151
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Commodore-Mensah Y, Turkson-Ocran RA, Foti K, Cooper LA, Himmelfarb CD. Associations Between Social Determinants and Hypertension, Stage 2 Hypertension, and Controlled Blood Pressure Among Men and Women in the United States. Am J Hypertens 2021; 34:707-717. [PMID: 33428705 PMCID: PMC8351505 DOI: 10.1093/ajh/hpab011] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Social determinants influence the development and control of hypertension. METHODS National Health and Nutrition Examination Survey (2011-2018) data for adults aged ≥18 included education, income, employment, race/ethnicity, healthcare access, marital status, and nativity status. Outcomes were hypertension (blood pressure [BP] ≥130/80 mm Hg or self-reported hypertension medication use), stage 2 hypertension (BP ≥140/90 mm Hg), and controlled BP (BP <130/80 mm Hg among those with hypertension). Poisson regression with robust variance estimates was used to examine associations between social determinants and outcomes, by sex. RESULTS The analysis included 21,664 adults (mean age 47.1 years), of whom 51% were women. After adjustment, hypertension and stage 2 hypertension prevalence remained higher among Black and Asian than White adults, regardless of sex. Blacks had lower prevalence of controlled BP than Whites. Compared with college graduates, men and women with less education had a higher prevalence of hypertension and stage 2 hypertension. Men (prevalence ratio [PR]: 0.28, 95% confidence interval: 0.16-0.49) and women (PR: 0.44, 0.24-0.78) with no routine place for healthcare had lower prevalence of controlled BP than those who had a routine place for healthcare. Uninsured men (PR: 0.66, 0.44-0.99) and women (PR: 0.67, 0.51-0.88) had lower prevalence of controlled BP than those insured. Unemployed or unmarried women were more likely to have controlled BP than employed or married women. CONCLUSIONS Social determinants were independently associated with hypertension outcomes in US adults. Policy interventions are urgently needed to address healthcare access and education, and eliminate racial disparities.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Ruth-Alma Turkson-Ocran
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Foti
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lisa A Cooper
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Health Behavior and Society, Baltimore, Maryland, USA
| | - Cheryl Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Health Behavior and Society, Baltimore, Maryland, USA
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152
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Yano Y, Lloyd-Jones DM. USPSTF Recommendations for Screening for Hypertension in Adults: It Is Time to Unmask Hypertensive Risk. JAMA Cardiol 2021; 6:869-871. [PMID: 33904903 DOI: 10.1001/jamacardio.2021.1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina.,Center for Novel and Exploratory Clinical Trials, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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153
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Laffin LJ, Bakris GL. Approach to Resistant Hypertension from Cardiology and Nephrology Standpoints: Tailoring Therapy. Cardiol Clin 2021; 39:377-387. [PMID: 34247751 DOI: 10.1016/j.ccl.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Resistant hypertension is commonly encountered in primary care, cardiology, and nephrology clinics. In patients presenting for the evaluation of resistant hypertension, taking a thoughtful approach to excluding pseudoresistant hypertension or a secondary cause of hypertension is important. When a patient is deemed to have true resistant hypertension, following an evidence-based treatment approach while considering patient-specific comorbidities results not only in better blood pressure control but also better patient long-term adherence to lifestyle and pharmacologic interventions. This article details an approach to the diagnosis and treatment of resistant hypertension with special consideration for patients with preexisting renal and/or cardiovascular disease.
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Affiliation(s)
- Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail code JB1, Cleveland, OH 44195, USA
| | - George L Bakris
- American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 1027, Chicago, IL 60637, USA.
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154
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Ye S, Anstey DE, Grauer A, Metser G, Moise N, Schwartz J, Kronish I, Abdalla M. The Impact of Telemedicine Visits on Controlling High Blood Pressure Quality Measure During the Covid-19 Pandemic: Observational Study (Preprint). JMIR Form Res 2021; 6:e32403. [PMID: 35138254 PMCID: PMC8945081 DOI: 10.2196/32403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/21/2021] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Siqin Ye
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - D Edmund Anstey
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Anne Grauer
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Gil Metser
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Joseph Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Ian Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Marwah Abdalla
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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155
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Fujiwara T, Hoshide S, Kanegae H, Kario K. Clinical Impact of the Maximum Mean Value of Home Blood Pressure on Cardiovascular Outcomes: A Novel Indicator of Home Blood Pressure Variability. Hypertension 2021; 78:840-850. [PMID: 34304579 DOI: 10.1161/hypertensionaha.121.17362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.).,Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
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156
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Eck C, Biola H, Hayes T, Bulgin D, Whitney C, Raman R, Bakovic M, Caesar A, Becerra-Soberon R, Chaplain J, Granger BB. Efficacy of Hypertension Self-Management Classes Among Patients at a Federally Qualified Health Center. Prev Chronic Dis 2021; 18:E70. [PMID: 34264812 PMCID: PMC8300538 DOI: 10.5888/pcd18.200628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Structural racism has contributed to persistent racial disparities in hypertension control, with Black men suffering the highest prevalence of uncontrolled hypertension. Lincoln Community Health Center, our urban Federally Qualified Health Center (FQHC), aimed to use hypertension self-management classes to improve hypertension control among our clinic patients, particularly Black men. Patients attending classes learned about hypertension, were given blood pressure cuffs to use at home, and had the opportunity to speak to physicians in a group setting. We used a nonexperimental quality improvement intervention design to identify baseline differences between participants who attended multiple classes and those who attended only 1 class. Participants who attended multiple classes, most of whom were Black men, achieved an average blood pressure reduction of 19.1/14.8 mm Hg. Although the classes were effective, current policies around health insurance reimbursement and federal quality reporting standards hamper the ability of health care providers to implement such patient education initiatives.
