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Lee J, Wang X, Liu C, Pathiravasan CH, Benjamin EJ, McManus DD, Murabito JM. Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:50-58. [PMID: 38765623 PMCID: PMC11096660 DOI: 10.1016/j.cvdhj.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. Objective To investigate the association between depressive symptoms and digital home BP. Methods Electronic Framingham Heart Study (eFHS) participants were invited to obtain a smartphone app and digital BP cuff at research exam 3 (2016-2019). Participants with ≥3 weeks of home BP measurements within 1 year were included. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear mixed models were used to test the associations of continuous CES-D score and dichotomous depressive symptoms (CES-D ≥16) (independent) with home BP (dependent), adjusting for age, sex, cohort, number of weeks since baseline, lifestyle factors, diabetes, and cardiovascular disease. Results Among 883 participants (mean age 54 years, 59% women, 91% White), the median CES-D score was 4. Depressive symptom prevalence was 7.6%. Mean systolic and diastolic BP at exam 3 were 119 and 76 mm Hg; hypertension prevalence was 48%. A 1 SD higher CES-D score was associated with 0.9 (95% CI: 0.18-1.56, P = .01) and 0.6 (95% CI: 0.06-1.07, P = .03) mm Hg higher home systolic BP and diastolic BP, respectively. Dichotomous depressive symptoms were not significantly associated with home BP (P > .2). Conclusion Depressive symptoms were not associated with clinically substantive levels of home BP. The association between depression and cardiovascular disease risk factors warrants more data, which may be supported by mobile health measures.
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Affiliation(s)
- Jasmine Lee
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Xuzhi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | | | - Emelia J. Benjamin
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - David D. McManus
- University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Joanne M. Murabito
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
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Tian X, Li Y, Solomon DH. How Do Qualities of Supportive Conversations Affect Heart Rate Variability During Conversations About the Death of a Parent? HEALTH COMMUNICATION 2023:1-16. [PMID: 37654001 DOI: 10.1080/10410236.2023.2252639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
This study examined the impact of person-centered communication on bereaved young adults' physiological stress responses when they talked about the death of their parent. Heart rate variability - indexed by the standard deviation of the normal-to-normal intervals (SDNN), the root mean square of successive differences (rMSSD), and the heart rate variability index (HRVi) - was monitored before, during, and after the interaction as an objective measure of stress reactivity and recovery. The final sample included 69 subjects, and they conversed with research confederates who provided varying levels of person-centered support. The results showed that participants who received highly person-centered support experienced faster stress recovery, as indicated by increased HRVi, compared to those who received moderately or low person-centered support. Bereaved adults' SDNN during the interaction was positively associated with subjective evaluations of cognitive reappraisal, emotional improvement, and support quality. The discussion highlights the significance of supportive interactions on physiological, psychological, and emotional well-being.
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Affiliation(s)
- Xi Tian
- Department of Communication, University of Delaware
| | - Yuwei Li
- Department of Communication Arts and Sciences, Penn State University
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Dube SR, Dube M, Damle S, Patil A. Ambulatory Blood Pressure Monitoring: Our Experience in Routine Clinical Practice. Cureus 2021; 13:e17390. [PMID: 34584800 PMCID: PMC8457258 DOI: 10.7759/cureus.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To evaluate feasibility and usefulness of ambulatory blood pressure monitoring (ABPM) in outpatient setting. Material and methods: In this prospective study, data of 58 patients who were evaluated with ABPM for diagnosis or therapeutic efficacy purpose were collected from their records. Demographic details of these were recorded. Patients were categorized into different categories based on 24 hours BP pattern. Dipping pattern was compared based on the gender, age, and presence of diabetes or hypertension. Number of patients diagnosed as hypertensive with ABPM reports was compared with office and home BP measurement. Results: Fifty-eight patients (mean age 57.8 years; 70.69% males) were included of whom 22 (37.93%) underwent ABPM for diagnostic purposes. There was gender-wise significant difference in terms of purpose of performing ABPM (p=0.040). Diabetes was present in 22 (37.93%) patients. Out of 36 known hypertensive patients, 17 (47.22%) patients were receiving dual therapy. Out of 45 patients whose records for active BP variability were available, 26 (57.78%) had high variability. The number and percentage of dippers, extreme dippers and reverse dippers as 23 (42.79%), three (5.56%), and six (11.11%), respectively. Depending on the age, there was significant difference in the dipping pattern (p=0.013). On office blood pressure measurement, 35 (64.81%) patients were found to have hypertension. ABPM revealed hypertension in 32 (59.26%). Masked hypertension and white-coat hypertension was observed in nine (16.17%) and 12 (22.22%) patients, respectively. Conclusion: ABPM is feasible and useful in routine outpatient clinical practice for diagnosis of essential hypertension, pattern of dipping, masked hypertension, and white-coat hypertension and also for the therapeutic evaluation of patients in clinical practice.
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Affiliation(s)
- Sunil R Dube
- Medicine, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
| | - Manjree Dube
- Family Physician, Shyamlata Clinic, Chembur, Mumbai, IND
| | - Sayali Damle
- Geriatrics, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
| | - Anant Patil
- Pharmacology, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
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Ganti V, Carek AM, Jung H, Srivatsa AV, Cherry D, Johnson LN, Inan OT. Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e27466. [PMID: 34338646 PMCID: PMC8369375 DOI: 10.2196/27466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. OBJECTIVE In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)-based device for monitoring BP in a diverse population. METHODS We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. RESULTS Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. CONCLUSIONS Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.
