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Verma N, Matsushita N, Salman E, Ohkubo T, Imai Y. GeogRaphic and socioecoNomic Distribution of real-world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India. J Clin Hypertens (Greenwich) 2023; 25:1105-1134. [PMID: 37909858 PMCID: PMC10710551 DOI: 10.1111/jch.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 11/03/2023]
Abstract
One-fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti-hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the "true BP control rate" should be performed using both clinic BP measurement and out-of-office BP measurement as the latter shows better prognosis for patients' hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan-India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.
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Affiliation(s)
- Narsingh Verma
- Department of PhysiologyOfficiating Head Department of Family MedicineKing George's Medical UniversityLucknowIndia
| | - Noriko Matsushita
- Global Medical AffairsAsia Pacific RegionalOmron Healthcare Singapore, Pte. Ltd.Alexandra TechnoParkSingapore
| | - Ebtehal Salman
- Technical Development HQClinical Development DepartmentOmron Healthcare Co., Ltd.MukoKyotoJapan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public HealthTeikyo University School of MedicineItabashi‐kuTokyoJapan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood PressureStation Plaza BuildingSendaiMiyagiJapan
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2
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Shah A, Kapcin K, Deicke M, Pappan N, Holden K, Routray SK, Schmetzer A, DuMont T, Nashar K, Bajwa O, Ivanova V. Hypertension in Women and Pregnancy. Crit Care Nurs Q 2023; 46:377-390. [PMID: 37684733 DOI: 10.1097/cnq.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Hypertension has been shown to have long-term cardiovascular effects if left untreated. Hypertension also has been shown to affect women during pregnancy, which can be detrimental not only to the patient but also to the fetus. Early identification and treatment are paramount to prevent adverse outcomes. This article details the epidemiology, clinical presentation, diagnosis, and treatment of essential hypertension in women, gestational hypertension, preeclampsia, and eclampsia.
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Affiliation(s)
- Aaisha Shah
- Divisions of Internal Medicine (Drs Shah, Kapcin, and Deicke), Pulmonary and Critical Care (Drs Holden, Schmetzer, and DuMont), Nephrology and Critical Care Medicine (Dr Routray), Nephrology (Dr Nashar), and Pulmonary and Critical Care Medicine (Dr Bajwa), Allegheny Health Network Medicine Institute, Pittsburgh, Pennsylvania; and Division of Cardiovascular Disease, Allegheny Health Network Cardiovascular Institute (Drs Pappan and Ivanova)
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3
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Mancusi C, Bisogni V, Maloberti A, Manzi MV, Visco V, Biolcati M, Giani V, Spannella F, Monticone S, Saladini F, Rivasi G, Turrin G, Pucci G, Pengo M, Bertacchini F, Ferri C, Grassi G, Muiesan ML, Fucile I, Sorvillo G, Grieco F, Jacobitti G, Di Costanzo A, Vittoria Govetosa M, D’Avino G, D’Agosto D, Schiavi P, Biondini S, Ristori L. Accuracy of home blood pressure measurement: the ACCURAPRESS study – a proposal of Young Investigator Group of the Italian Hypertension Society (Società Italiana dell’Ipertensione Arteriosa). Blood Press 2022; 31:297-304. [DOI: 10.1080/08037051.2022.2137461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Bisogni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- ASST GOM Niguarda Hospital, Milan, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Marco Biolcati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Valentina Giani
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Silvia Monticone
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Martino Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabio Bertacchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Ferri
- MeSVA Department and San Salvatore Hospital, UOC Internal Medicine and Nephrology, University of L’Aquila, L’Aquila, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Fucile
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Gianmarco Sorvillo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Fabrizia Grieco
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giulia Jacobitti
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Anita Di Costanzo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Maria Vittoria Govetosa
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giuseppina D’Avino
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Domenico D’Agosto
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