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Affiliation(s)
- Cameron Eck
- Duke-Margolis Center for Health Policy, Durham, North Carolina.,109 Arthur Ln, Durham, NC 27705.
| | - Holly Biola
- Lincoln Community Health Center, Durham, North Carolina
| | - Tiffany Hayes
- Lincoln Community Health Center, Durham, North Carolina
| | - Dominique Bulgin
- Duke University School of Nursing, Durham, North Carolina.,University of Tennessee, Knoxville College of Nursing, Knoxville, Tennessee
| | | | - Rohith Raman
- Lincoln Community Health Center, Durham, North Carolina
| | - Melanie Bakovic
- Duke Clinical and Translational Science Institute, Durham, North Carolina
| | - Awanya Caesar
- Lincoln Community Health Center, Durham, North Carolina
| | | | - Joan Chaplain
- Lincoln Community Health Center, Durham, North Carolina
| | - Bradi B Granger
- Duke-Margolis Center for Health Policy, Durham, North Carolina.,Duke University School of Nursing, Durham, North Carolina
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157
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Randomized feasibility trial of a digital intervention for hypertension self-management. J Hum Hypertens 2021; 36:718-725. [PMID: 34239050 DOI: 10.1038/s41371-021-00574-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55 y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n = 41) or a control group (n = 21). Median follow-up was 22.9 (SD = 6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1 = 52.5, Q3 = 89.6) and sustained over time. The decline in systolic [12 mm Hg (SD = 17)] and diastolic BP [5 mm Hg (SD = 7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate -0.56 (-0.96, -0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.
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158
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most prevalent risk factor for cardiovascular disease (CVD) worldwide, affecting 1.39 billion people. This review discusses recent literature regarding the global burden of HTN and emerging concepts in prevalence, treatment, and control in different regions around the globe. RECENT FINDINGS Community-based interventions and telemedicine may be useful in increasing access to care and identifying/assisting patients with HTN, especially in populations with geographical and economic barriers to healthcare. Home blood pressure monitoring is beneficial for HTN control in diverse regions. Polypills have proven benefits to decrease HTN and CVD risk. Continuation of treatment with angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers in high risk COVID-19 patients appears appropriate. SUMMARY Extensive research demonstrates that early screening/treatment, lifestyle modification, and pharmacotherapy are essential to control HTN worldwide. This review highlights recent research and novel concepts on effective interventions being used globally.
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159
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most common chronic disease impacting over half the US adult population. Our current office-based model of care is failing in its ability to control blood pressure (BP) as only 44% of adult US hypertensives are achieving minimal levels of BP control (< 140/90 mmHg), leading to high rates of preventable cardiovascular events and death. RECENT FINDINGS Reengineering care delivery using a fully digital platform combined with a dedicated team-based approach to HTN management has demonstrated superior BP control rates, very high levels patient acceptance, and the ability to better diagnose and treat masked and white coat HTN. SUMMARY A digital medicine program in the clinical care setting can be an effective and convenient mechanism of delivering HTN management, outperforming traditional office-based care, and is well accepted by patients.
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Affiliation(s)
- Richard V Milani
- Center for Healthcare Innovation
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hector O Ventura
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
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160
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Cohen JB, Hsu CY, Glidden D, Linke L, Palad F, Larson HL, Mehrotra R, Townsend RR, Bansal N. Ambulatory and Home Blood Pressure Monitoring in Hemodialysis Patients: A Mixed-Methods Study Evaluating Comparability and Tolerability of Blood Pressure Monitoring. Kidney Med 2021; 3:457-460. [PMID: 34136793 PMCID: PMC8178468 DOI: 10.1016/j.xkme.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California-San Francisco, San Francisco, CA
| | - David Glidden
- Department of Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Lori Linke
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Farshad Palad
- Division of Nephrology, University of California-San Francisco, San Francisco, CA
| | - Hanna L Larson
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | | | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, WA
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161
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Arrieta A, Woods J, Wozniak G, Tsipas S, Rakotz M, Jay S. Return on investment of self-measured blood pressure is associated with its use in preventing false diagnoses, not monitoring hypertension. PLoS One 2021; 16:e0252701. [PMID: 34143817 PMCID: PMC8213192 DOI: 10.1371/journal.pone.0252701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/20/2021] [Indexed: 01/14/2023] Open
Abstract
Previous research indicates that patient self-measured blood pressure (SMBP) is a cost-effective strategy for improving hypertension (HTN) diagnosis and control. However, it is unknown which specific uses of SMBP produce the most value. Our goal is to estimate, from an insurance perspective, the return-on-investment (ROI) and net present value associated with coverage of SMBP devices when used (a) only to diagnose HTN, (b) only to select and titrate medication, (c) only to monitor HTN treatment, or (d) as a bundle with all three uses combined. We employed national sample of claims data, Framingham risk predictions, and published sensitivity-specificity values of SMBP and clinic blood-pressure measurement to extend a previously-developed local decision-analytic simulation model. We then used the extended model to determine which uses of SMBP produce the most economic value when scaled to the U.S. adult population. We found that coverage of SMBP devices yielded positive ROIs for insurers in the short-run and at lifetime horizon when the three uses of SMBP were considered together. When each use was evaluated separately, positive returns were seen when SMBP was used for diagnosis or for medication selection and titration. However, returns were negative when SMBP was used exclusively to monitor HTN treatment. When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million false positive HTN diagnoses, thereby improving quality of care while saving insurance plans $254 per member. A strong economic case exists for insurers to cover the cost of SMBP devices, but it matters how devices are used.