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Affiliation(s)
- Venu Ganti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrew M Carek
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hewon Jung
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Adith V Srivatsa
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | | | | | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Quan X, Liu J, Roxlo T, Siddharth S, Leong W, Muir A, Cheong SM, Rao A. Advances in Non-Invasive Blood Pressure Monitoring. SENSORS (BASEL, SWITZERLAND) 2021; 21:s21134273. [PMID: 34206457 PMCID: PMC8271585 DOI: 10.3390/s21134273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 01/30/2023]
Abstract
This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary studies on a range of patient populations and discuss the accuracy and limitations of this capacitive-based technology and its potential application in hospitals and communities.
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Affiliation(s)
- Xina Quan
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
- Correspondence: ; Tel.: +1-408-216-0099
| | - Junjun Liu
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Thomas Roxlo
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Siddharth Siddharth
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Weyland Leong
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Arthur Muir
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - So-Min Cheong
- Department of Geography & Atmospheric Science, University of Kansas, Lawrence, KS 66045, USA;
| | - Anoop Rao
- Department of Pediatrics, Neonatology, Stanford University, Palo Alto, CA 94304, USA;
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Ganti VG, Carek AM, Nevius BN, Heller JA, Etemadi M, Inan OT. Wearable Cuff-Less Blood Pressure Estimation at Home via Pulse Transit Time. IEEE J Biomed Health Inform 2021; 25:1926-1937. [PMID: 32881697 PMCID: PMC8221527 DOI: 10.1109/jbhi.2020.3021532] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We developed a wearable watch-based device to provide noninvasive, cuff-less blood pressure (BP) estimation in an at-home setting. METHODS The watch measures single-lead electrocardiogram (ECG), tri-axial seismocardiogram (SCG), and multi-wavelength photoplethysmogram (PPG) signals to compute the pulse transit time (PTT), allowing for BP estimation. We sent our custom watch device and an oscillometric BP cuff home with 21 healthy subjects, and captured the natural variability in BP over the course of a 24-hour period. RESULTS After calibration, our Pearson correlation coefficient (PCC) of 0.69 and root-mean-square-error (RMSE) of 2.72 mmHg suggest that noninvasive PTT measurements correlate with around-the-clock BP. Using a novel two-point calibration method, we achieved a RMSE of 3.86 mmHg. We further demonstrated the potential of a semi-globalized adaptive model to reduce calibration requirements. CONCLUSION This is, to the best of our knowledge, the first time that BP has been comprehensively estimated noninvasively using PTT in an at-home setting. We showed a more convenient method for obtaining ambulatory BP than through the use of the standard oscillometric cuff. We presented new calibration methods for BP estimation using fewer calibration points that are more practical for a real-world scenario. SIGNIFICANCE A custom watch (SeismoWatch) capable of taking multiple BP measurements enables reliable remote monitoring of daily BP and paves the way towards convenient hypertension screening and management, which can potentially reduce hospitalizations and improve quality of life.
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Paccione CE, Diep LM, Stubhaug A, Jacobsen HB. Motivational nondirective resonance breathing versus transcutaneous vagus nerve stimulation in the treatment of fibromyalgia: study protocol for a randomized controlled trial. Trials 2020; 21:808. [PMID: 32967704 PMCID: PMC7510318 DOI: 10.1186/s13063-020-04703-6] [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: 04/28/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic widespread pain (CWP), including fibromyalgia (FM), affects one in every ten adults and is one of the leading causes of sick leave and emotional distress. Due to an unclear etiology and a complex pathophysiology, FM is a condition with few, if any, effective and safe treatments. However, current research within the field of vagal nerve innervation suggests psychophysiological and electrical means by which FM may be treated. This study will investigate the efficacy of two different noninvasive vagal nerve stimulation techniques for the treatment of FM. METHODS The study will use a randomized, single-blind, sham-controlled design to investigate the treatment efficacy of motivational nondirective resonance breathing (MNRB™) and transcutaneous vagus nerve stimulation (Nemos® tVNS) on patients diagnosed with FM. Consenting FM patients (N = 112) who are referred to the Department of Pain Management and Research at Oslo University Hospital, in Oslo, Norway, will be randomized into one of four independent groups. Half of these participants (N = 56) will be randomized to either an experimental tVNS group or a sham tVNS group. The other half (N = 56) will be randomized to either an experimental MNRB group or a sham MNRB group. Both active and sham treatment interventions will be delivered twice per day at home, 15 min/morning and 15 min/evening, for a total duration of 2 weeks (14 days). Participants are invited to the clinic twice, once for pre- and once for post-intervention data collection. The primary outcome is changes in photoplethysmography-measured heart rate variability. Secondary outcomes include self-reported pain intensity on a numeric rating scale, changes in pain detection threshold, pain tolerance threshold, and pressure pain limit determined by computerized pressure cuff algometry, blood pressure, and health-related quality of life. DISCUSSION The described randomized controlled trial aims to compare the efficacy of two vagal nerve innervation interventions, MNRB and tVNS, on heart rate variability and pain intensity in patients suffering from FM. This project tests a new and potentially effective means of treating a major public and global health concern where prevalence is high, disability is severe, and treatment options are limited. TRIAL REGISTRATION ClinicalTrials.gov NCT03180554 . Registered on August 06, 2017.
