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Gnanenthiran SR, Barnhart M, Tan I, Zeng M, O'Hagan E, Gianacas C, Chow C, Schlaich M, Rodgers A, Schutte AE. Shop-to-Stop Hypertension: A multicenter cluster-randomized controlled trial protocol to improve screening and text message follow-up of adults with high blood pressure at health kiosks in hardware retail stores. Contemp Clin Trials 2024; 143:107610. [PMID: 38878995 DOI: 10.1016/j.cct.2024.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
High blood pressure (BP) is the leading preventable risk factor for death, but only one in three patients achieve target BP control. A key contributor to this problem is poor population awareness of high BP, as the majority of patients are asymptomatic. The Shop-To-Stop Hypertension study is a multicenter, cluster-randomized controlled trial to identify, refer and follow adults in need of hypertension care, whilst raising population-wide awareness. In participants with high BP measured by SiSU Health Stations located in major hardware chain stores across New South Wales, Australia, we will determine whether text message-based nudges will encourage repeat BP checks and visits to their doctor. Based on pilot data, we anticipate 65,340 participants will be screened over 12 months, of which 18% will have high BP. Thirty hardware stores will be randomized (1:1) to: (i) Intervention: participants detected with high BP (≥140/≥90 mmHg) will receive text message-based nudges to return for a repeat SiSU Health Station BP check and to visit their general practitioner (GP) to check and manage their BP; (ii) Control: participants with high BP will not receive text messages. The primary outcome is the difference in the proportion of participants with high BP having a repeat BP check at hardware Health Stations in the intervention vs. control group at 12 months. This novel setting for screening utilises a novel 'citizen science' approach inviting the general public to perform their own BP screening at health kiosks and foster behavioral change. This will allow screening in a low-stress environment.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; Concord Repatriation General Hospital, Concord West, Sydney, NSW, Australia
| | - Molly Barnhart
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Isabella Tan
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Mingjuan Zeng
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Anthony Rodgers
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia.
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Gnanenthiran SR, Tan I, Atkins ER, Avolio A, Bennett B, Chapman N, Chow CK, Freed R, Gnjidic D, Hespe C, Kaur B, Liu HM, Patel A, Peiris D, Reid CM, Schlaich M, Sharman JE, Stergiou GS, Usherwood T, Gianacas C, Rodgers A, Schutte AE. Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol. Am Heart J 2023; 265:50-58. [PMID: 37479162 DOI: 10.1016/j.ahj.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. METHODS The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. CONCLUSIONS NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. TRIAL REGISTRATION ACTRN12622001583730.
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Affiliation(s)
- Sonali R Gnanenthiran
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Isabella Tan
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Emily R Atkins
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Alberto Avolio
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Belinda Bennett
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Niamh Chapman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Ruth Freed
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Baldeep Kaur
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Huei Ming Liu
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Anushka Patel
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - James E Sharman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - George S Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tim Usherwood
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia.
