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Ivensky V, Zonga P, Dallaire G, Desbiens LC, Nadeau-Fredette AC, Rousseau G, Goupil R. Differences in Antihypertensive Medication Prescription Profiles Between 2009 and 2021: A Retrospective Cohort Study of CARTaGENE. Can J Kidney Health Dis 2024; 11:20543581241234729. [PMID: 38601903 PMCID: PMC11005488 DOI: 10.1177/20543581241234729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/14/2024] [Indexed: 04/12/2024] Open
Abstract
Background Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline. Objective To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021. Design This is a retrospective cohort study. Setting We used data from the CARTaGENE population-based cohort linked to administrative health databases. Patients Participants with any drug claim in the 6 months prior to the end of follow-up were included. Measurements Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021). Methods Prescriptions practices from the 2 time periods were compared using Pearson's chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up). Results Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis. Limitations Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available. Conclusions Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.
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Affiliation(s)
- Victoria Ivensky
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Medicine, Université de Montréal, QC, Canada
| | - Pitchou Zonga
- Department of Pharmacology and Physiology, Université de Montréal, QC, Canada
| | - Gabriel Dallaire
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Pharmacy, Université de Montréal, QC, Canada
| | | | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, QC, Canada
- Hôpital Maisonneuve-Rosemont, CIUSSS de l’Est-de-l’île-de-Montréal, QC, Canada
| | - Guy Rousseau
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Pharmacology and Physiology, Université de Montréal, QC, Canada
| | - Rémi Goupil
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Medicine, Université de Montréal, QC, Canada
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Uwakwe SI, Uwakwe C, Edeh NI, Chukwu CJ, Enyi C, Irouwakwe C, Chukwuemeka-Nworu JI, David AO, Ezepue EI, Aneke MC, Nwankwo BC, Isilebo CN, Ezurike CA, Nweke PO. Efficacy of rational emotive behavior therapy for the improvement of knowledge and risk perception of hypertension among university lecturers in South East Nigeria: REBT for university lecturers' hypertension improvement. Medicine (Baltimore) 2023; 102:e32171. [PMID: 36820571 PMCID: PMC9907944 DOI: 10.1097/md.0000000000032171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study determined the effectiveness of a rational emotive behavioral therapy (REBT) intervention on knowledge of risks of hypertension among university lecturers in South-east geopolitical zone of Nigeria. METHODS The study used a group randomized controlled trial design to group the participants into treatment group and a waiting-list control group and the hypertension knowledge questionnaire and the Perceived Risks of Hypertension Questionnaire to collect a pretest, posttest, and follow-up data of this study. The sample of the study was 84 university lecturers in public universities in Southeast Nigeria (University of Nigeria, Nsukka, Enugu State, Nnamdi Azikiwe University, Awka, Anambra State) who satisfies the requirements to participate in the study. The study lasted for 10 weeks. The data collected for the study were analyzed using repeated measures ANOVA and t test statistics. RESULTS The findings of this study were that REBT health educational intervention effectively increased the education foundation and business education lecturers' knowledge and perceived risk of hypertension compared to participants in waitlist group. Lastly, the outcomes of the follow-up measures indicate that the increased knowledge and perceived risks of hypertension acquired during the training program was sustained by the treatment group one month after the end of program. CONCLUSION The REBT health educational intervention program could be utilized to increase knowledge and perceived risks of hypertension among university lecturers in public universities in Southeast Nigeria.
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Affiliation(s)
- Stephen Iro Uwakwe
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | | | - Nathaniel Ifeanyi Edeh
- Department of Business Education, University of Nigeria, Nsukka, Nigeria
- * Correspondence: Nathaniel Ifeanyi Edeh, Department of Business Education, University of Nigeria, Nsukka 410001, Nigeria (e-mail: )
| | | | - Chinwe Enyi
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | | | | | | | | | - Mary Chioma Aneke
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
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Denche-Zamorano Á, Pérez-Gómez J, Mendoza-Muñoz M, Carlos-Vivas J, Oliveira R, Brito JP. Risk of Hypertension and Use of Antihypertensive Drugs in the Physically Active Population under-70 Years Old—Spanish Health Survey. Healthcare (Basel) 2022; 10:healthcare10071283. [PMID: 35885810 PMCID: PMC9319692 DOI: 10.3390/healthcare10071283] [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: 06/08/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Reducing the prevalence of hypertension is a major priority of the World Health Organization (WHO). Its high prevalence and associated risks generate high economic and social costs. Physical activity (PA) is associated with a decrease in hypertension and in the use of antihypertensive drugs. Objective: To explore the association between PA levels (PAL), prevalence of hypertension and the use of antihypertensive drugs in Spanish population. To calculate risks of hypertension and use of antihypertensive in the inactive versus physically active population. Method: This cross-sectional study used data from 17717 individuals, sampled in the 2017 National Health Survey. Interaction by sex, age groups, body mass index (BMI), hypertension prevalence, antihypertensive drugs use and PAL, using a pairwise z-test, and dependence relationships between variables, were studied using a chi square test. Odds ratios of hypertension and antihypertensive drug use were calculated among the inactive and the physically active populations. Results: The findings showed a significant inverse association between prevalence of hypertension, antihypertensive use, and PAL in both sexes and different age and BMI groups, with lower prevalence of hypertension and antihypertensive use when PAL were higher. The risks of hypertension and antihypertensive use seems to be reduced when related to higher PAL compared to inactive people. Conclusions: High PAL is associated with lower prevalence of hypertension and lower antihypertensive use. Thus, being physically active or very active may reduce the risks of suffering from hypertension and the need to use antihypertensives compared to inactive people or walkers.