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Affiliation(s)
- Charles Ethan Paccione
- Doctoral Fellow in Medicine and Health Sciences, Faculty of Medicine, University of Oslo, Klaus Torgårds 3, 0372 Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
| | - Lien My Diep
- Oslo Center for Biostatistics and Epidemiology, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
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Picchiottino M, Leboeuf-Yde C, Gagey O, Hallman DM. The acute effects of joint manipulative techniques on markers of autonomic nervous system activity: a systematic review and meta-analysis of randomized sham-controlled trials. Chiropr Man Therap 2019; 27:17. [PMID: 30911373 PMCID: PMC6413458 DOI: 10.1186/s12998-019-0235-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background The autonomic nervous system (ANS) interests many chiropractors and manual therapists, because joint manipulative techniques (JMT), e.g. high velocity low amplitude (HVLA) manipulations and mobilizations, appear to produce acute changes in ANS mediated physiology. The complexity of this issue justifies a systematic critical literature review. Objective To review the literature comparing the acute changes in markers of ANS activity between JMT applied on spinal or peripheral joints and a sham procedure in healthy or symptomatic subjects. Method We searched PsycINFO, PEDro, PubMed, Cochrane library, EMBASE, and Medline up to December 2017. We updated the search with PubMed, Cochrane library, EMBASE, and Medline including July 2018. Inclusion criteria were: randomized sham-controlled trials assessing the effect of JMT on markers of ANS activity; manually applied JMT, regardless of technique, applied on either healthy or symptomatic humans; outcome measurements recorded at baseline and repeated during and/or after interventions. Selection of articles and data extraction were performed independently by two reviewers. The quality of studies was assessed using the Cochrane ‘risk of bias’ tool and a technical check-list. Results were reported narratively with some meta-analyses. The Cochrane GRADE approach was used to assess the certainty of evidence. Results Twenty-nine of 2267 studies were included in the synthesis. Mobilizations (oscillatory technique) probably produce an immediate and short-term, bilateral increase in skin sympathetic nerve activity (reflected by an increase in skin conductance) regardless of the area treated (moderate-certainty evidence). It is uncertain whether the sympathetic arousal also explains an increase in respiratory rate (very low-certainty evidence). Our evaluation of the literature suggests that spinal sustained apophyseal glides (SNAGs) mobilization and HVLA manipulation of the spine may have no acute effect on the studied markers of ANS activity (very low- to low-certainty evidence). Conclusion Some types of mobilizations probably produce an immediate and short-term, statistically significant increase in skin sympathetic nerve activity when compared to a sham procedure, whereas spinal SNAGs and spinal HVLA techniques may have no acute effect on the studied markers of ANS activity. No region-specific results were noted. The literature suffers from several shortcomings, for which reason we strongly suggest further research. Electronic supplementary material The online version of this article (10.1186/s12998-019-0235-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mathieu Picchiottino
- 1CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay Cedex, France.,2CIAMS, Université d'Orléans, Orléans, France.,Institut Franco-européen de Chiropraxie (IFEC), Ivry-sur-Seine, France
| | - Charlotte Leboeuf-Yde
- 1CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay Cedex, France.,2CIAMS, Université d'Orléans, Orléans, France.,Institut Franco-européen de Chiropraxie (IFEC), Ivry-sur-Seine, France.,4Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Olivier Gagey
- 1CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay Cedex, France.,2CIAMS, Université d'Orléans, Orléans, France
| | - David M Hallman
- 5Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
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Morawski K, Ghazinouri R, Krumme A, McDonough J, Durfee E, Oley L, Mohta N, Juusola J, Choudhry NK. Rationale and design of the Medication adherence Improvement Support App For Engagement-Blood Pressure (MedISAFE-BP) trial. Am Heart J 2017; 186:40-47. [PMID: 28454831 DOI: 10.1016/j.ahj.2016.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertension is a major contributor to the health and economic burden imposed by stroke, heart disease, and renal insufficiency. Antihypertensives can prevent many of the harmful effects of elevated blood pressure, but medication nonadherence is a known barrier to the effectiveness of these treatments. Smartphone-based applications that remind patients to take their medications, provide education, and allow for social interactions between individuals with similar health concerns have been widely advocated as a strategy to improve adherence but have not been subject to rigorous testing. METHODS/DESIGN The MedISAFE-BP study is a prospective, randomized control trial designed to evaluate the impact on blood pressure and medication adherence of an mhealth application (Medisafe). Four hundred thirteen patients with uncontrolled hypertension have been enrolled and randomized in a 1:1 fashion to usual care or to the use of the Medisafe mhealth platform. Patients will be followed up for 12 weeks and the trial's co-primary outcomes will be change in systolic blood pressure and self-reported medication adherence. DISCUSSION The MedISAFE-BP trial is the first study to rigorously evaluate an mhealth application's effect on blood pressure and medication adherence. The results will inform the potential effectiveness of this simple system in improving cardiovascular disease risk factors and clinical outcomes.