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3
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Jobe M, Mactaggart I, Hydara A, Kim MJ, Bell S, Badjie O, Bittaye M, Perel P, Prentice AM, Burton MJ. Evaluating the hypertension care cascade in middle-aged and older adults in The Gambia: findings from a nationwide survey. EClinicalMedicine 2023; 64:102226. [PMID: 37767194 PMCID: PMC10520336 DOI: 10.1016/j.eclinm.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background Hypertension is a major public health problem in sub-Saharan Africa with poor treatment coverage and high case-fatality rates. This requires assessment of healthcare performance to identify areas where intervention is most needed. To identify areas where health resources should be most efficiently targeted, we assessed the hypertension care cascade i.e., loss and retention across the various stages of care, in Gambian adults aged 35 years and above. Methods This study was embedded within the nationally representative 2019 Gambia National Eye Health Survey of adults ≥35 years. We constructed a hypertension care cascade with four categories: prevalence of hypertension (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of medication prescribed for hypertension); those aware of their diagnosis; those treated; and those with a controlled blood pressure (defined as blood pressure <140/90 mmHg). Analyses were age- and sex-standardised to the population structure of The Gambia. Logistic regression was used to assess the socio-demographic factors associated with prevalence, awareness, treatment and control of hypertension. Findings Of 9171 participants with data for blood pressure, the prevalence of hypertension was 47.0%. Among people with hypertension, the prevalence of awareness was 54.7%, the prevalence of hypertension treatment was 32.5%, and prevalence of control was 10.0% with little difference between urban and rural residence. The cascade of care performance was better in women. However, there was no difference in achieving blood pressure control between men and women who were receiving treatment. Female sex, older age and higher body mass index were associated with higher hypertension awareness whilst having an occupation compared to being unemployed was associated with higher odds of being treated. Patients in the underweight category had higher odds of achieving blood pressure control. Interpretation There is a high prevalence of hypertension and low performance of the health care system that impact on the hypertension care cascade among middle-aged and older adults in The Gambia. Addressing the full cascade will be paramount especially in reducing the mounting prevalence and improving diagnosis of patients with hypertension, where the greatest dividends will be gained. Funding The Queen Elizabeth Diamond Jubilee Trust, Wellcome Trust.
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Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Min J. Kim
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Omar Badjie
- Directorate of Health Promotion & Education, Ministry of Health, The Gambia
| | - Mustapha Bittaye
- Directorate of Health Services, Ministry of Health, The Gambia
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Franzos MA, Stiegmann RA. Partnerships to Facilitate Total Force Fitness. Mil Med 2023; 188:24-27. [PMID: 37665583 DOI: 10.1093/milmed/usad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 09/05/2023] Open
Abstract
Total force fitness (TFF) is a multi-domain framework designed to assess, promote, and sustain human performance optimization across a service member's career arc. During the September 2021, TFF Summit sponsored by the Consortium for Health and Military Performance (CHAMP), a working group explored partnerships that could facilitate effective implementation and sustainment of TFF principles. Many potential partners were identified, both internal and external to the DoD. This report highlights some positions and organizations that provide the highest yield for successfully inculcating TFF across the services.
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Affiliation(s)
- M Alaric Franzos
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Regan A Stiegmann
- Tracks and Special Programs, Preventive Medicine and Lifestyle Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, USA
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Dhungana RR, Pedisic Z, Dhimal M, Bista B, de Courten M. Hypertension screening, awareness, treatment, and control: a study of their prevalence and associated factors in a nationally representative sample from Nepal. Glob Health Action 2022; 15:2000092. [PMID: 35132939 PMCID: PMC8843246 DOI: 10.1080/16549716.2021.2000092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The growing burden of hypertension is emerging as one of the major healthcare challenges in low- and middle-income countries (LMICs), such as Nepal. Given that they are struggling to deliver adequate health services, some LMICs have significant gaps in the cascade of hypertension care (including screening, awareness, treatment, and control). This results in uncontrolled hypertension, placing a high burden on both patients and healthcare providers. Objective The objective of this study was to quantify the gaps in hypertension screening, awareness, treatment, and control in the Nepalese population. Methods We used the data from a pooled sample of 9682 participants collected through two consecutive STEPwise approach to Surveillance (STEPS) surveys conducted in Nepal in 2013 and 2019. A multistage cluster sampling method was applied in the surveys, to select nationally representative samples of 15- to 69-year-old Nepalese individuals. Prevalence ratios were calculated using multivariable Poisson regression. Results Among the hypertensive participants, the prevalence of hypertension screening was 65.9% (95% CI: 62.2, 69.5), the prevalence of hypertension awareness was 20% (95% CI: 18.1, 22.1), the prevalence of hypertension treatment was 10.3% (95% CI: 8.8, 12.0), and the prevalence of hypertension control was 3.8% (95% CI: 2.9, 4.9). The unmet need of hypertension treatment and control was highest amongst the poorest individuals, the participants from Lumbini and Sudurpaschim provinces, those who received treatment in public hospitals, the uninsured, and those under the age of 30 years. Conclusions The gaps in the cascade of hypertension care in Nepal are large. These gaps are particularly pronounced among the poor, persons living in Lumbini and Sudurpaschim provinces, those who sought treatment in public hospitals, those who did not have health insurance, and young people. National- and local-level public health interventions are needed to improve hypertension screening, awareness, treatment, and control in Nepal.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | | | - Maximilian de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Australia
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Philbert SC, Lawrence-Williams P, Gebre Y, Hutchinson ML, Belmar-George S. Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative. Rev Panam Salud Publica 2022; 46:e128. [PMID: 36071919 PMCID: PMC9440734 DOI: 10.26633/rpsp.2022.128] [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: 04/01/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRACT
Objective.