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Sang Z, Zeng X, Yuan X, Wang X, Fu L, Zhuang W. Association of Office and Ambulatory Blood Pressure with Left Ventricular Structure and Function in Hypertensive Patients. Int J Gen Med 2022; 15:4649-4656. [PMID: 35548589 PMCID: PMC9081003 DOI: 10.2147/ijgm.s357508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Zhuo Sang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
- Correspondence: Zhuo Sang, Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China, Tel +86-752-2288288, Email
| | - Xianli Zeng
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Xiaohui Yuan
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Xiaolin Wang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Liancong Fu
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
| | - Wenwen Zhuang
- Department of General Practice, Huizhou Municipal Central Hospital, Huizhou, Guangdong, People’s Republic of China
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Leite-Santos NC, de Melo DO, Mantovani-Silva RA, Gabriel FC, Fornasari GS, Dórea EL, Molino CDGRC, Ribeiro E. Guidelines for hypertension management in primary care: is local adaptation possible? J Hypertens 2020; 38:2059-2073. [PMID: 32890283 DOI: 10.1097/hjh.0000000000002516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypertension affects more than one billion people worldwide. There has been much discussion about clinical practice guidelines (CPGs) following the proposal of lower thresholds for starting pharmacological treatment. Some smaller groups or institutions could benefit from adapting CPGs to their local context, a process that requires high-quality CPGs with few points of conflict in their recommendations. To address this issue, we have compared high-quality hypertension CPGs and highlighted conflicting recommendations. METHODS CPGs were searched in MEDLINE, Embase, the Cochrane Library, as well as specific websites. Only CPGs published between 2016 and 2019 were included. We defined CPGs as high-quality if the 'rigor of development' and 'editorial independence' AGREE II domains were scored at least 60%. We compared recommendations made by high-quality CPGs and highlighted areas of conflict (defined as disagreements between more than two CPGs). RESULTS Nineteen CPGs were identified. The highest scoring domain was 'scope and purpose' (74.3%) and the lowest scoring was 'applicability' (40.0%). Eight CPGs were rated as high quality. Most CPG recommendations on the management of hypertension were consistent. Conflicting recommendations were regarding blood pressure (BP) levels to initiate pharmacotherapy and therapeutic goals, particularly in patients with low cardiovascular risk and older patients. CONCLUSION It is possible to adapt hypertension CPGs once high-quality documents have been identified with agreement between most recommendations. Guideline developers can focus on the adaption process and concentrate efforts on implementation.
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Affiliation(s)
| | - Daniela O de Melo
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo
| | - Rafael A Mantovani-Silva
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo
| | - Franciele C Gabriel
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo
| | - Guido S Fornasari
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Egídio L Dórea
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline de G R C Molino
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - Eliane Ribeiro
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo
- Departamento de Farmácia e Laboratório Clínico do Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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Cohen JB, Geara AS, Hogan JJ, Townsend RR. Hypertension in Cancer Patients and Survivors: Epidemiology, Diagnosis, and Management. JACC CardioOncol 2019; 1:238-251. [PMID: 32206762 PMCID: PMC7089580 DOI: 10.1016/j.jaccao.2019.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Cancer patients and survivors of cancer have a greater burden of cardiovascular disease compared to the general population. Much of the elevated cardiovascular risk in these individuals is likely attributable to hypertension, as individuals with cancer have a particularly high incidence of hypertension following cancer diagnosis. Treatment with chemotherapy is an independent risk factor for hypertension due to direct effects of many agents on endothelial function, sympathetic activity, and renin-angiotensin system activity as well as nephrotoxicity. Diagnosis and management of hypertension in cancer patients requires accurate blood pressure measurement and consideration of potential confounding factors, such as adjuvant treatments and acute pain, that can temporarily elevate blood pressure readings. Home blood pressure monitoring can be a useful tool to facilitate longitudinal blood pressure monitoring for titration of antihypertensive medications. Selection of antihypertensive agents in cancer patients should account for treatment-specific morbidities and target organ injury.