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Affiliation(s)
- Kyle Morawski
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Roya Ghazinouri
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alexis Krumme
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Julianne McDonough
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | - Namita Mohta
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol 2017; 8:213. [PMID: 28265249 PMCID: PMC5316555 DOI: 10.3389/fpsyg.2017.00213] [Citation(s) in RCA: 952] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023] Open
Abstract
Psychophysiological research integrating heart rate variability (HRV) has increased during the last two decades, particularly given the fact that HRV is able to index cardiac vagal tone. Cardiac vagal tone, which represents the contribution of the parasympathetic nervous system to cardiac regulation, is acknowledged to be linked with many phenomena relevant for psychophysiological research, including self-regulation at the cognitive, emotional, social, and health levels. The ease of HRV collection and measurement coupled with the fact it is relatively affordable, non-invasive and pain free makes it widely accessible to many researchers. This ease of access should not obscure the difficulty of interpretation of HRV findings that can be easily misconstrued, however, this can be controlled to some extent through correct methodological processes. Standards of measurement were developed two decades ago by a Task Force within HRV research, and recent reviews updated several aspects of the Task Force paper. However, many methodological aspects related to HRV in psychophysiological research have to be considered if one aims to be able to draw sound conclusions, which makes it difficult to interpret findings and to compare results across laboratories. Those methodological issues have mainly been discussed in separate outlets, making difficult to get a grasp on them, and thus this paper aims to address this issue. It will help to provide psychophysiological researchers with recommendations and practical advice concerning experimental designs, data analysis, and data reporting. This will ensure that researchers starting a project with HRV and cardiac vagal tone are well informed regarding methodological considerations in order for their findings to contribute to knowledge advancement in their field.
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Affiliation(s)
- Sylvain Laborde
- Institute of Psychology, Department of Performance Psychology, German Sport University CologneCologne, Germany; Normandie Université Caen, UFR STAPS, EA 4260Caen, France
| | - Emma Mosley
- Southampton Solent UniversitySouthampton, UK; Bournemouth UniversityBournemouth, UK
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Serrat-Costa M, Baltasar Bagué A, Machado Velasco R, Juvinyà Canal D, Bertran Noguer C, Ricart W. Are nurses sufficiently well prepared to take on the detection of hypertension? HIPERTENSION Y RIESGO VASCULAR 2016; 33:126-132. [PMID: 27443260 DOI: 10.1016/j.hipert.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/11/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The detection of arterial hypertension requires training and knowledge by the responsible health professional. The current guidelines recommend doctors and nurses to work together for the screening of hypertension. OBJECTIVES To assess the level of knowledge among primary healthcare nurses' in the screening of arterial hypertension. METHODS Descriptive, observational and transversal study. A random representative sample of 165 nurses working with adult patients in community-based primary healthcare centres were asked to complete an evaluation test of theoretical knowledge about hypertension. Higher scores indicated a greater knowledge about the detection of hypertension. RESULTS 32.1% of the participants obtained a score equal to or more than 72.7 which corresponded to the 75th percentile of correct answers. Nurses with lower scores were older, permanent employees with technical training studies. A higher age and technical training studies contributed independently to a lower score. In the multiple linear regression model, age and type of studies contributed independently to questionnaire's score variance. CONCLUSION Currently, primary care nurses in the studied region do not have sufficient theoretical knowledge to detect hypertension. The results show the need to establish strategies to achieve the necessary knowledge for the implementation of a correct hypertension screening. For professional nurses, continuing education is essential to safe and effective nursing care.
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Affiliation(s)
- M Serrat-Costa
- Institut Català de la Salut, Generalitat de Catalunya, Spain.
| | | | - R Machado Velasco
- Residéncia geriátrica Gent Gran Palafrugell, Ayuntamiento de Palafrugell, Girona, Spain
| | | | | | - W Ricart
- Institut Català de la Salut, Generalitat de Catalunya, Spain
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Kokubo M, Shimizu A, Mitsui T, Miyagi M, Nomoto K, Murohara T, Toba K, Sakurai T. Impact of night-time blood pressure on cerebral white matter hyperintensity in elderly hypertensive patients. Geriatr Gerontol Int 2016; 15 Suppl 1:59-65. [PMID: 26671159 DOI: 10.1111/ggi.12662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
AIM Cerebral white matter hyperintensity (WMH) is highly prevalent in the elderly population, and increases the risk of dementia and stroke. We investigated the relationship between ambulatory blood pressure monitoring levels and quantitatively measured WMH volumes among elderly hypertensive patients with well-controlled blood pressure (BP) to re-evaluated effective hypertension management methods to prevent the progression of WMH. METHODS Participants comprised 84 hypertensive patients aged between 65 and 75 years without symptomatic heart failure, ischemic heart disease, atrial fibrillation, stroke or cognitive dysfunction. RESULTS Linear regression analysis showed that office BP was not associated with WMH volume increases. Raised night-time systolic BP (P = 0.013) were associated with greater WMH volumes during ambulatory blood pressure monitoring. To clarify the effect of asleep systolic BP on WML volume, we then classified patients into two systolic BP groups as follows: <125 mmHg (n = 47) and ≥125 mmHg (n = 37). Baseline characteristics were almost similar in both groups, except the dipper type of circadian BP variation was significantly common in the group with night-time systolic BP <125 mmHg. However, WMH volume was greater in the group with night-time systolic BP ≥125 mmHg than that in the <125 mmHg group (9.0 ± 8.4 mL vs 4.1 ± 4.3 mL, P = 0.015). CONCLUSION Higher night-time systolic BP levels were observed to contribute greater WMH volumes in elderly hypertensive patients. To prevent the progression of WMH, controlling BP on the basis of ambulatory blood pressure monitoring is important.