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Affiliation(s)
- Ángel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Pérez-Gómez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Maria Mendoza-Muñoz
- Research Group on Physical and Health Literacy and Health-Related Quality of Life (PHYQOL), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
| | - Jorge Carlos-Vivas
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Rafael Oliveira
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2040-403 Rio Maior, Portugal
| | - João Paulo Brito
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development, Quinta de Prados, Edifício Ciências de Desporto, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2040-403 Rio Maior, Portugal
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4
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Yang L, Chen H, Shu T, Pan M, Huang W. Risk of incident atrial fibrillation with low-to-moderate alcohol consumption is associated with gender, region, alcohol category: a systematic review and meta-analysis. Europace 2021; 24:729-746. [PMID: 34864980 DOI: 10.1093/europace/euab266] [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: 06/01/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. METHODS AND RESULTS A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07-1.11, P < 0.00001], Europeans (HR 1.32, 95% CI: 1.23-1.42, P < 0.00001), and Asians (HR 1.09, 95% CI: 1.07-1.11, P < 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02-1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01-1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07-1.17, P < 0.00001). CONCLUSIONS This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol's effect on predisposing AF.
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Affiliation(s)
- Lingzhi Yang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Huaqiao Chen
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Tingting Shu
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Mingyong Pan
- College of Mathematics and Statistics, Chongqing University, No. 174 Shazhengjie, Shapingba District, Chongqing, 400044, China
| | - Wei Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
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Okorie C, Ajibesin K, Sanyaolu A, Islam A, Lamech S, Mupepi K, Mupepi T, Oseni A, Oyeleke O, Abioye A. A Review of the Therapeutic Benefits of Moringa oleifera in Controlling High Blood Pressure (Hypertension). CURRENT TRADITIONAL MEDICINE 2019. [DOI: 10.2174/2215083805666190208163441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Moringa oleifera (M. oleifera) is an angiosperm plant that is a member of the Moringaceae family. It is a natural plant that is native to the sub-Himalayan northern regions of India, Bangladesh, Pakistan, and Afghanistan. The plant grows abundantly throughout tropical and subtropical areas of the world. For several centuries, many cultures have utilized various parts of the moringa plant as traditional medicine to treat common illnesses and control life-threatening conditions such as hypertension (HTN), diabetes, hyperlipidemia, inflammation, etc. This article reviewed the current literature on the therapeutic benefits of M. oleifera on hypertension, primarily focusing on identifying the plant’s key components and its roles in hindering the common pathophysiological pathways associated with hypertension. The number of people living with HTN has been predicted to increase to 1.56 billion worldwide by 2025 in spite of the myriads of preventive and treatment strategies available today. Therefore, it would be of great value to explore alternative complementary ways of controlling high blood pressure. HTN is commonly defined as blood pressure equal to or higher than 140/90 mm Hg. HTN itself is not a disease condition and does not elicit specific symptoms, however, if left untreated for a long time, it can lead to complicated cardiovascular diseases such as angina, congestive heart failure, myocardial infarction as well as stroke and chronic kidney diseases. Primary hypertension is diagnosed when there is no known identifiable underlying cause for the onset of the condition. Secondary hypertension is diagnosed when there is evidence of a disease or disorder triggering the onset of the condition. It is apparent that understanding the role of M. oleifera in the management of hypertension would expand the valuable strategies for the control of this condition.