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Affiliation(s)
- Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - John Woods
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stavros Tsipas
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Michael Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stephen Jay
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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162
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Fu SN, Dao MC, Wong CKH, Cheung BMY. Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter? Postgrad Med J 2021; 98:610-616. [PMID: 34039693 PMCID: PMC9340004 DOI: 10.1136/postgradmedj-2020-139329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 11/04/2022]
Abstract
Background Little is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme. Methods A cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models. Results 287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (−0.3±2.0 kg vs +0.7 ±1.7 kg, p<0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p<0.001). Conclusion Patients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education. Trial registration number NCT02551393.
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Affiliation(s)
- Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon West Cluster, New Territories, Hong Kong
| | - Man Chi Dao
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon West Cluster, New Territories, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Bernard M Y Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
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163
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Abstract
Recently published national data demonstrate inadequate and worsening control of high blood pressure (HBP) in the United States, outcomes that likely have been made even worse by the coronavirus disease 2019 (COVID-19) pandemic. This major public health crisis exposes shortcomings of the US health care delivery system and creates an urgent opportunity to reduce mortality, major cardiovascular events, and costs for 115 million Americans. Ending this crisis will require a more coherent and systemic change to traditional patterns of care. The authors present an evidence-based Blueprint for Change for comprehensive health delivery system redesign based on current national clinical practice guidelines and quality measures. This innovative model includes a systems-based approach to ensuring proper BP measurement, assessment of cardiovascular risk, effective patient-centered team-based care, addressing social determinants of health, and shared decision-making. The authors also propose building on current national quality improvement initiatives designed to better control HBP.
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164
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Bress AP, Cohen JB, Anstey DE, Conroy MB, Ferdinand KC, Fontil V, Margolis KL, Muntner P, Millar MM, Okuyemi KS, Rakotz MK, Reynolds K, Safford MM, Shimbo D, Stuligross J, Green BB, Mohanty AF. Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic. J Am Heart Assoc 2021; 10:e020997. [PMID: 34006116 PMCID: PMC8483507 DOI: 10.1161/jaha.121.020997] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Adam P Bress
- Department of Population Health Sciences Division of Health System Innovation and Research University of Utah School of Medicine Salt Lake City UT
| | - Jordana B Cohen
- Department of Medicine Renal-Electrolyte and Hypertension Division Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - David Edmund Anstey
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | - Molly B Conroy
- Division of General Internal Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | | | - Valy Fontil
- Division of General Internal Medicine Department of Medicine Zuckerberg San Francisco General HospitalUniversity of California San Francisco CA.,Center for Vulnerable Populations Zuckerberg San Francisco General HospitalUniversity of California San Francisco CA
| | | | - Paul Muntner
- Department of Epidemiology School of Public Health University of Alabama at Birmingham Birmingham AL
| | - Morgan M Millar
- Division of General Internal Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT
| | - Kolawole S Okuyemi
- Department of Family & Preventive Medicine University of Utah School of Medicine Salt Lake City UT
| | | | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA Pasadena CA.,Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA
| | - Monika M Safford
- Department of Medicine Joan and Sanford I Weill Medical College of Cornell University New York NY
| | - Daichi Shimbo
- Division of Cardiology Department of Medicine Columbia University Medical Center New York NY
| | | | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute Seattle WA
| | - April F Mohanty
- Division of General Internal Medicine, Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT.,Informatics Decision-Enhancement, and Analytic Sciences Center (IDEAS) VA Salt Lake City Health Care System Salt Lake City UT
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165
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Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2021; 325:1650-1656. [PMID: 33904861 DOI: 10.1001/jama.2021.4987] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Hypertension is a prevalent condition that affects approximately 45% of the adult US population and is the most commonly diagnosed condition at outpatient office visits. Hypertension is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease. OBJECTIVE To reaffirm its 2015 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertension in adults, the accuracy of office blood pressure measurement for initial screening, and the accuracy of various confirmatory blood pressure measurement methods. POPULATION Adults 18 years or older without known hypertension. EVIDENCE ASSESSMENT Using a reaffirmation deliberation process, the USPSTF concludes with high certainty that screening for hypertension in adults has substantial net benefit. RECOMMENDATION The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation).
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Affiliation(s)
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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166
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Marseille BR, Commodore-Mensah Y, Davidson PM, Baker D, D'Aoust R, Baptiste DL. Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study. J Clin Nurs 2021; 30:2960-2967. [PMID: 33872425 DOI: 10.1111/jocn.15803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension. BACKGROUND Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension. DESIGN Pre-test and post-test feasibility study. METHODS A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes. RESULTS Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period. CONCLUSION The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities. RELEVANCE TO CLINICAL PRACTICE Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.