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Affiliation(s)
- Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Toko Mitsui
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Motohiro Miyagi
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University, Nagoya, Aichi, Japan
| | - Kenji Toba
- Department of Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Department of Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
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McCain J. William B. White Explains the Changes In the Way We Look at Blood Pressure: Which Numbers Matter Most-and Why Can They Be Deceptive? P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2016; 41:573-580. [PMID: 27630528 PMCID: PMC5010271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dr. White, known worldwide as an expert in the use of 24-hour ambulatory blood pressure monitoring (ABPM), discusses hypertension, the importance of accurate measurement, and the utility of ABPM for effective diagnoses and treatment.
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Mahmoud KS, Ismail TT, Saad M, Mohsen LA, Ibrahiem MA, Fadeel NA, Sotouhy A. Values of ambulatory blood pressure monitoring for prediction of cognitive function impairment in elderly hypertensive patients. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
Apparent treatment-resistant hypertension (aTRH), defined as uncontrolled blood pressure using 3 or more antihypertensive medications or controlled using 4 or more antihypertensive medications, affects approximately 30% of uncontrolled and 12% of controlled blood pressure (BP) patients. aTRH is used when pseudoresistance cannot be excluded (eg, BP measurement artifacts, mainly office resistance, suboptimal adherence, suboptimal treatment regimens, and true TRH). True TRH comprises approximately 30% to 50% of TRH. Patients with TRH have a high prevalence of obesity, insulin resistance, sleep apnea, and volume expansion. Aldosterone, a mineralocorticoid, is an important contributor to TRH, with primary aldosteronism present in approximately 20% of patients. Spironolactone, a mineralocorticoid-receptor antagonist, as a fourth-line agent, decreases BP 20 to 25/10 to 12 mm Hg in TRH patients with and without primary aldosteronism. The BP response to spironolactone is roughly double that of other classes of antihypertensive medications in TRH. Although approximately 70% of patients with uncontrolled TRH have estimated glomerular filtration rate of 50 or greater and a serum potassium level of 4.5 or less, which are associated with a low risk for hyperkalemia, only a small percentage receive a mineralocorticoid-receptor antagonist. This review examines the clinical epidemiology and pharmacotherapy of controlled and uncontrolled hypertension with an emphasis on aTRH, the role of aldosterone in blood pressure regulation, and the potential benefits of mineralocorticoid-receptor antagonist in uncontrolled TRH.
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Affiliation(s)
- Brent M Egan
- Department of Medicine, Care Coordination Institute, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC
| | - Jiexiang Li
- Department of Mathematics, College of Charleston, Charleston, SC
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Taylor C, Tillin T, Chaturvedi N, Dewey M, Ferri CP, Hughes A, Prince M, Richards M, Shah A, Stewart R. Midlife hypertensive status and cognitive function 20 years later: the Southall and Brent revisited study. J Am Geriatr Soc 2013; 61:1489-98. [PMID: 24028355 PMCID: PMC3902992 DOI: 10.1111/jgs.12416] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: To investigate long-term prospective associations between a range of measurements of hypertensive status in midlife and cognitive impairment 20 years later. Design: Cohort study. Setting: Two areas (Southall and Brent) of northwest London. Participants: Survey samples of a multiethnic population (European, African Caribbean, South Asian) aged 40 to 67 were followed up 20 years later. Measurements: Comprehensive cardiovascular assessments were performed at baseline, including measurements of resting blood pressure (BP) and, in a subsample, ambulatory BP. At follow-up, a battery of cognitive assessments was administered, and a composite outcome was derived, with impairment defined as the lowest 10% within each ethnic group. Logistic regression models were used to investigate associations with prior measures of hypertensive status. Results: In 1,484 participants at follow-up, cognitive impairment showed significant U-shaped associations with baseline diastolic BP (DBP) and mean arterial pressure (MAP; strongest for those aged ≥50 at baseline), independent of a range of covariates, but no associations were found with systolic BP or pulse pressure. Cognitive impairment was also associated with antihypertensive medication use and higher evening ambulatory DBP at baseline. No substantial differences in strengths of association were found between ethnic groups. Conclusion: Low and high DBP and MAP were associated with cognitive impairment 20 years later. Higher evening DBP on ambulatory monitoring was also associated with greater risk.