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Affiliation(s)
- Chuku Okorie
- Essex County College, Newark, New Jersey, United States
| | - Kola Ajibesin
- Department of Pharmacognosy and Herbal Medicine, Faculty of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
| | | | - Adeena Islam
- Saint James School of Medicine, Anguilla, West Indies
| | | | | | | | - Akeem Oseni
- Saint James School of Medicine, Anguilla, West Indies
| | | | - Amos Abioye
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, United States
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6
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Pimenta FC, Montrezol FT, Dourado VZ, da Silva LFM, Borba GA, de Oliveira Vieira W, Medeiros A. High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise. Eur J Appl Physiol 2019; 119:1235-1243. [PMID: 30848358 DOI: 10.1007/s00421-019-04114-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Physical exercise is associated with reduced blood pressure (BP). Moderate-intensity continuous exercise (MCE) promotes post-exercise hypotension (PEH), which is highly recommended to hypertensive patients. However, recent studies with high-intensity interval exercise (HIIE) have shown significant results in cardiovascular disease. Thus, this study aimed to analyze PEH in hypertensive subjects submitted to HIIE and compare it to post MCE hypotension. METHODS 20 hypertensive adults (51 ± 8 years), treated with antihypertensive medications, were submitted to two different exercise protocols and a control session. The MCE was performed at 60-70% of VO2 reserve, while HIIE was composed of five bouts of 3 min at 85-95% VO2 reserve with 2 min at 50% of VO2 reserve. The following variables were evaluated during exercise, pre- and post-session: clinical BP, heart rate (HR), double product, perception of effort, body mass, height and body mass index. RESULTS Systolic BP decreased after exercise in both sessions, showing greater decrease after HIIE (- 7 ± 10 and - 11 ± 12 mmHg, after MCE and HIIE, respectively, p ≤ 0.01). Diastolic BP also decreased after both sessions, but there were no significant differences between the two sessions (- 4 ± 8 and - 7 ± 8 mmHg, after MCE and HIIE, respectively). CONCLUSION Both exercise sessions produced PEH, but HIIE generated a greater magnitude of hypotension. The HIIE protocol performed in this study caused a greater cardiovascular stress during exercise; however, it was safe for the studied population and efficient for reducing BP after exercise.
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Affiliation(s)
- Flávia C Pimenta
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Fábio Tanil Montrezol
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, 11015-020, Brazil
| | | | - Gabriela Alves Borba
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Wesley de Oliveira Vieira
- Department of Human Movement Sciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, 11015-020, Brazil
| | - Alessandra Medeiros
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil.
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7
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Yimer H, Yaregal D, Getinet H, Hailekirose A. Evidence based guideline on perioperative optimization of hypertensive patients booked for elective surgery at a low-income country. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Padwal RS, Tran KC, Grover S, Rabkin SW, Moe GW, Howlett JG, Lindsay P, Hill MD, Sharma M, Field T, Wein TH, Shoamanesh A, Dresser GK, Hamet P, Herman RJ, Burgess E, Gryn SE, Grégoire JC, Lewanczuk R, Poirier L, Campbell TS, Feldman RD, Lavoie KL, Tsuyuki RT, Honos G, Prebtani APH, Kline G, Schiffrin EL, Don-Wauchope A, Tobe SW, Gilbert RE, Leiter LA, Jones C, Woo V, Hegele RA, Selby P, Pipe A, McFarlane PA, Oh P, Gupta M, Bacon SL, Kaczorowski J, Trudeau L, Campbell NRC, Hiremath S, Roerecke M, Arcand J, Ruzicka M, Prasad GVR, Vallée M, Edwards C, Sivapalan P, Penner SB, Fournier A, Benoit G, Feber J, Dionne J, Magee LA, Logan AG, Côté AM, Rey E, Firoz T, Kuyper LM, Gabor JY, Townsend RR, Rabi DM, Daskalopoulou SS. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2018; 34:506-525. [PMID: 29731013 DOI: 10.1016/j.cjca.2018.02.022] [Citation(s) in RCA: 420] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Kara A Nerenberg
- Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Kelly B Zarnke
- O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St. Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven Grover
- McGill Comprehensive Health Improvement Program (CHIP), Montreal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Lindsay
- Director of Stroke, Heart and Stroke Foundation of Canada, Adjunct Faculty, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Sharma
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Thalia Field
- University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Theodore H Wein
- McGill University, Stroke Prevention Clinic, Montreal General Hospital, Montreal, Quebec, Canada
| | - Ashkan Shoamanesh
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Robert J Herman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ellen Burgess
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven E Gryn
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Luc Poirier
- Institut National d'Excellence en Sante et Services Sociaux, Québec, Quebec, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Feldman
- Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim L Lavoie
- University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - George Honos
- CHUM, University of Montreal, Montreal, Quebec, Canada
| | - Ally P H Prebtani
- Internal Medicine, Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Kline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Sheldon W Tobe
- University of Toronto, Toronto, Ontario, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Charlotte Jones
- Department of Medicine, UBC Southern Medical Program, Kelowna, British Columbia, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehab and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Norman R C Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Cedric Edwards
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Praveena Sivapalan
- Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | - Evelyne Rey
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Tabassum Firoz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura M Kuyper
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Y Gabor
- Interlake-Eastern Regional Healthy Authority, Concordia Hospital, Winnipeg, Manitoba, Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Doreen M Rabi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
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Glaser E, Richard C, Lussier MT. The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:2062-2070. [PMID: 28535926 DOI: 10.1016/j.pec.2017.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care. METHODS Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia. INTERVENTIONS (1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care. OUTCOME Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for. RESULTS Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up. CONCLUSIONS Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients. PRACTICE IMPLICATIONS Web communication interventions are an effective tool that can be used in primary care.
