blood pressure variability (BPV) has been associated with an increased risk for cognitive decline and mortality in the general population. Whether BPV is associated with increased all-cause mortality in older people with cognitive impairment is unknown. OBJECTIVE: To investigate the association between day-to-day home BPV and all-cause mortality in older patients attending a memory clinic. METHODS: We included 279 patients attending a memory clinic, who measured home blood pressure (BP) for 7 consecutive days in the morning and evening. Within-subject BPV was defined as the variation independent of the mean (VIM). Time-to-death was verified through the Dutch population registry. Cox proportional hazard regression was used. Separate analyses were performed for morning-to-morning and evening-to-evening BPV. RESULTS: Mean age was 73±9 years, dementia and mild cognitive impairment were diagnosed in 35% and 34% respectively, and mean home BP was 139/79âmmHg. After a mean follow-up of 3.2 years, 52 patients had died. Neither day-to-day systolic nor diastolic VIM were associated with mortality (adjusted hazard ratio [HR] systolic VIM: 0.99, 95% -CI 0.92-1.06, pâ=â0.770, HR diastolic VIM: 1.04, 95% -CI 0.93-1.17, pâ=â0.517). When morning and evening measurements were analyzed separately, systolic morning-to-morning VIM was associated with mortality (adjusted HR: 1.09, 95% -CI 1.01-1.18, pâ=â0.033). CONCLUSION: In this study, day-to-day BPV was not associated with all-cause mortality in patients attending a memory clinic. However, morning-to-morning BPV was. Due to the short assessment window, there is still a lack of clarity; hence future research is warranted to clarify the role of all BPV components in aging.
Subject(s)
Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Blood Pressure/physiology , Cognitive Dysfunction/physiopathology , Mortality , Aged , Aging/physiology , Female , Humans , Male , Risk FactorsABSTRACT
BACKGROUND: Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure. PURPOSE: To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension. METHODS: This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period. RESULTS: Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.
Subject(s)
Aging/physiology , Exercise Therapy/methods , Hypertension/rehabilitation , Aged , Aged, 80 and over , Aging/blood , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Female , Glycated Hemoglobin/analysis , Humans , Hypertension/blood , Hypertension/diagnosis , Hypertension/physiopathology , Male , Middle Aged , Quality of Life , Randomized Controlled Trials as Topic , Resistance Training/methods , Treatment OutcomeABSTRACT
The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.
Subject(s)
Blood Pressure Monitoring, Ambulatory , COVID-19/epidemiology , Health Services Accessibility , Healthcare Disparities/standards , Hypertension , Racism/prevention & control , Social Determinants of Health/ethnology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Status Disparities , Humans , Hypertension/ethnology , Hypertension/therapy , Needs Assessment , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiologyABSTRACT
[Figure: see text].
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure/physiology , Cardiovascular Diseases , Hypertension , Prognosis , Risk Assessment , Age Factors , Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Cause of Death , Cohort Studies , Correlation of Data , Female , Global Health , Heart Disease Risk Factors , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Male , Middle Aged , Mortality , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Sex Factors , Vascular Stiffness/physiologyABSTRACT
Objetivos: Identificar o controle pressórico em hipertensos acompanhados por uma equipe da Saúde da Família. Métodos: Trata-se de um estudo longitudinal, realizado por meio da análise de prontuários de 134 indivíduos hipertensos maiores de 18 anos com, no mínimo, três aferições de pressão arterial ao longo do período citado, em uma Unidade Básica da Saúde da Família, durante o ano de 2017, no município de Itajaí (SC). Resultados: Da amostra total, 60,5% eram do sexo feminino. A faixa etária predominante foi dos 60 aos 69 anos (33,6%), e 80,7% tinham até 8 anos de escolaridade. Em relação ao número de medicações utilizadas, 34,3% estavam em monoterapia, 41,8% em terapia dupla, 17,9% em terapia tripla e 6% em terapia quádrupla. A taxa de controle pressórico foi de 28,4%. Apenas 9% da amostra apresentava índice de massa corporal dentro do ideal. No grupo compensado, 52,7% dos indivíduos apresentavam sobrepeso, enquanto 65,6% do grupo descompensado apresentavam obesidade (p<0,05). Da amostra total, 47,8% dos indivíduos eram portadores de diabetes mellitus, correspondendo a 53,1% do grupo descompensado (p<0,05). Ainda nesse grupo, 46,9% apresentavam níveis inadequados de LDL-colesterol (p<0,05), bem como 35,4% dos hipertensos descompensados apresentavam alto risco cardiovascular (p<0,05). Conclusão: Menos de um terço dos hipertensos apresentou níveis pressóricos adequados, sendo que os fatores que mostraram associação significativa com o controle da pressão arterial foram diabetes mellitus, dislipidemia, elevado índice de massa corporal e risco cardiovascular intermediário e alto.