To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia.
Methods.
From January 2020 to December 2021, St Lucia’s Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring.
Results.
Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data.
Conclusions.
The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.
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Affiliation(s)
| | | | - Yitades Gebre
- Pan American Health Organization, Bridgetown, Barbados
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7
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Schutte AE, Webster R, Jennings G, Schlaich MP. Uncontrolled blood pressure in Australia: a call to action. Med J Aust 2021; 216:61-63. [PMID: 34865237 DOI: 10.5694/mja2.51350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Aletta E Schutte
- University of New South Wales, Sydney, NSW.,The George Institute for Global Health, Sydney, NSW
| | - Ruth Webster
- The George Institute for Global Health, Sydney, NSW.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW
| | | | - Markus P Schlaich
- Dobney Hypertension Centre, University of Western Australia, Perth, WA
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8
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Treating hypertension: who speaks for the patient? J Hum Hypertens 2021; 35:1057-1058. [PMID: 34148059 DOI: 10.1038/s41371-021-00564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/08/2022]
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Dhungana RR, Pandey AR, Shrestha N. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in Nepal between 2000 and 2025: A Systematic Review and Meta-Analysis. Int J Hypertens 2021; 2021:6610649. [PMID: 33747559 PMCID: PMC7952181 DOI: 10.1155/2021/6610649] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Understanding the burden and trend of hypertension and the associated care cascade can provide direction to the development of interventions preventing and controlling hypertension. This study aimed to assess prevalence and trends of hypertension and its awareness, treatment, and control in Nepal. METHODS We systematically searched CINAHL, Embase, ProQuest, PubMed, Web of Science, WorldCat, and government and health agency-owned websites to identify studies reporting prevalence of hypertension, awareness, treatment, and control in Nepal between 2000 and 2020. We applied the random-effects model to compute the pooled prevalence in the overall population and among subgroups in each 5-year interval period between 2000 and 2020. We used linear meta-regression analysis to predict hypertension from 2000 to 2025. RESULTS We identified 23 studies having a total of 84,006 participants. The pooled prevalence of hypertension, awareness, treatment, and control for 2016-2020 was 32% (95% CI: 23-40%), 50% (95% CI: 30-69%), 27% (95% CI: 19-34%), and 38% (95% CI: 28-48%), respectively. The prevalence of hypertension varied by age, gender, education, and geographical area. Hypertension increased by 6 percentage points (pp), awareness increased by 12 pp, treatment increased by 11 pp, and control increased by 3 pp over the 20 years studied. Since 2000, the rate of increment of hypertension has been 3.5 pp per decade, where 44.7% of men are expected to suffer from hypertension by 2025. CONCLUSION The markedly increased prevalence of hypertension and relatively poor progress in hypertension awareness, treatment, and control in Nepal suggest that there is a need for hypertension preventive approaches as well as strategies to optimize hypertension care cascade.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Nepal Family Development Foundation, Kathmandu, Nepal
| | | | - Nipun Shrestha
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Angkurawaranon C, Pinyopornpanish K, Srivanichakorn S, Sanchaisuriya P, Thepthien BO, Tooprakai D, Ngetich E, Damasceno A, Olsen MH, Sharman JE, Garg R. Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand. J Clin Hypertens (Greenwich) 2021; 23:702-712. [PMID: 33501760 PMCID: PMC8678746 DOI: 10.1111/jch.14193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90–120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow‐up are possible target areas to improve hypertension control in Thailand.