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Affiliation(s)
- Beatrice Remy Marseille
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | | | - Deborah Baker
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rita D'Aoust
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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167
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Andraos J, Munjy L, Kelly MS. Home blood pressure monitoring to improve hypertension control: a narrative review of international guideline recommendations. Blood Press 2021; 30:220-229. [PMID: 33853465 DOI: 10.1080/08037051.2021.1911622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Home blood pressure monitoring (HBPM) is a convenient way to assess out-of-office blood pressure control and is recommended by numerous international guidelines to aid clinicians in the diagnosis and management of essential hypertension. Although available guidelines recommend the use of HBPM in patients receiving antihypertensive medication, their specific recommendations regarding optimal monitoring schedule, duration, and clinician interpretation of home blood pressure readings may differ among guidelines. Purpose: The purpose of this article is to review available international hypertension guideline recommendations related to the use of HBPM to improve hypertension control among patients receiving antihypertensive therapy. We also briefly highlight clinical trials that have shown improved blood pressure control using HBPM to intensify antihypertensive therapy and provide a practical guide for implementing HBPM to improve hypertension control. Results: Eleven international guidelines were identified and reviewed. In total, recommendations relating to which HBPM to use, number of measurements per day, and how to interpret home blood pressure values were largely in agreement among available guidelines. Conclusion: Clinicians recommending HBPM to their patients with hypertension should utilise a standardised HBPM protocol, based on available guideline recommendations.
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Affiliation(s)
- John Andraos
- Cedars-Sinai Medical Network, Los Angeles, CA, USA
| | - Luma Munjy
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, USA
| | - Michael S Kelly
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, USA
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168
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van Dorst DC, Dobbin SJ, Neves KB, Herrmann J, Herrmann SM, Versmissen J, Mathijssen RH, Danser AJ, Lang NN. Hypertension and Prohypertensive Antineoplastic Therapies in Cancer Patients. Circ Res 2021; 128:1040-1061. [PMID: 33793337 PMCID: PMC8011349 DOI: 10.1161/circresaha.121.318051] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of a wide range of novel antineoplastic therapies has improved the prognosis for patients with a wide range of malignancies, which has increased the number of cancer survivors substantially. Despite the oncological benefit, cancer survivors are exposed to short- and long-term adverse cardiovascular toxicities associated with anticancer therapies. Systemic hypertension, the most common comorbidity among cancer patients, is a major contributor to the increased risk for developing these adverse cardiovascular events. Cancer and hypertension have common risk factors, have overlapping pathophysiological mechanisms and hypertension may also be a risk factor for some tumor types. Many cancer therapies have prohypertensive effects. Although some of the mechanisms by which these antineoplastic agents lead to hypertension have been characterized, further preclinical and clinical studies are required to investigate the exact pathophysiology and the optimal management of hypertension associated with anticancer therapy. In this way, monitoring and management of hypertension before, during, and after cancer treatment can be improved to minimize cardiovascular risks. This is vital to optimize cardiovascular health in patients with cancer and survivors, and to ensure that advances in terms of cancer survivorship do not come at the expense of increased cardiovascular toxicities.
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Affiliation(s)
- Daan C.H. van Dorst
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (D.C.H.v.D., J.V., A.H.J.D.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute (D.C.H.v.D., R.H.J.M.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephen J.H. Dobbin
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.J.H.D., K.B.N., N.N.L.)
| | - Karla B. Neves
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.J.H.D., K.B.N., N.N.L.)
| | - Joerg Herrmann
- Department of Cardiovascular Medicine (J.H.), Mayo Clinic, Rochester, MN
| | - Sandra M. Herrmann
- Division of Nephrology and Hypertension (S.M.H.), Mayo Clinic, Rochester, MN
| | - Jorie Versmissen
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (D.C.H.v.D., J.V., A.H.J.D.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Hospital Pharmacy (J.V.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ron H.J. Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute (D.C.H.v.D., R.H.J.M.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A.H. Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (D.C.H.v.D., J.V., A.H.J.D.), Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ninian N. Lang
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.J.H.D., K.B.N., N.N.L.)
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169
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Ferdinand KC, Brown AL. Will the 2021 USPSTF Hypertension Screening Recommendation Decrease or Worsen Racial/Ethnic Disparities in Blood Pressure Control? JAMA Netw Open 2021; 4:e213718. [PMID: 33904917 DOI: 10.1001/jamanetworkopen.2021.3718] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Keith C Ferdinand
- Tulane Heart and Vascular Institute, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Angela L Brown
- Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
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170
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Anstey DE, Bradley C, Shimbo D. USPSTF Recommendation Statement on Hypertension Screening in Adults-Where Do We Go From Here? JAMA Netw Open 2021; 4:e214203. [PMID: 33904916 DOI: 10.1001/jamanetworkopen.2021.4203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Edmund Anstey
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Corey Bradley
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
| | - Daichi Shimbo
- The Columbia Hypertension Center and Lab, Columbia University Irving Medical Center, New York, New York
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171
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Koratala A, Chamarthi G, Touyz RM, Dominiczak AF, Elijovich F, Spence JD, Grim CE, Taler SJ, Mohandas R. Renovascular Hypertension: One Size Does Not Fit All: Challenges in Diagnosis and Management. Hypertension 2021; 77:1022-1028. [PMID: 33689462 DOI: 10.1161/hypertensionaha.121.17022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abhilash Koratala
- From the Division of Nephrology (A.K.), Medical College of Wisconsin, Milwaukee
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (R.T.), University of Glasgow, United Kingdom
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences (A.F.D.), University of Glasgow, United Kingdom
| | - Fernando Elijovich
- Department of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (F.E.)