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Affiliation(s)
- Clare Taylor
- King's College London (Institute of Psychiatry), London, UK
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Xu T, Zhang Y, Tan X. Estimate of nocturnal blood pressure and detection of non-dippers based on clinical or ambulatory monitoring in the inpatient setting. BMC Cardiovasc Disord 2013; 13:37. [PMID: 23692688 PMCID: PMC3665662 DOI: 10.1186/1471-2261-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure monitoring is regarded as the gold standard for monitoring nocturnal blood pressure (NBP) and is usually performed out of office. Currently, a novel method for monitoring NBP is indispensible in the inpatient setting. The widely used manual BP monitoring procedure has the potential to monitor NBP in the hospital setting. The feasibility and accuracy of manual sphygmomanometer to monitor NBP has not been explored widely. METHODS A cross-sectional study was conducted at the cardiology department of a university-affiliated hospital to study patients with mild-to-moderate essential hypertension. One hundred and fifty-five patients were recruited to compare BP derived from a manual device and ambulatory BP monitoring (ABPM). The manual BP measurement was performed six times at 22:00, 02:00, 06:00, 10:00, 14:00 and 18:00 h. The measurements at 22:00, 02:00 and 06:00 h were defined as night-time and the others as daytime. ABPM was programmed to measure at 30-min intervals between measurements. RESULTS All-day, daytime and night-time BP did not differ significantly from 24-h ambulatory systolic BP [all-day mean difference -0.52±4.67 mmHg, 95% confidence interval (CI) -1.26 to 0.22, P=0.168; daytime mean difference 0.24±5.45 mmHg, 95% CI -0.62 to 1.11, P=0.580; night-time mean difference 0.30±7.22 mmHg, 95% CI -0.84 to 1.45, P=0.601) rather than diastolic BP. There was a strong correlation between clinical and ambulatory BP for both systolic and diastolic BP. On the basis of ABPM, 101 (65%) patients were classified as non-dippers, compared with 106 (68%) by manual sphygmomanometer (P<0.001). CONCLUSIONS Traditional manual sphygmomanometer provides similar daytime and night-time systolic BP measurements in hospital. Moreover, the detection of non-dippers by manual methods is in good agreement with 24-h ABPM. Further studies are required to confirm the clinical relevance of these findings by comparing the association of NBP in the hospital ward assessed by manual monitoring with preclinical organ damage and cardiovascular and cerebrovascular outcomes.
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Affiliation(s)
- Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yongqing Zhang
- Department of Cardiology, Peoples’ Hospital of SanYan, SanYan, Hainan 572000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
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Oladipo I, Adedokun A. Comparison of the average of five readings with averages from fewer readings for automated oscillometric blood pressure measurement in an outpatient clinic. Korean Circ J 2013; 43:329-35. [PMID: 23755079 PMCID: PMC3675307 DOI: 10.4070/kcj.2013.43.5.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/05/2012] [Accepted: 12/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The optimal number of consecutive measurements for obtaining an average blood pressure (BP) reading in clinical practice is yet undefined by research. This study aimed to compare readings obtained from an average of 5 with averages of 2, 3, and 4, sequential measurements. SUBJECTS AND METHODS Using an automated oscillometric device (BpTRU), BP measurement was conducted on 410 consenting adults attending a general outpatients clinic. Comparison of an average of 5 readings with averages of 2, 3, and 4 readings involved evaluation of correlations, Bland-Altman analysis, comparison of means and distribution of readings, and determination of the proportion of differences between compared readings which were clinically non-significant. RESULTS 397 (96.8%) sets of complete BP readings were suitable for analysis. Clinically non-significant differences (≤5 mm Hg) were found between at least 79.3% (n=315) and 96.5% (n=383) of compared systolic and diastolic readings, respectively. Bland-Altman's analysis revealed that the 95% limits of agreement for the differences between compared readings were approximately 2-4, 3-7, and 4-11 mm Hg for 2, 3 and 4 readings' systolic comparisons while those for diastolic comparisons were 2-3, 3-5, and 4-7 mm Hg, respectively. Statistically non-significant differences were observed in all comparisons of the distributions of readings that were classified as <140 mm Hg or ≥140 mm Hg and <90 mm Hg or ≥90 mm Hg for systolic and diastolic readings, respectively. Strong positive correlations were found between 5 average readings and each of 2, 3, and 4 average readings, respectively. CONCLUSION An average of 5 readings may be excessive for routine BP measurement using this device at outpatient clinics.
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Affiliation(s)
- Idris Oladipo
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Ayoade Adedokun
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
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Shahbazian N, Shahbazian H, Mohammadjafari R, Mousavi M. Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy. J Nephropharmacol 2013; 2:5-9. [PMID: 28197434 PMCID: PMC5297468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/14/2012] [Indexed: 11/01/2022] Open
Abstract
Introduction: If the blood pressure of a pregnant woman is ≥140/90 mmHg at the clinic, but her ambulatory blood pressure is less <135/85 mmHg at daytime and <125/75 at night and her average ambulatory in 24 hours is <130/80 mmHg, her high blood pressure at clinic is considered white coat hypertension. Objectives: To evaluate the value of ambulatory blood pressure monitoring in pregnant women. Patients and Methods: This prospective cohort study was conducted in Imam-Khomeini hospital of Ahwaz, Iran between 2011 to 2012. A total of 105 pregnant women who had blood pressure of higher than 140/90 mmHg during the third trimester of pregnancy were monitored. Thirty five women with white coat hypertension, 35 women with gestational hypertension and 35 women with normal blood pressure were followed. The data were analyzed using the Kolmogorov-Smirnov test, Pearson correlation coefficient and Chi-square tests. Results: The prevalence of white coat hypertension was 31.3%. The maternal and neonatal outcomes and laboratory examinations in white coat hypertension were similar to the normal blood pressure, but the frequency of caesarean section was more than the other two groups. Conclusion: The findings of the study indicate the efficacy of 24 hour holter monitoring of blood pressure and using it more comprehensively , compared to the limited visits.