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Affiliation(s)
- Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Pattara Sanchaisuriya
- Department of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Bang-On Thepthien
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - Dusida Tooprakai
- Department of Social Medicine, Lampang Hospital, Lampang, Thailand
| | - Elisha Ngetich
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Albertino Damasceno
- Lancet Commission on Hypertension Group, London, UK.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Michael Hecht Olsen
- Lancet Commission on Hypertension Group, London, UK.,Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - James E Sharman
- Lancet Commission on Hypertension Group, London, UK.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Renu Garg
- World Health Organization Country Office for Thailand, Nonthaburi, Thailand
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11
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Change of education strategy associated with slippage in Canadian hypertension awareness treatment and control rates. J Hum Hypertens 2021; 35:1054-1056. [PMID: 33767391 PMCID: PMC7993069 DOI: 10.1038/s41371-021-00519-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
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12
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Guimarães MCDLP, Coelho JC, da Silva GV, Drager LF, Gengo e Silva Butcher RDC, Butcher HK, Pierin AMG. Blood Pressure Control and Adherence to Drug Treatment in Patients with Hypertension Treated at a Specialized Outpatient Clinic: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2749-2761. [PMID: 34916785 PMCID: PMC8670885 DOI: 10.2147/ppa.s336524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service. METHODS A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤0.05. RESULTS Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34-4.28), use of calcium channel blockers (OR 0.4; CI 0.19-0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66-0.92). Adherence was not associated with any of the variables studied. CONCLUSION There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.
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Affiliation(s)
- Mayra Cristina da Luz Pádua Guimarães
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
- Correspondence: Mayra Cristina da Luz Pádua Guimarães Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil Email
| | - Juliana Chaves Coelho
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
| | - Giovanio Vieira da Silva
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Luciano Ferreira Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | | | - Howard K Butcher
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Angela Maria Geraldo Pierin
- Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil
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13
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A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation. Can J Neurol Sci 2020; 48:487-495. [PMID: 33059775 DOI: 10.1017/cjn.2020.231] [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: 12/29/2022]
Abstract
BACKGROUND Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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Jorgensen JMA, Hedt KH, Omar OM, Davies JI. Hypertension and diabetes in Zanzibar - prevalence and access to care. BMC Public Health 2020; 20:1352. [PMID: 32887593 PMCID: PMC7472575 DOI: 10.1186/s12889-020-09432-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/23/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are among the most common causes of hospital admissions and deaths in Zanzibar. This study assessed prevalence of, and antecedent factors and care access for the two common cardiovascular risk factors, hypertension and diabetes, to support health system improvements. METHODS Data was from a population based nationally representative survey. Prevalence of hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or a self-reported diagnosis of hypertension; diabetes was defined as a fasting blood glucose ≥6.1 mmol/L or a self-reported diagnosis of diabetes. Care-cascades for hypertension and diabetes were created with four stages: being tested, diagnosed, treated, and achieving control. Multivariable logistic regression models were constructed to evaluate individual-level factors - including symptoms of mental illness - associated with having hypertension or diabetes, and with progressing through the hypertension care cascade. Whether people at overt increased risk of hypertension or diabetes (defined as > 50 years old, BMI > 30 kg/m2, or currently smoking) were more likely to be tested was assessed using chi squared. RESULTS Prevalence of hypertension was 33.5% (CI 30.6-36.5). Older age (OR 7.7, CI 4.93-12.02), some education (OR 0.6, CI 0.44-0.89), obesity (OR 3.1, CI 2.12-4.44), and raised fasting blood glucose (OR 2.4, CI 2.38) were significantly independently associated with hypertension. Only 10.9% (CI 8.6-13.8) of the entire hypertensive population achieved blood pressure control, associated factors were being female (OR 4.8, CI 2.33-9.88), formally employed (OR 3.0, CI 1.26-7.17), and overweight (OR 2.5, CI 1.29-4.76). The prevalence of diabetes was 4.4% (CI 3.4-5.5), and associated with old age (OR 14.1, CI 6.05-32.65) and almost significantly with obesity (OR 2.1, CI 1.00-4.37). Only 11.9% (CI 6.6-20.6) of the diabetic population had achieved control. Individuals at overt increased risk were more likely to have been tested for hypertension (chi2 19.4) or diabetes (chi2 33.2) compared to the rest of the population. Symptoms of mental illness were not associated with prevalence of disease or progress through the cascade. CONCLUSION High prevalence of hypertension and suboptimal management along the care cascades indicates a large unmet need for hypertension and diabetes care in Zanzibar.