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Western University, London, Ontario, Canada (J.D.S.)
| | | | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (S.J.T.)
| | - Rajesh Mohandas
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
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172
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Reliability of Office, Home, and Ambulatory Blood Pressure Measurements and Correlation With Left Ventricular Mass. J Am Coll Cardiol 2021; 76:2911-2922. [PMID: 33334418 DOI: 10.1016/j.jacc.2020.10.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Determining the reliability and predictive validity of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) can inform which is best for diagnosing hypertension and estimating risk of cardiovascular disease. OBJECTIVES This study aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons. METHODS The Improving the Detection of Hypertension (IDH) study, a community-based observational study, enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram. Mean age was 41.2 ± 13.1 years, 59.5% were women, 25.5% African American, and 64.0% Hispanic. RESULTS The reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89. After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE]: 1.48) and 3.92 (SE: 2.14) g/m2 higher LVMI, respectively. After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI. CONCLUSIONS OBP, HBP, and ABP assess somewhat distinct parameters. Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI. These data suggest that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.
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173
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Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The "American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update" is a summary document (updated yearly) regarding CVD risk factors. This "ASPC Top Ten CVD Risk Factors 2021 Update" summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the "ASPC Top Ten CVD Risk Factors 2021 Update" to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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174
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Fujiwara T, Hoshide S, Tomitani N, Cheng H, Soenarta AA, Turana Y, Chen C, Minh HV, Sogunuru GP, Tay JC, Wang T, Chia Y, Verma N, Li Y, Wang J, Kario K. Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia. J Clin Hypertens (Greenwich) 2021; 23:457-466. [PMID: 33591641 PMCID: PMC8029527 DOI: 10.1111/jch.14218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/01/2022]
Abstract
Nocturnal home blood pressure (BP) monitoring has been used in clinical practice for ~20 years. The authors recently showed that nocturnal systolic BP (SBP) measured by a home BP monitoring (HBPM) device in a Japanese general practice population was a significant predictor of incident cardiovascular disease (CVD) events, independent of office and morning home SBP levels, and that masked nocturnal hypertension obtained by HBPM (defined as nocturnal home BP ≥ 120/70 mmHg and average morning and evening BP < 135/85 mmHg) was associated with an increased risk of CVD events compared with controlled BP (nocturnal home BP < 120/70 mmHg and average morning and evening BP < 135/85 mmHg). This evidence revealed that (a) it is feasible to use a nocturnal HBPM device for monitoring nocturnal BP levels, and (b) such a device may offer an alternative to ambulatory BP monitoring, which has been the gold standard for the measurement of nocturnal BP. However, many unresolved clinical problems remain, such as the measurement schedule and conditions for the use of nocturnal HBPM. Further investigation of the measurement of nocturnal BP using an HBPM device and assessments of the prognostic value are thus warranted. Asians are at high risk of developing nocturnal hypertension due to high salt sensitivity and salt intake, and the precise management of their nocturnal BP levels is important. Information and communication technology‐based monitoring devices are expected to facilitate the management of nocturnal hypertension in Asian populations.
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Affiliation(s)
- Takeshi Fujiwara
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan
| | - Hao‐min Cheng
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
- Center for Evidence‐Based Medicine Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine Faculty of Medicine University of Indonesia‐National Cardiovascular Center Jakarta Indonesia
| | - Yuda Turana
- Faculty of Medical and Health Sciences Atma Jaya Catholic University of Indonesia Jakarta Indonesia
| | - Chen‐Huan Chen
- Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
| | - Huynh Van Minh
- Department of Internal Medicine University of Medicine and PharmacyHue University Hue Vietnam
| | - Guru Prasad Sogunuru
- Department of Cardiology MIOT International Hospital Chennai India
- College of Medical Sciences Kathmandu University Bharatpur Nepal
| | - Jam Chin Tay
- Department of General Medicine Tan Tock Seng Hospital Singapore Singapore
| | - Tzung‐Dau Wang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital Taipei City Taiwan
- Division of Hospital Medicine Department of Internal Medicine National Taiwan University Hospital Taipei City Taiwan
| | - Yook‐Chin Chia
- Department of Medical Sciences School of Healthcare and Medical Sciences Sunway University Bandar Sunway Malaysia
- Department of Primary Care Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Narsingh Verma
- Department of Physiology King George's Medical University Lucknow India
| | - Yan Li
- Department of Hypertension Centre for Epidemiological Studies and Clinical Trials The Shanghai Institute of Hypertension Shanghai Key Laboratory of Hypertension Ruijin HospitalShanghai Jiaotong University School of Medicine Shanghai China
| | - Ji‐Guang Wang
- Department of Hypertension Centre for Epidemiological Studies and Clinical Trials The Shanghai Institute of Hypertension Shanghai Key Laboratory of Hypertension Ruijin HospitalShanghai Jiaotong University School of Medicine Shanghai China
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan
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175
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Roy D, Meador M, Sasu N, Whelihan K, Lewis JH. Are Community Health Center Patients Interested in Self-Measured Blood Pressure Monitoring (SMBP) - And Can They Do It? Integr Blood Press Control 2021; 14:19-29. [PMID: 33603456 PMCID: PMC7886240 DOI: 10.2147/ibpc.s285007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/16/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Self-measured blood pressure monitoring (SMBP) helps diagnose and manage hypertension from outside the clinic, which has implications for patient empowerment and outcomes, continuity of care, and resilience in care communities catering to vulnerable populations. Methods We instituted a protocol for SMBP among hypertensive patients at 9 community health centers in 3 states and administered questionnaires to patients before and after the protocol was instituted to assess knowledge and engagement with disease management, beliefs and attitudes towards, and experience doing SMBP. Questionnaires included 16 items designed to evaluate patient perceptions and beliefs about SMBP. These included a series of questions using a 5-point Likert scale, binary questions related to their perceived ability to comply with specific SMBP guidelines and open-ended questions to obtain descriptions of experiences with SMBP. Results The pre-questionnaire was completed by 478 patients and the post-questionnaire was completed by 372. Seventy-seven percent of respondents knew their ideal blood pressure and their engagement with blood pressure management increased significantly (p=0.0024) after completing the protocol. Additionally, 85% of respondents said that they had a positive experience doing SMBP. Open-ended responses revealed insight regarding why patients chose to do SMBP and factors patients appreciated about SMBP. Discussion When trained properly and supported, community health center patients are capable of and motivated to perform accurate SMBP. Our study provides evidence that health center patients can follow detailed SMBP protocols and monitor their own blood pressure from the safety of their homes, which is critical to their care continuum, particularly in days of a pandemic.