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Affiliation(s)
- Emma Glaser
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Faculty of Medicine, Université de Montréal, Canada.
| | - Claude Richard
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada
| | - Marie-Thérèse Lussier
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Canada
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Khan NA, McAlister FA, Pilote L, Palepu A, Quan H, Hill MD, Fang J, Kapral MK. Secondary prevention treatment after acute stroke in older South Asian, Chinese and other Canadians: a retrospective data analysis. CMAJ Open 2017; 5:E702-E709. [PMID: 28899946 PMCID: PMC5621941 DOI: 10.9778/cmajo.20160147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke. METHODS Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009). We compared prescriptions filled for statins, warfarin, any antihypertensive agent, the recommended combination of angiotensin-converting-enzyme (ACE) inhibitor and diuretic, and the combination of ACE inhibitor, diuretic and statin within 1 year after ischemic or primary intracerebral hemorrhagic stroke. RESULTS There were 118 362 patients with acute stroke (3430 Chinese, 2075 South Asian and 112 857 other Canadians). Among those with ischemic stroke (n = 108 699), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor, diuretic and statin (adjusted odds ratio [OR] 0.64 [95% confidence interval (CI) 0.55-0.74]) and, in those with atrial fibrillation, for warfarin (adjusted OR 0.75 [95% CI 0.59-0.95]). There were no differences in filling of prescriptions for antihypertensive therapy overall between the 3 groups. Among patients with intracerebral hemorrhagic stroke (n = 9663), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor and diuretic (adjusted OR 0.51 [95% CI 0.38-0.69]), and South Asians were more likely than other Canadian patients to fill prescriptions for any antihypertensive agent (adjusted OR 1.73 [95% CI 1.21-2.49]). INTERPRETATION We identified ethnic differences in filling of prescriptions for several secondary prevention medications after acute stroke. The reasons underlying these differences need to be investigated.
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Affiliation(s)
- Nadia A Khan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Finlay A McAlister
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Louise Pilote
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Anita Palepu
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Hude Quan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Michael D Hill
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Jiming Fang
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Moira K Kapral
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
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Richard C, Glaser E, Lussier M. Communication and patient participation influencing patient recall of treatment discussions. Health Expect 2017; 20:760-770. [PMID: 27868327 PMCID: PMC5513012 DOI: 10.1111/hex.12515] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. OBJECTIVES To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. DESIGN Observational study within a RCT. SETTING & PARTICIPANTS Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. MAIN VARIABLES Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. MAIN OUTCOME MEASURES Recall of CD, lifestyle treatment and medication information. RESULTS Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. DISCUSSION Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. CONCLUSION Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.
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Affiliation(s)
- Claude Richard
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
| | - Emma Glaser
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Marie‐Thérèse Lussier
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Family Medicine and Emergency Medicine DepartmentFaculty of MedicineUniversité de MontréalMontréalQCCanada
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12
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Lussier MT, Richard C, Glaser E, Roberge D. The impact of a primary care e-communication intervention on the participation of chronic disease patients who had not reached guideline suggested treatment goals. PATIENT EDUCATION AND COUNSELING 2016; 99:530-541. [PMID: 26657041 DOI: 10.1016/j.pec.2015.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/29/2015] [Accepted: 11/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs. METHODS 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires. RESULTS Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change. CONCLUSION Following interventions, CD patients were more activated even in well-established doctor-patient relationships. PRACTICE IMPLICATIONS PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it.