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Affiliation(s)
- Jutta M Adelin Jorgensen
- Mnazi Mmoja Referral Hospital, Kaunda Rd, Vuga, Po Box 3793, Zanzibar, Tanzania.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | | | - Omar Mwalim Omar
- Head of NCD unit, Zanzibar Ministry of Health, Zanzibar, Tanzania
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- King's Centre for Global Health, King's College, London, UK
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Leung AA, Williams JV, McAlister FA, Campbell NR, Padwal RS, Tran K, Tsuyuki R, McAlister FA, Campbell NR, Khan N, Padwal R, Quan H, Leung AA. Worsening Hypertension Awareness, Treatment, and Control Rates in Canadian Women Between 2007 and 2017. Can J Cardiol 2020; 36:732-739. [DOI: 10.1016/j.cjca.2020.02.092] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 01/13/2023] Open
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16
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Martins RDS, Santiago LM, Reis MT, Roque AC, Pinto M, Simões JA, Rosendo I. Implications for medical activity of differences between individuals with controlled and uncontrolled hypertension. Rev Port Cardiol 2020; 38:745-753. [PMID: 32019713 DOI: 10.1016/j.repc.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare clinical characteristics, medical activity, and family and social characteristics of individuals with controlled and uncontrolled hypertension. METHODS This was an observational study on an alphabetically organized randomized sample of individuals suffering from hypertension in a primary care setting followed by 25 general practitioners at three clinics in the Central region of Portugal in mid-2018. Electronic medical records of individuals with an ICPC-2 classification of hypertension were analyzed. Epidemiologic, family, social and therapeutic data were gathered for descriptive and inferential analysis. RESULTS From a total population of 8750 patients classified as having hypertension, a representative sample of 387 individuals (n=369 required for a 95% confidence interval and 5% error margin) was studied. The incidence of uncontrolled hypertension was 56.1%, significantly higher among those living alone (p=00.24) or in a nuclear family (p=0.011), in lower socioeconomic classes (p=0.018), and prescribed anti-inflammatory drugs (p=0.018). The calculated cardiovascular risk was no higher for uncontrolled hypertension (p=0.116). Therapeutic inertia was not found either in number of medicines or in their association (p=0.274). No other studied variables showed a significant difference. Binary logistic regression revealed that living alone or in a nuclear family, and in a family with low socioeconomic level, were associated with uncontrolled hypertension, this model representing 9.6% of the likelihood of having uncontrolled hypertension. CONCLUSIONS Medical activity in general practice and other settings should, in the light of these findings, ally therapeutic competencies with knowledge gained from studying individual, family and social characteristics in order to improve blood pressure control.
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Affiliation(s)
| | - Luiz Miguel Santiago
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | | | | | - José Augusto Simões
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
| | - Inês Rosendo
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Abstract
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
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Affiliation(s)
- Michel Burnier
- From the Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (M.B.)
| | - Brent M Egan
- Department of Medicine, Care Coordination Institute, University of South Carolina School of Medicine, Greenville, SC (B.M.E.)