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Affiliation(s)
- Debosree Roy
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Margaret Meador
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Nana Sasu
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Kate Whelihan
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Joy H Lewis
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
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176
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Lakshminarayan K, Murray TA, Westberg SM, Connett J, Overton V, Nyman JA, Culhane-Pera KA, Pergament SL, Drawz P, Vollbrecht E, Xiong T, Everson-Rose SA. Mobile Health Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Protocol for the mGlide Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25424. [PMID: 33492231 PMCID: PMC7870345 DOI: 10.2196/25424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
Background Suboptimal treatment of hypertension remains a widespread problem, particularly among minorities and socioeconomically disadvantaged groups. We present a health system–based intervention with diverse patient populations using readily available smartphone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. Objective The mGlide randomized controlled trial is a National Institutes of Health–funded study, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between interprofessional health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. Methods We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150), and community medical centers including Federally Qualified Health Centers serving low-income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. Results To date, we have randomized 107 participants (54 intervention, 53 control). Conclusions This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. Trial Registration Clinicaltrials.gov NCT03612271; https://clinicaltrials.gov/ct2/show/NCT03612271 International Registered Report Identifier (IRRID) DERR1-10.2196/25424
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Affiliation(s)
- Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah M Westberg
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Val Overton
- Fairview Health Services, Minneapolis, MN, United States
| | - John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States.,Minnesota Community Care, Saint Paul, MN, United States
| | | | - Paul Drawz
- Division of Renal Disease and Hypertension, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Emily Vollbrecht
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, MN, United States
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177
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Iacopo F, Branch M, Cardinale D, Middeldorp M, Sanders P, Cohen JB, Achirica MC, Jaiswal S, Brown SA. Preventive Cardio-Oncology: Cardiovascular Disease Prevention in Cancer Patients and Survivors. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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178
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Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts. Curr Hypertens Rep 2021; 23:5. [PMID: 33483867 PMCID: PMC7821846 DOI: 10.1007/s11906-020-01121-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To outline intervention efforts focused on reducing hypertension disparities in immigrant communities in the U.S. and to identify areas in the design, implementation, and evaluation of these interventions that warrant further exploration guided by an implementation science framework. RECENT FINDINGS Studies examined (n = 11) included immigrant populations of African, Hispanic, and Asian origin. Men were underrepresented in most studies. Culturally tailored group-based educational sessions in religious or community spaces were common. Intervention agents included research assistants, registered nurses, community health workers, and faith-based organization volunteers. Community stakeholders were engaged in most studies, although most commonly for recruitment efforts. Surveys/interviews were used for intervention evaluation, and documentation of intervention activities and trainings was used to assess fidelity. Identified pathways for further intervention innovation included gender or migration-status-based targeting, diversifying intervention agents, enhancing mixed-method process evaluations, and tailoring to emerging needs during the COVID-19 pandemic.
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179
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Hare AJ, Chokshi N, Adusumalli S. Novel Digital Technologies for Blood Pressure Monitoring and Hypertension Management. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:11. [PMID: 34127936 PMCID: PMC8188759 DOI: 10.1007/s12170-021-00672-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Hypertension is common, impacting an estimated 108 million US adults, and deadly, responsible for the deaths of one in six adults annually. Optimal management includes frequent blood pressure monitoring and antihypertensive medication titration, but in the traditional office-based care delivery model, patients have their blood pressure measured only intermittently and in a way that is subject to misdiagnosis with white coat or masked hypertension. There is a growing opportunity to leverage our expanding repository of digital technology to reimagine hypertension care delivery. This paper reviews existing and emerging digital tools available for hypertension management, as well as behavioral economic insights that could supercharge their impact. RECENT FINDINGS Digitally connected blood pressure monitors offer an alternative to office-based blood pressure monitoring. A number of cuffless blood pressure monitors are in development but require further validation before they can be deployed for widespread clinical use. Patient-facing hubs and applications offer a means to transmit blood pressure data to clinicians. Though artificial intelligence could allow for curation of this data, its clinical use for hypertension remains limited to assessing risk factors at this time. Finally, text-based and telemedicine platforms are increasingly being employed to translate hypertension data into clinical outcomes with promising results. SUMMARY The digital management of hypertension shows potential as an avenue for increasing patient engagement and improving clinical efficiency and outcomes. It is important for clinicians to understand the benefits, limitations, and future directions of digital health to optimize management of hypertension.