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Affiliation(s)
- Nahid Shahbazian
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Razieh Mohammadjafari
- Department of obstetric & gynecologist, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahsan Mousavi
- Department of obstetric & gynecologist, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Oladipo I, Ayoade A. The effect of the first office blood pressure reading on hypertension-related clinical decisions. Cardiovasc J Afr 2012; 23:456-62. [PMID: 23044502 PMCID: PMC3721854 DOI: 10.5830/cvja-2012-052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 06/08/2012] [Indexed: 12/03/2022] Open
Abstract
The effect of the first office blood pressure reading (FBPR) on hypertension-related decisions was evaluated using blood pressure (BP) readings taken with the BpTRU BPM-100 device. BP readings were grouped into three pairs: (1) single readings (first and second readings), (2) computed average of three readings (one including and one excluding the first reading), and (3) computed average of five readings (one including and one excluding the first reading). Categorisation of BP readings under JNC-7 classes and distribution into < 140/90 and ≥ 140/90 mmHg groups were selected as parameters guiding hypertension-related decisions. Readings including FBPR had strong positive correlations to those excluding FBPR (Pearson's correlation coefficient ranged from 0.86-1.00). Also, FBPR-included and FBPR-excluded readings did not differ statistically in JNC-7 categorisation or distribution into < 140/90 or ≥ 140/90 mmHg groups. Our findings suggest that exclusion of FBPR may have no significant impact on hypertension-related clinical decisions.
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Affiliation(s)
- Idris Oladipo
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.
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Giles TD, Alessi T, Purkayastha D, Zappe D. Comparative Efficacy of Aliskiren/Valsartan vs Valsartan in Nocturnal Dipper and Nondipper Hypertensive Patients: A Pooled Analysis. J Clin Hypertens (Greenwich) 2012; 14:299-306. [DOI: 10.1111/j.1751-7176.2012.00608.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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White WB, Wolfson L, Wakefield DB, Hall CB, Campbell P, Moscufo N, Schmidt J, Kaplan RF, Pearlson G, Guttmann CRG. Average daily blood pressure, not office blood pressure, is associated with progression of cerebrovascular disease and cognitive decline in older people. Circulation 2012; 124:2312-9. [PMID: 22105196 DOI: 10.1161/circulationaha.111.037036] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High blood pressure (BP) is a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain, which has been associated with functional decline in mobility and cognition in older people. METHODS AND RESULTS This was a prospective cohort of subjects 75 to 89 years of age to determine relations among vascular risk factors, white matter hyperintensity volume, and functional status. Ninety-nine subjects were enrolled through the use of a balanced 3×3 matrix stratified by age and mobility performance, and 72 subjects completed all sets of baseline and follow-up studies at 2 years. Subjects were excluded if there were medications or systemic or neurological diseases that could compromise mobility. Ambulatory and clinic BP monitoring, magnetic resonance imaging, gait studies, and neuropsychological testing were performed at baseline and after 24 months. Brain classification into normal white matter and T2-hyperintense white matter hyperintensity volume was performed with semiautomated segmentation. Quantitative measures of mobility and cognitive function were obtained longitudinally. Increased ambulatory systolic BP, but not clinic systolic BP, from baseline to 24 month follow-up was associated with increased white matter hyperintensity volume over that same period, as well as measures of executive function/processing speed. Similar associations were observed for 24-hour BP, awake BP, and sleep BP but not for the surge between the sleep and awake time at the 24-month time point. CONCLUSIONS These data demonstrate for the first time the importance of 24-hour systolic BP in the progression of brain white matter hyperintensity volume burden associated with impairment of cognitive function in older people. The 24-hour systolic BP may be a potential target for intervention in the elderly to reduce vascular disease of the brain and impairment of function.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030-3940, USA.
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Boivin JM, Tsou-Gaillet TJ, Fay R, Dobre D, Rossignol P, Zannad F. Influence of the recommendations on the implementation of home blood pressure measurement by French general practitioners. J Hypertens 2011; 29:2105-15. [DOI: 10.1097/hjh.0b013e32834b7efb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gruman JC. Making health information technology sing for people with chronic conditions. Am J Prev Med 2011; 40:S238-40. [PMID: 21521600 DOI: 10.1016/j.amepre.2011.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/14/2011] [Accepted: 02/01/2011] [Indexed: 12/21/2022]
Affiliation(s)
- Jessie C Gruman
- Center for Advancing Health, 2000 Florida Avenue NW, Washington, DC 20009, USA.