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Affiliation(s)
- Marie-Thérèse Lussier
- Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Canada; Primary Care Research Team, Centre Intégré de Santé et des Services Sociaux de Laval, Canada.
| | - Claude Richard
- Primary Care Research Team, Centre Intégré de Santé et des Services Sociaux de Laval, Canada
| | - Emma Glaser
- Faculty of Medicine, Université de Montréal, Canada
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Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Lebel M, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Trudeau L, Petrella RJ, Hiremath S, Drouin D, Lavoie KL, Hamet P, Fodor G, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Harris KC, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol 2016; 32:569-88. [PMID: 27118291 DOI: 10.1016/j.cjca.2016.02.066] [Citation(s) in RCA: 337] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 12/28/2022] Open
Abstract
Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Marcel Lebel
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- Division of Endocrinology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Best Practices and Performance, Heart and Stroke Foundation, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Pierre Larochelle
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard I Ogilvie
- University Health Network, Departments of Medicine and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Robert J Petrella
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - George Fodor
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- The Canadian Stroke Network, Ottawa, Ontario, Canada
| | - Debra Reid
- Canadian Forces Health Services, Department of National Defence and Dietitians of Canada, Ottawa, Ontario, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London, London, United Kingdom
| | | | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Cruickshank JM. The Role of Beta-Blockers in the Treatment of Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:149-166. [PMID: 27957711 DOI: 10.1007/5584_2016_36] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Two major guide-line committees (JNC-8 and NICE UK) have dropped beta-blockers as first-line therapy in the treatment of hypertension. Also, recent meta-analyses (that do not take age into account) have concluded that beta-blockers are inappropriate first-line agents in the treatment of hypertension. This review seeks to shed some light on the "rights and wrongs" of such actions and conclusions. OBJECTIVES Because the pathophysiology of primary/essential hypertension differs in elderly and younger subjects, the latter being closely linked to obesity and increased sympathetic nerve activity, the author sought to clarify the efficacy of beta-blockers in the younger/middle-aged group in reducing the risk of death, and cardiovascular end-points. EVIDENCE ACQUISITION Four searches were undertaken, utilising PubMed up to 31st Dec 2015. One search was under the terms "hypertension AND obesity AND sympathetic nerve activity". A second was "hypertension AND plasma noradrenaline/norepinephrine AND survival". A third was "beta-blockers or adrenergic beta-antagonists AND hypertension AND age AND stroke or myocardial infarction or death". A fourth was "meta-analysis of beta-blockers AND hypertension AND age AND death, stroke, myocardial infarction" RESULTS: Diastolic (with or without systolic) hypertension, in contrast to isolated systolic hypertension, occurs primarily in younger subjects, and is linked to overweight/obesity and increased sympathetic nerve activity. In younger/middle-aged hypertensive subjects, high plasma norepinephrine levels are linked (independent of blood pressure) to an increased risk of future cardiovascular events and death. High resting heart rates (a surrogate for high sympathetic nerve activity) likewise predict premature all-cause death, coronary heart disease and cardiovascular events in younger hypertensive subjects. In this younger/middle-aged hypertensive group, antihypertensive agents that increase sympathetic nerve activity (diuretics, dihydropyridine calcium blockers, and angiotensin receptor blockers (ARBs)) do not decrease (and may increase) the risk of myocardial infarction, and are therefore inappropriate first-line agents in this age-group. By contrast, in younger/middle-aged hypertensive subjects (less than 60 years old), meta-analysis has shown that beta-blockers are significantly superior to randomised placebo, and at least as effective as randomised comparator agents, in reducing death/stroke/myocardial infarction. In this younger/middle-aged hypertensive group beta-blockers have been shown (vs randomised placebo or diuretics) to reduce the risk of myocardial infarction by 35-50 %, and stroke by 50-55 % (vs placebo), in non-smoker men. Atenolol was at least as effective as ACE-inhibition (captopril) in reducing all 7 cardiovascular endpoints (including stroke which was reduced by 50 %), vs less tight control of blood pressure, in obese hypertensive subjects with type-2 diabetes (UKPDS study); and after 20 years follow-up, atenolol was significantly (23 %) superior to the ACE-inhibitor in reducing the risk of all-cause death (beta-blockers have anti-cancer properties, which maybe relevant). CONCLUSIONS AND RELEVANCE Primary/essential hypertension in younger/middle-age is underpinned by high sympathetic nerve activity. In this age-group high resting heart rates and high plasma norepinephrine levels (independent of blood pressure) are linked to premature cardiovascular events and death. Thus, anti-hypertensive agents that increase sympathetic nerve activity ie diuretics, dihydropyridine calcium blockers, and ARBs, are inappropriate first-line choices in this younger age-group. Beta-blockers perform well vs randomised placebo and other antihypertensive agents regarding reduced risk of death/stroke/myocardial infarction in younger (<60 years) hypertensive subjects, and are a reasonable first-line choice of therapy (certainly in men). These facts should be reflected in the recommendations of guideline committees around the world.
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Affiliation(s)
- John M Cruickshank
- Oxonian Cardiovascular Consultancy, 42 Harefield, Long Melford, Suffolk, CO10 9DE, UK.