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Affiliation(s)
- Allison J Hare
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
| | - Neel Chokshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
| | - Srinath Adusumalli
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
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180
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Padwal R, Wood PW. Digital Health Approaches for the Assessment and Optimisation of Hypertension Care Provision. Can J Cardiol 2020; 37:711-721. [PMID: 33340672 DOI: 10.1016/j.cjca.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Although many aspects of our lives have been transformed by digital innovation, widespread adoption of digital health advancements within the health care sector in general, and for hypertension care specifically, has been limited. However, it is likely that, over the next decade, material increases in the uptake of digital health innovations for hypertension care delivery will be seen. In this narrative review, we summarise those innovations thought to have the greatest chance for impact in the next decade. These include provision of virtual care combined with home blood pressure (BP) telemonitoring, use of digital registries and protocolised care, leveraging continuous BP measurement to collect vast amounts of individual and population-based BP data, and adoption of digital therapeutics to provide low-cost scalable interventions for patients with or at risk for hypertension. Of these, home BP telemonitoring is likely the most ready for implementation, but it needs to be done in a way that enables efficient guideline-concordant care in a cost-effective manner. In addition, efforts must be focused on implementing digital health solutions in a manner that addresses the major challenges to digital adoption. This entails ensuring that innovations are accessible, usable, secure, validated, evidence based, cost-effective, and integrated into the electronic systems that are already used by patients or providers. Increasing the use of broader digital innovations such as artificial/augmented intelligence, data analytics, and interactive voice response is also critically important. The digital revolution holds substantial promise, but success will depend on the ability of collaborative stakeholders to adopt and implement innovative, usable solutions.
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Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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181
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Murphy AR, Suffoletto BP, Muldoon MF. Matchmaking and the Future of Hypertension Management. Circ Cardiovasc Qual Outcomes 2020; 14:e007062. [PMID: 33302716 DOI: 10.1161/circoutcomes.120.007062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew R Murphy
- Department of Medicine (A.R.M.), University of Pittsburgh School of Medicine, PA
| | - Brian P Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, CA (B.P.S.)
| | - Matthew F Muldoon
- Division of Cardiology, Department of Medicine (M.F.M.), University of Pittsburgh School of Medicine, PA.,Heart and Vascular Institute, UPMC Health Care System, Pittsburgh, PA (M.F.M.)
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182
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A small contribution to mitigate the collision of transmissible and chronic diseases, exemplified by the management of hypertension during the COVID-19 pandemic. J Hum Hypertens 2020; 35:387-388. [PMID: 33303952 PMCID: PMC7727092 DOI: 10.1038/s41371-020-00461-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/08/2020] [Accepted: 11/25/2020] [Indexed: 02/01/2023]
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183
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Webel AR, Schexnayder J, Rentrope CR, Bosworth HB, Hileman CO, Okeke NL, Vedanthan R, Longenecker CT. The influence of healthcare financing on cardiovascular disease prevention in people living with HIV. BMC Public Health 2020; 20:1768. [PMID: 33228623 PMCID: PMC7685650 DOI: 10.1186/s12889-020-09896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. METHODS As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. RESULTS Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. CONCLUSIONS With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. TRIAL REGISTRATION Clinical Trial Registration Number: NCT03643705 .
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Affiliation(s)
- Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | - C. Robin Rentrope
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | | | - Corrilynn O. Hileman
- Case Western Reserve University School of Medicine, Cleveland, OH USA
- The MetroHealth System, Cleveland, OH USA
| | | | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, NY USA
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184
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Affiliation(s)
- Jerome M Adams
- Office of the Surgeon General, Department of Health and Human Services, Washington, DC
| | - Janet S Wright
- Office of the Surgeon General, Department of Health and Human Services, Washington, DC
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185
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Abstract
BACKGROUND The prevalence of hypertension (HTN) in Blacks is among the highest in the world. For Black women, 46% experience stage 2 HTN (blood pressure [BP] ≥140/90 mm Hg) as compared with 42% of Black men. Because of higher rates of stage 2 HTN, Black women have greater rates of cardiovascular disease and stroke. For reasons unknown, nonadherence to lifestyle modifications and antihypertensive medications continues. An understudied potential factor associated with poor adherence to the treatment regimen and negative health outcomes is stigma. OBJECTIVE The aim of this study was to gain insight and describe the psychological factor of stigma as an influence on poorly controlled HTN in Black women. METHODS Hypertensive Black women attending a 6-week self-management program were invited to participate in an open-ended questionnaire. Six groups were held with 62 women aged 24 to 70 years, with group size ranging from 10 to 15. Women anonymously wrote their answer to 2 questions to capture individual responses without group persuasion. Data were analyzed using thematic analysis. RESULTS Five themes were generated inductively from the data and included (1) desire to get control, (2) shame and embarrassment, (3) obesity characterizations, (4) stereotype threats, and lastly, (5) disrupted normality. During member checking, younger participants were more vocal about stigma, whereas older participants did not view stigma as problematic. CONCLUSIONS Hypertension stigma could potentially deter adherence to high BP treatment. Further research is needed to explore the prevalence of stigma in this population and its impact on behaviors that hinder BP control.