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Effects of telmisartan and amlodipine in combination on ambulatory blood pressure in stages 1-2 hypertension. Blood Press Monit 2010; 15:205-12. [PMID: 20613496 DOI: 10.1097/mbp.0b013e32833c5722] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evaluation of combination therapy with antihypertensive agents by clinic blood pressure (BP) measurements may yield results that differ from out-of-office BP readings. This is of clinical relevance because out-of-office BP values are of prognostic importance. We studied the effects of combining telmisartan and amlodipine on ambulatory BP in patients with stages 1-2 hypertension. METHODS We conducted an 8-week, placebo-controlled, double-blind, 4x4 factorial design trial in which 562 patients with clinic diastolic BP at least 95 and 119 mmHg or less were randomized to receive telmisartan (0, 20, 40, or 80 mg) and/or amlodipine (0, 2.5, 5, or 10 mg). Ambulatory BP monitoring was performed at baseline and after 8 weeks of treatment; the end points of interest were the changes from baseline in 24-h systolic and diastolic BP. Secondary end points included the proportion of responders (> or =10 mmHg BP reduction from baseline and/or <130/80 mean 24-h BP) and controlled patients (<130/80 mmHg mean 24-h BP). RESULTS Combination therapies of telmisartan and amlodipine lowered 24-h BP to a larger extent than the corresponding monotherapies at all doses. Mean reductions from baseline in 24-h BP for the combination of the highest doses of telmisartan (80 mg) and amlodipine (10 mg) were -22.4/-14.6 versus -11.9/-6.9 mmHg for amlodipine (10 mg) and -11.0/-6.9 mmHg for telmisartan (80 mg) (P<0.0001 for each comparison). In addition, BP response and control rates (24-h BP <130/80 mmHg) were significantly higher with the combination therapy versus the monotherapy groups. CONCLUSION These findings show that telmisartan and amlodipine in combination provide substantial 24-h BP efficacy that is superior to either monotherapy in patients with stages 1 and 2 hypertension.
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Kramer MH, Breydo E, Shubina M, Babcock K, Einbinder JS, Turchin A. Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study. BMC Health Serv Res 2010; 10:139. [PMID: 20504370 PMCID: PMC2882386 DOI: 10.1186/1472-6963-10-139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care. METHODS A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies. RESULTS Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets). Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p < 0.0001 for both), consistent with prospective data. Probability of home BP documentation increased by 23.0% for each 10 mm Hg of office systolic BP (p < 0.0001), by 6.2% for each $10,000 in median income of zip code (p = 0.0055), and by 17.7% for each decade in the patient's age (p < 0.0001). CONCLUSIONS Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.
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Affiliation(s)
- Michael H Kramer
- Department of Computer Science, Harvard College, Cambridge, MA, USA
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Gruman J, Rovner MH, French ME, Jeffress D, Sofaer S, Shaller D, Prager DJ. From patient education to patient engagement: implications for the field of patient education. PATIENT EDUCATION AND COUNSELING 2010; 78:350-6. [PMID: 20202780 DOI: 10.1016/j.pec.2010.02.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Advances in health care require that individuals participate knowledgeably and actively in their health care to realize its full benefit. Implications of these changes for the behavior of individuals and for the practice of patient education are described. METHODS An "engagement behavior framework" (EBF) was compiled from literature reviews and key informant interviews. To assess the focus of research and interventions on the identified engagement behaviors, the EBF was used to code scientific sessions in professional conferences relevant to patient education in the US in 2006-2007. RESULTS Many specific behaviors constitute engagement. Professional conferences on patient education show only modest attention to the full range of relevant behaviors. CONCLUSION People must make informed choices about insurance and clinicians, coordinate communications among providers and manage complex treatments on their own. Not doing so risks preventable illness, suboptimal outcomes and wasted resources. PRACTICE IMPLICATIONS Increased responsibilities of individuals, sick and well, to find and actively participate in high quality health care provides an opportunity for patient education researchers and clinicians to improve health outcomes by developing innovative strategies to support all individuals to effectively participate in their care to the extent possible.
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Affiliation(s)
- Jessie Gruman
- Center for Advancing Health, Washington, DC 20009-1231, USA.
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Baghianimoghadam MH, Rahaee Z, Morowatisharifabad MA, Sharifirad G, Andishmand A, Azadbakht L. Effects of education on self-monitoring of blood pressure based on BASNEF model in hypertensive patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2010; 15:70-7. [PMID: 21526062 PMCID: PMC3082790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 12/12/2009] [Indexed: 12/03/2022]
Abstract
BACKGROUND Hypertension is one of the most important health problems. Self-monitoring may be an effective method for controlling this disease. The aim of this study is to determine the effectiveness of education on blood pressure self-monitoring in patients with hypertension based on BASNEF model. METHODS In this clinical trial, 150 outpatients with hypertension were randomly selected from those referred to private clinics in Yazd, Iran, during 2008. They were divided in two groups. The data were collected by a validated and reliable questionnaire. The implementing educational program was continued for 2 months and the pre-test and post-test had an interval of 2-months. BASNEF model was applied to explain the motivation of a behavior. Descriptive analysis, correlation test and also regression analysis were used to analyze data. RESULTS The respondents acquired 17.72% of total score for self-monitoring behavior, 47.03% of attitude, 12.37% of subjective norms, 33.46% of intention and 50.95% of enabling factors. After intervention, there were significant increases in self-monitoring behavior (173.31%), attitude (62.60%), subjective norms (54.70%), intention (129.93%) and enabling factors (46.62%) in the intervention group. There was no significant difference between the constructs of BASNEF model in the control group after intervention compared to the baseline values (p > 0.05). CONCLUSIONS The results of this study showed that the level of self-monitoring behavior in the patients was low. Educational programs are helpful and necessary to improve self-monitoring behavior in patients with hypertension.
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Affiliation(s)
| | - Zohreh Rahaee
- MS in Health Education, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Gholamreza Sharifirad
- Associate Professor in Health Education, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abas Andishmand
- Assistant Professor in Cardiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Leila Azadbakht
- Assistant Professor in Nutrition, Nutrition and Food Security Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran,* Corresponding Author E-mail:
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