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18
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Implications for medical activity of differences between individuals with controlled and uncontrolled hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Hamm NC, Pelletier L, Ellison J, Tennenhouse L, Reimer K, Paterson JM, Puchtinger R, Bartholomew S, Phillips KAM, Lix LM. Trends in chronic disease incidence rates from the Canadian Chronic Disease Surveillance System. Health Promot Chronic Dis Prev Can 2019; 39:216-224. [PMID: 31210047 PMCID: PMC6699608 DOI: 10.24095/hpcdp.39.6/7.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) produces population-based estimates of chronic disease prevalence and incidence using administrative health data. Our aim was to assess trends in incidence rates over time, trends are essential to understand changes in population risk and to inform policy development. METHODS Incident cases of diagnosed asthma, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease (IHD), and stroke were obtained from the CCDSS online infobase for 1999 to 2012. Trends in national and regional incidence estimates were tested using a negative binomial regression model with year as a linear predictor. Subsequently, models with year as a restricted cubic spline were used to test for departures from linearity using the likelihood ratio test. Age and sex were covariates in all models. RESULTS Based on the models with year as a linear predictor, national incidence rates were estimated to have decreased over time for all diseases, except diabetes; regional incidence rates for most diseases and regions were also estimated to have decreased. However, likelihood ratio tests revealed statistically significant departures from a linear year effect for many diseases and regions, particularly for hypertension. CONCLUSION Chronic disease incidence estimates based on CCDSS data are decreasing over time, but not at a constant rate. Further investigations are needed to assess if this decrease is associated with changes in health status, data quality, or physician practices. As well, population characteristics that may influence changing incidence trends also require exploration.
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Affiliation(s)
- Naomi C Hamm
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Kim Reimer
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | | | - Rolf Puchtinger
- Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | | | - Karen A M Phillips
- Chief Public Health Office, Prince Edward Island Department of Health and Wellness, Charlottetown, Prince Edward Island, Canada
| | - Lisa M Lix
- University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Dubrofsky L, Tobe SW. Guideline Alignment in Related Areas. Can J Cardiol 2019; 35:606-610. [DOI: 10.1016/j.cjca.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 12/01/2022] Open
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21
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Bacon SL, Campbell NR, Raine KD, Tsuyuki R, Khan NA, Arango M, Kaczorowski J. Canada's New Healthy Eating Strategy: Implications for Healthcare Professionals and a Call to Action. Can J Diabetes 2019; 43:155-160. [DOI: 10.1016/j.jcjd.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. Canada's new Healthy Eating Strategy: Implications for health care professionals and a call to action. Can Pharm J (Ott) 2019; 152:151-157. [PMID: 31156726 DOI: 10.1177/1715163519834891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Norm R C Campbell
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Kim D Raine
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Ross T Tsuyuki
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Nadia A Khan
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Manuel Arango
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Janusz Kaczorowski
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
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Fortuna RJ, Rocco TA, Freeman J, Devine M, Bisognano J, Williams GC, Nagel A, Beckman H. A community-wide quality improvement initiative to improve hypertension control and reduce disparities. J Clin Hypertens (Greenwich) 2019; 21:196-203. [PMID: 30609182 DOI: 10.1111/jch.13469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 01/13/2023]
Abstract
Initiatives to improve hypertension control within academic medical centers and closed health systems have been extensively studied, but large community-wide quality improvement (QI) initiatives have been both less common and less successful in the United States. The authors examined a community-wide QI initiative across 226 843 patients from 198 practices in nine counties across upstate New York to improve hypertension control and reduce disparities. The QI initiative focused on (a) providing population and practice-level comparative data, (b) community engagement, especially in underserved communities, and (c) practice-level quality improvement assistance, but was not designed to examine causality of specific components. Across the nine counties, hypertension control rates improved from 61.9% in 2011 to 69.5% in 2016. Improvements were greatest among whites (73.7%-81.5%) and more modest among black patients (58.8%-64.7%). The authors noted a considerable improvement in BP within the group of patients with the highest risk (defined as a BP ≥ 160/100) and a decrease in disparities within this group. The quality collaborative identified five key lessons to help guide future community initiatives: (a) anticipate a plateauing of response; (b) distinguish the needs of disparate populations and create subpopulation-specific strategies to address and reduce disparities; (c) recognize the variation across low SES practices; (d) remain open to the refinement of outcome measures; and (e) continually seek best practices and barriers to success. Overall, a large community-wide QI initiative, involving multiple different stakeholders, was associated with improvements in BP control and modest reductions in some targeted disparities.