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186
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Manta C, Jain SS, Coravos A, Mendelsohn D, Izmailova ES. An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID-19. Clin Transl Sci 2020; 13:1034-1044. [PMID: 32866314 PMCID: PMC7719373 DOI: 10.1111/cts.12874] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) global pandemic has shifted how many patients receive outpatient care. Telehealth and remote monitoring have become more prevalent, and measurements taken in a patient's home using biometric monitoring technologies (BioMeTs) offer convenient opportunities to collect vital sign data. Healthcare providers may lack prior experience using BioMeTs in remote patient care, and, therefore, may be unfamiliar with the many versions of BioMeTs, novel data collection protocols, and context of the values collected. To make informed patient care decisions based on the biometric data collected remotely, it is important to understand the engineering solutions embedded in the products, data collection protocols, form factors (physical size and shape), data quality considerations, and availability of validation information. This article provides an overview of BioMeTs available for collecting vital signs (temperature, heart rate, blood pressure, oxygen saturation, and respiratory rate) and discusses the strengths and limitations of continuous monitoring. We provide considerations for remote data collection and sources of validation information to guide BioMeT use in the era of COVID-19 and beyond.
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Affiliation(s)
- Christine Manta
- Elektra LabsBostonMassachusettsUSA
- Digital Medicine SocietyBostonMassachusettsUSA
| | - Sneha S. Jain
- Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Andrea Coravos
- Elektra LabsBostonMassachusettsUSA
- Digital Medicine SocietyBostonMassachusettsUSA
- Harvard‐MIT Center for Regulatory ScienceBostonMassachusettsUSA
| | - Dena Mendelsohn
- Elektra LabsBostonMassachusettsUSA
- Digital Medicine SocietyBostonMassachusettsUSA
| | - Elena S. Izmailova
- Digital Medicine SocietyBostonMassachusettsUSA
- Koneksa HealthNew YorkNew YorkUSA
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187
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Taguchi S, Tamura K. Afternoon blood pressure increase on home blood pressure measurement: A forgotten entity? J Clin Hypertens (Greenwich) 2020; 22:2202-2203. [PMID: 33058448 DOI: 10.1111/jch.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Shiniya Taguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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188
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Gong S, Xu Y, Ye R, Liu K, Li J, Yang C, Yan X, Chen X. Peak blood pressure-guided monitoring may serve as an effective approach for blood pressure control in the out-of-office setting. J Clin Hypertens (Greenwich) 2020; 22:2192-2201. [PMID: 33058413 DOI: 10.1111/jch.14080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023]
Abstract
We aimed to explore whether diurnal blood pressure (BP) peak characteristics have a significant influence on the association between left ventricular damage with the two BP components (morning BP vs. afternoon peak BP) in untreated hypertensives. This cross-sectional study included 1084 hypertensives who underwent echocardiography and 24-h ambulatory BP monitoring. Participants were stratified according to the relationship between morning systolic BP (MSBP; average SBP within 2 h of waking up) and afternoon peak systolic BP (ASBP; average SBP between 16:00 and 18:00). Afternoon and morning hypertension was defined as ≥ 135/85 mm Hg. The morning and afternoon peak BPs occurred at around 7:00 and 17:00, respectively. In general hypertensives, morning BP and afternoon peak BP are significantly different in absolute values (for binary SBP, McNemar's χ2 = 6.42; p = .014). ASBP was more pronounced than MSBP in 602 patients (55.5%), in whom 24-h SBP showed higher consistency with ASBP than with MSBP (Kappa value: 0.767 vs 0.646, both p < .01). In subjects with ASBP ≥ MSBP, ASBP was associated with left ventricular hypertrophy independent of MSBP (logistic regression analysis odds ratio: 1.046, p < .01), and left ventricular mass index was more strongly correlated with ASBP than with MSBP (multiple regression coefficient β: 0.453, p < .01), in which the relationships held true independently of 24-h SBP. The opposite results were obtained in subjects with MSBP > ASBP. Peak BP-guided monitoring may serve as an effective approach to out-of-office hypertension monitoring and control, providing the best consistency with 24-h average SBP and highest discrimination performance for target organ damage, independently of 24-h SBP.
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Affiliation(s)
- Shenzhen Gong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiangbo Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Changqiang Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Yan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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189
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Affiliation(s)
- Jordana B. Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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190
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Shan R, Ding J, Weng D, Spaulding EM, Wongvibulsin S, Lee MA, Demo R, Marvel FA, Martin SS. Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology. Am J Prev Cardiol 2020; 3:100089. [PMID: 32964212 PMCID: PMC7497394 DOI: 10.1016/j.ajpc.2020.100089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Objective There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. Methods In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. Results Sixty-eight AMI patients (mean age 58 ± 10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3–64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3–87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17–2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6–5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5–20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. Conclusion The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health. Digital health reveals home blood pressure trends during early recovery after an event. ~40% of early MI patients had mean daily blood pressure exceeding the guideline goal of <130/80 mmHg. Hypotension occurred rarely over 30 days post-MI. The gap in BP control was especially large in patients in whom MI represented recurrent CVD. There is opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.
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Affiliation(s)
- Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jie Ding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M. Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
- Corresponding author. Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States.
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191
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Sharman JE, Padwal R, Campbell NRC. Global Marketing and Sale of Accurate Cuff Blood Pressure Measurement Devices. Circulation 2020; 142:321-323. [PMID: 32718253 DOI: 10.1161/circulationaha.120.046205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (J.E.S.)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada (R.P.)
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (N.R.C.C.)
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