Objectives: To identify pressure control in hypertensive patients followed by a Family Health Team. Methods: This is a longitudinal study carried out through the analysis of medical records of 134 hypertensive patients over 18 years of age, with at least three blood pressure measurements during the period mentioned, in a Primary Family Health Unit, during 2017 in the municipality of Itajaí (SC). Results: Of the total sample, 60.5% were women. The predominant age group was between 60 and 69 years (33.6%) and 80.7% had up to 8 years of schooling. Regarding the number of medications used, 34.3% were in monotherapy, 41.8% in double therapy, 17.9% in triple therapy, and 6% in quadruple therapy. The pressure control rate was 28.4%. Only 9% of the sample had optimal body mass index. In the compensated group, 52.7% of the individuals were overweight, while 65.6% of the decompensated group were obese (p<0.05). Of the total sample, 47.8% of the individuals had diabetes mellitus, corresponding to 53.1% of the decompensated group (p<0.05). Still in this group, 46.9% had inadequate LDL levels (p<0.05), as well as 35.4% of the decompensated hypertensive patients presented high cardiovascular risk (p<0.05). Conclusion: Less than one-third of hypertensive patients presented adequate blood pressure levels, and the factors showing a significant association with blood pressure control were diabetes mellitus, dyslipidemia, high body mass index, and intermediate and high cardiovascular risk
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Hypertension/epidemiology , Health Profile , Body Mass Index , Comorbidity , Longitudinal Studies , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Heart Disease Risk Factors , Hypertension/diagnosis , Hypertension/drug therapySubject(s)
Blood Pressure Monitoring, Ambulatory/statistics & numerical data , COVID-19/complications , Family Practice/statistics & numerical data , Hypertension/diagnosis , Practice Patterns, Physicians'/statistics & numerical data , Blood Pressure , Canada , Humans , Hypertension/virology , SARS-CoV-2ABSTRACT
[Figure: see text].
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure/physiology , Brain/diagnostic imaging , Circadian Rhythm/physiology , Dementia , Aged , Aged, 80 and over , Biological Clocks/physiology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Correlation of Data , Dementia/diagnosis , Dementia/epidemiology , Dementia/physiopathology , Humans , Longitudinal Studies , Magnetic Resonance Imaging/methods , Male , Middle Aged , Sweden/epidemiologyABSTRACT
OBJECTIVES: As part of the HEARTS in the Americas initiative, Chilean primary healthcare centers have implemented novel hypertension management strategies, including new diagnostic approaches. This study evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM). METHODS: This was an observational cohort study to evaluate and compare attended AOBP and ABPM for the diagnosis of hypertension in adults in a primary healthcare setting. RESULTS: The study evaluated 309 participants (54.2 ± 15.7 years; 50.5% male) from four primary healthcare centers in Santiago, Chile. Attended AOBP measurements were obtained at the clinic on two separate days, followed by ABPM. AOBP values indicated that 69.6% of patients had a systolic blood pressure (SBP) of ≥140 mm Hg and 34.6% had a diastolic blood pressure (DBP) of ≥90 mm Hg. A total of 83.5% had hypertension, 45.3% had high SBP, and 56.0% had high DBP. ABPM values indicated that 65.0% of patients had hypertension. The combined AOBP and ABPM analysis showed that 57.0% of patients had sustained hypertension, 26.5% had white coat hypertension, 8.1% had masked hypertension, and 8.4% were normotensive. The concordance between AOBP and ABPM (κ coefficient) was low (κ = 0.133; 95% confidence interval 0.028-0.237). The comparison of AOBP and ABPM measurements (Bland-Altman plots and bias calculations) showed an important bias in BP as measured using the AOBP method, especially for SBP (13.7 ± 11.6, 95% confidence interval -9.1 to 36.5). CONCLUSIONS: Attended AOBP alone may not be sufficient for adequate classification, diagnosis, and management of hypertension in Chile or other countries with similar demographics.