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16
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Lifestyle Medicine for the Prevention and Treatment of Depression. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Chan Q, Stamler J, Oude Griep LM, Daviglus ML, Van Horn L, Elliott P. An Update on Nutrients and Blood Pressure. J Atheroscler Thromb 2015; 23:276-89. [PMID: 26686565 PMCID: PMC6323301 DOI: 10.5551/jat.30000] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Adverse blood pressure (BP) is a major independent risk factor for epidemic cardiovascular diseases affecting almost one-quarter of the adult population worldwide. Dietary intake is a major determinant in the development and progression of high BP. Lifestyle modifications, including recommended dietary guidelines, are advocated by the American Society of Hypertension, the International Society of Hypertension, the Japanese Society of Hypertension, and many other organisations for treating all hypertensive people, prior to initiating drug therapy and as an adjunct to medication in persons already on drug therapy. Lifestyle modification can also reduce high BP and prevent development of hypertension. This review synthesizes results from the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP), a cross-sectional epidemiological study of 4,680 men and women aged 40-59 years from Japan, the People's Republic of China, the United Kingdom, and the United States, published over the past few years on cross cultural BP differences. INTERMAP has previously reported that intakes of vegetable protein, glutamic acid, total and insoluble fibre, total polyunsaturated fatty acid and linoleic acid, total n-3 fatty acid and linolenic acid, phosphorus, calcium, magnesium, and non-heme iron were inversely related to BP. Direct associations of sugars (fructose, glucose, and sucrose) and sugar-sweetened beverages (especially combined with high sodium intake), cholesterol, glycine, alanine, and oleic acid from animal sources with BP were also reported by the INTERMAP Study.
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Affiliation(s)
- Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Linda M. Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Martha L. Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Minority Health Research, University of Chicago, IL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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18
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Wasserstrum Y, Kornowski R, Raanani P, Leader A, Pasvolsky O, Iakobishvili Z. Hypertension in cancer patients treated with anti-angiogenic based regimens. CARDIO-ONCOLOGY 2015; 1:6. [PMID: 33530150 PMCID: PMC7837153 DOI: 10.1186/s40959-015-0009-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/25/2015] [Indexed: 02/08/2023]
Abstract
New anti-cancer drugs that inhibit the vascular endothelial growth factor (VEGF) signaling pathway are highly effective in the treatment of solid tumors, however concerns remain regarding their cardiovascular safety. The most common side effect of VEGF signaling pathway (VSP) inhibition is the development of systemic hypertension. We review the incidence, possible mechanisms, significance and management of hypertension in patients treated with VSP inhibitors.
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Affiliation(s)
- Yishay Wasserstrum
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Department of Cardiology, Rabin Medical Center, Petah Tikva, 49100, Israel. .,Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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19
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Sarris J, Nishi D, Xiang YT, Su KP, Bannatyne A, Oliver G, Kua EH, Ng CH. Implementation of psychiatric-focused lifestyle medicine programs in Asia. Asia Pac Psychiatry 2015; 7:345-54. [PMID: 26403310 DOI: 10.1111/appy.12212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022]
Abstract
Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Daisuke Nishi
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
| | - Amy Bannatyne
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Oliver
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ee-Heok Kua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Hong Ng
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Clark JL, Zahradka P, Taylor CG. Efficacy of flavonoids in the management of high blood pressure. Nutr Rev 2015; 73:799-822. [PMID: 26491142 DOI: 10.1093/nutrit/nuv048] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Plant compounds such as flavonoids have been reported to exert beneficial effects in cardiovascular disease, including hypertension. Information on the effects of isolated individual flavonoids for management of high blood pressure, however, is more limited. This review is focused on the flavonoids, as isolated outside of the food matrix, from the 5 main subgroups consumed in the Western diet (flavones, flavonols, flavanones, flavan-3-ols, and anthocyanins), along with their effects on hypertension, including the potential mechanisms for regulating blood pressure. Flavonoids from all 5 subgroups have been shown to attenuate a rise in or to reduce blood pressure during several pathological conditions (hypertension, metabolic syndrome, and diabetes mellitus). Flavones, flavonols, flavanones, and flavanols were able to modulate blood pressure by restoring endothelial function, either directly, by affecting nitric oxide levels, or indirectly, through other pathways. Quercetin had the most consistent blood pressure-lowering effect in animal and human studies, irrespective of dose, duration, or disease status. However, further research on the safety and efficacy of the flavonoids is required before any of them can be used by humans, presumably in supplement form, at the doses required for therapeutic benefit.