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Affiliation(s)
- Jordana B. Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abdallah S. Geara
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan J. Hogan
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond R. Townsend
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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The medical treatment of radioiodine-refractory differentiated thyroid cancers in 2019. A TUTHYREF® network review. Bull Cancer 2019; 106:812-819. [DOI: 10.1016/j.bulcan.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/07/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
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Abstract
Recent guidelines on diagnosis and management of high blood pressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with high BP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals, and a different approach to resistant hypertension. Finally, differences among guidelines, the persistent controversies that have led to them, and their implications for clinical practice are discussed.
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Affiliation(s)
| | - Robert D Brook
- University of Michigan, Ann Arbor, Michigan (J.B.B., R.D.B.)
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Guthrie NL, Berman MA, Edwards KL, Appelbaum KJ, Dey S, Carpenter J, Eisenberg DM, Katz DL. Achieving Rapid Blood Pressure Control With Digital Therapeutics: Retrospective Cohort and Machine Learning Study. JMIR Cardio 2019; 3:e13030. [PMID: 31758792 PMCID: PMC6834235 DOI: 10.2196/13030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/17/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Behavioral therapies, such as electronic counseling and self-monitoring dispensed through mobile apps, have been shown to improve blood pressure, but the results vary and long-term engagement is a challenge. Machine learning is a rapidly advancing discipline that can be used to generate predictive and responsive models for the management and treatment of chronic conditions and shows potential for meaningfully improving outcomes. OBJECTIVE The objectives of this retrospective analysis were to examine the effect of a novel digital therapeutic on blood pressure in adults with hypertension and to explore the ability of machine learning to predict participant completion of the intervention. METHODS Participants with hypertension, who engaged with the digital intervention for at least 2 weeks and had paired blood pressure values, were identified from the intervention database. Participants were required to be ≥18 years old, reside in the United States, and own a smartphone. The digital intervention offers personalized behavior therapy, including goal setting, skill building, and self-monitoring. Participants reported blood pressure values at will, and changes were calculated using averages of baseline and final values for each participant. Machine learning was used to generate a model of participants who would complete the intervention. Random forest models were trained at days 1, 3, and 7 of the intervention, and the generalizability of the models was assessed using leave-one-out cross-validation. RESULTS The primary cohort comprised 172 participants with hypertension, having paired blood pressure values, who were engaged with the intervention. Of the total, 86.1% participants were women, the mean age was 55.0 years (95% CI 53.7-56.2), baseline systolic blood pressure was 138.9 mmHg (95% CI 136.6-141.3), and diastolic was 86.2 mmHg (95% CI 84.8-87.7). Mean change was -11.5 mmHg for systolic blood pressure and -5.9 mmHg for diastolic blood pressure over a mean of 62.6 days (P<.001). Among participants with stage 2 hypertension, mean change was -17.6 mmHg for systolic blood pressure and -8.8 mmHg for diastolic blood pressure. Changes in blood pressure remained significant in a mixed-effects model accounting for the baseline systolic blood pressure, age, gender, and body mass index (P<.001). A total of 43% of the participants tracking their blood pressure at 12 weeks achieved the 2017 American College of Cardiology/American Heart Association definition of blood pressure control. The 7-day predictive model for intervention completion was trained on 427 participants, and the area under the receiver operating characteristic curve was .78. CONCLUSIONS Reductions in blood pressure were observed in adults with hypertension who used the digital therapeutic. The degree of blood pressure reduction was clinically meaningful and achieved rapidly by a majority of the studied participants. Greater improvement was observed in participants with more severe hypertension at baseline. A successful proof of concept for using machine learning to predict intervention completion was presented.
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Affiliation(s)
| | - Mark A Berman
- Better Therapeutics, San Francsico, CA, United States
| | | | | | - Sourav Dey
- Manifold, Inc, Oakland, CA, United States
| | | | - David M Eisenberg
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - David L Katz
- Better Therapeutics, San Francsico, CA, United States
- Yale-Griffin Prevention Research Center, Griffin Hospital, Yale School of Public Health, Derby, CT, United States
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