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Affiliation(s)
- Robert J Fortuna
- Departments of Internal Medicine and Pediatrics, Center for Primary Care, University of Rochester, Rochester, New York
| | - Thomas A Rocco
- Department of Internal Medicine, University of Rochester, Rochester, New York
| | | | - Mathew Devine
- Department of Family Medicine, University of Rochester, Rochester, New York
| | - John Bisognano
- Division of Cardiology, University of Rochester, Rochester, New York
| | - Geoffrey C Williams
- Department of Internal Medicine, University of Rochester, Rochester, New York
| | - Angela Nagel
- Department of Pharmacy Practice & Administration, Wegman's School of Pharmacy St. John Fisher College, Rochester, New York
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May Measurement Month 2017: an analysis of blood pressure screening results worldwide. LANCET GLOBAL HEALTH 2018; 6:e736-e743. [PMID: 29778399 DOI: 10.1016/s2214-109x(18)30259-6] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. METHODS This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. FINDINGS Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays. INTERPRETATION Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure. FUNDING International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co.
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Prevalence, Awareness, Treatment, and Control of Hypertension and Its Risk Factors in (Central) Vietnam. Int J Hypertens 2018; 2018:6326984. [PMID: 29887994 PMCID: PMC5977008 DOI: 10.1155/2018/6326984] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction The objective of this study is to describe the prevalence, awareness, treatment, and control of hypertension and its associated risk factors in (Central) Vietnam. Methods In this cross-sectional study, a multistage sampling was used to select 969 participants from the general population aged from 40 to 69 years. The cardiovascular risk factors were collected throughout the interviews with a standardized questionnaire. Multivariate logistic regression analysis was conducted to test the relationship between the prevalence, awareness, treatment, and control of hypertension and the prevalence of risk factors. Results The prevalence of hypertension was 44.8%. It was higher in men than in women (51.3% versus 39.7%, p < 0.001). In total 67.3% (74.5% in women, 60.1% in men; p = 0.001) of the participants were aware of their hypertension, 33.2% (37.5% in women, 28.9% in men; p = 0.01) of the participants were treated, and 12.2% (16.7% in women, 7.8% in men; p < 0.001) of the hypertensive participants' hypertension was controlled. Age, gender, place of residence, body mass index, and diabetes were found to be independent risk factors for hypertension. Conclusion The prevalence of hypertension in Vietnam is high, and the proportion of treated and controlled patients is rather low.
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Affiliation(s)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands
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27
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The ratio of monocyte frequency to HDL cholesterol level as a predictor of asymptomatic organ damage in patients with primary hypertension. Hypertens Res 2017; 40:758-764. [DOI: 10.1038/hr.2017.36] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 11/08/2022]
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Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet 2017; 389:37-55. [PMID: 27863813 PMCID: PMC5220163 DOI: 10.1016/s0140-6736(16)31919-5] [Citation(s) in RCA: 1376] [Impact Index Per Article: 196.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. METHODS For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. FINDINGS We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7-128·3) in men and 122·3 mm Hg (121·0-123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9-79·5) for men and 76·7 mm Hg (75·9-77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4-27·1) in men and 20·1% (17·8-22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. INTERPRETATION During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. FUNDING Wellcome Trust.
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