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Affiliation(s)
- Jaime L Clark
- J.L. Clark, P. Zahradka, and C.G. Taylor are with the Department of Human Nutritional Sciences, University of Manitoba, Manitoba, Canada. P. Zahradka and C.G. Taylor are with the Department of Physiology and Pathophysiology, University of Manitoba, Manitoba, Canada. J.L. Clark, P. Zahradka, and C.G. Taylor are with the Canadian Centre for Agri-Food Research in Health and Medicine, St Boniface Research Centre, Winnipeg, Manitoba, Canada
| | - Peter Zahradka
- J.L. Clark, P. Zahradka, and C.G. Taylor are with the Department of Human Nutritional Sciences, University of Manitoba, Manitoba, Canada. P. Zahradka and C.G. Taylor are with the Department of Physiology and Pathophysiology, University of Manitoba, Manitoba, Canada. J.L. Clark, P. Zahradka, and C.G. Taylor are with the Canadian Centre for Agri-Food Research in Health and Medicine, St Boniface Research Centre, Winnipeg, Manitoba, Canada
| | - Carla G Taylor
- J.L. Clark, P. Zahradka, and C.G. Taylor are with the Department of Human Nutritional Sciences, University of Manitoba, Manitoba, Canada. P. Zahradka and C.G. Taylor are with the Department of Physiology and Pathophysiology, University of Manitoba, Manitoba, Canada. J.L. Clark, P. Zahradka, and C.G. Taylor are with the Canadian Centre for Agri-Food Research in Health and Medicine, St Boniface Research Centre, Winnipeg, Manitoba, Canada.
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21
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The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2015; 31:549-68. [PMID: 25936483 DOI: 10.1016/j.cjca.2015.02.016] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.
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22
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Randomized evaluation of a novel, fixed-dose combination of perindopril 3.5 mg/amlodipine 2.5 mg as a first-step treatment in hypertension. J Hypertens 2015; 33:653-61; discussion 662. [DOI: 10.1097/hjh.0000000000000440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Daly B, Kenealy T, Arroll B, Sheridan N, Scragg R. Do primary health care nurses address cardiovascular risk in diabetes patients? Diabetes Res Clin Pract 2014; 106:212-20. [PMID: 25271111 DOI: 10.1016/j.diabres.2014.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 08/15/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
Abstract
AIMS To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. METHODS Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. RESULTS The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001). CONCLUSIONS Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Timothy Kenealy
- General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Bruce Arroll
- General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Nicolette Sheridan
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
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Huang Z, Liu Z, Luo Q, Zhao Q, Zhao Z, Ma X, Xi Q, Yang D. Predictors of Blood Pressure Fall With Continuous Positive Airway Pressure Treatment in Hypertension With Coronary Artery Disease and Obstructive Sleep Apnea. Can J Cardiol 2014; 31:853-9. [PMID: 25660149 DOI: 10.1016/j.cjca.2014.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/15/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present study aimed to investigate the predictors of changes in blood pressure (BP) with continuous positive airway pressure (CPAP) treatment in hypertensive patients with coronary heart disease (CHD) and obstructive sleep apnea (OSA). METHODS Seventy-one hypertensive patients with CHD and OSA were enrolled in this study. Daytime systolic BP (SBP), diastolic BP (DBP), Epworth Sleepiness Scale (ESS), and anthropometric characteristics were assessed at baseline and follow-up. RESULTS Sixty-six patients completed the study. The median follow-up period was 36 months (interquartile range, 24-60 months). The mean duration of CPAP application was 4.3 ± 1.2 hours per night. From baseline to follow-up, SBP and DBP were reduced by 5.6 mm Hg (95% confidence interval [CI], 3.0-8.1) and 3.0 mm Hg (95% CI, 0.8-5.3), respectively. Daytime somnolence was significantly improved (ESS, from 9.5 ± 3.4 at baseline to 3.6 ± 2.0 at follow-up; P < 0.001); the mean improvement in ESS was 6.0 (95% CI, 5.1-6.9). Correlation analysis of the fall in mean BP (MBP) showed that baseline MBP, change in ESS, heart rate, and CPAP compliance showed a positive correlation, whereas the baseline body mass index (BMI) and ESS had an inverse relationship. Stepwise multiple linear regression analysis, however, indicated that only baseline BMI, baseline MBP, and CPAP compliance were independently correlated with the fall in MBP. CONCLUSIONS Long-term CPAP treatment reduces BP in hypertensive patients with CHD and moderate/severe OSA; baseline BMI, baseline MBP, and CPAP compliance are independent predictors of the decrease in BP with CPAP treatment in these patients.
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Affiliation(s)
- Zhiwei Huang
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihong Liu
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qin Luo
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhao
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhao
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuping Ma
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qunying Xi
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Yang
- State Key Laboratory of Cardiovascular Disease, Sleep Disorders Research Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J Am Coll Cardiol 2014; 64:281-9. [PMID: 25034065 DOI: 10.1016/j.jacc.2014.03.048] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although high alcohol consumption has been associated with increased risk of atrial fibrillation (AF), the role of light to moderate drinking remains unclear. OBJECTIVES The study sought to investigate the association between alcohol consumption and AF risk in a prospective study of Swedish men and women and to conduct a meta-analysis of prospective studies to summarize available evidence. METHODS We followed 79,019 men and women who, at baseline, were free from AF and had completed a questionnaire about alcohol consumption and other risk factors for chronic diseases. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. For the meta-analysis, studies were identified by searching PubMed through January 10, 2014, and by reviewing references of pertinent publications. Study-specific relative risks (RRs) were combined using a random effects model. RESULTS Over 859,420 person-years of follow-up (1998 to 2009), 7,245 incident AF cases were identified in our own cohort study. The association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74). Compared with current drinkers of <1 drink/week (12 g alcohol/drink), the multivariable RRs of AF were 1.01 (95% confidence interval [CI]: 0.94 to 1.09) for 1 to 6 drinks/week, 1.07 (95% CI: 0.98 to 1.17) for 7 to 14 drinks/week, 1.14 (95% CI: 1.01 to 1.28) for 15 to 21 drinks/week, and 1.39 (95% CI: 1.22 to 1.58) for >21 drinks/week. Results were similar after excluding binge drinkers. In a meta-analysis of 7 prospective studies, including 12,554 AF cases, the RRs were 1.08 (95% CI: 1.06 to 1.10) for 1 drink/day, 1.17 (95% CI: 1.13 to 1.21) for 2 drinks/day, 1.26 (95% CI: 1.19 to 1.33) for 3 drinks/day, 1.36 (95% CI: 1.27 to 1.46) for 4 drinks/day, and 1.47 (95% CI: 1.34 to 1.61) for 5 drinks/day, compared with nondrinkers. CONCLUSIONS These findings indicate that alcohol consumption, even at moderate intakes, is a risk factor for atrial fibrillation.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Dasgupta K, Quinn RR, Zarnke KB, Rabi DM, Ravani P, Daskalopoulou SS, Rabkin SW, Trudeau L, Feldman RD, Cloutier L, Prebtani A, Herman RJ, Bacon SL, Gilbert RE, Ruzicka M, McKay DW, Campbell TS, Grover S, Honos G, Schiffrin EL, Bolli P, Wilson TW, Lindsay P, Hill MD, Coutts SB, Gubitz G, Gelfer M, Vallée M, Prasad GR, Lebel M, McLean D, Arnold JMO, Moe GW, Howlett JG, Boulanger JM, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Burns KD, Petrella RJ, Hiremath S, Milot A, Stone JA, Drouin D, Lavoie KL, Lamarre-Cliche M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk GB, Burgess E, Lewanczuk R, Dresser GK, Penner SB, Hegele RA, McFarlane PA, Khara M, Pipe A, Oh P, Selby P, Sharma M, Reid DJ, Tobe SW, Padwal RS, Poirier L. The 2014 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol 2014; 30:485-501. [DOI: 10.1016/j.cjca.2014.02.002] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/20/2022] Open
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Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry 2014; 14:107. [PMID: 24721040 PMCID: PMC3998225 DOI: 10.1186/1471-244x-14-107] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 03/07/2014] [Indexed: 12/16/2022] Open
Abstract
The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Adrienne O’Neil
- School of Medicine, Deakin University, Geelong, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Isaac Schweitzer
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- School of Medicine, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Orygen Youth Health Research Institute, Parkville, Australia
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Coca A, Mazón P, Aranda P, Redón J, Divisón JA, Martínez J, Calvo C, Galcerán JM, Barrios V, Coll ARCI. Role of dihydropyridinic calcium channel blockers in the management of hypertension. Expert Rev Cardiovasc Ther 2014; 11:91-105. [DOI: 10.1586/erc.12.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Epstein BJ, Smith SM, Choksi R. Recent changes in the landscape of combination RAS blockade. Expert Rev Cardiovasc Ther 2014; 7:1373-84. [DOI: 10.1586/erc.09.127] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Akbar S, Alorainy MS. The current status of beta blockers' use in the management of hypertension. Saudi Med J 2014; 35:1307-17. [PMID: 25399206 PMCID: PMC4362137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The invention of beta (β)-blockers culminated in a new era in the treatment of cardiovascular diseases (CD), and changed the course of pharmacology research for years to come. Since the introduction of propranolol into clinical practice in 1964, β-blockers enjoyed a special place in the clinicians' armamentarium against CDs, especially for patients with ischemic heart diseases, and are still one of the most extensively used therapeutic drugs in both cardiac and non-cardiac ailments. Current uses of β-blockers in CDs include ischemic heart diseases, hypertension, cardiac arrhythmias, and heart failure. Other substantial non-cardiac uses include glaucoma, migraine, situational anxiety, benign essential tremors, and cardiac symptoms of thyrotoxicosis. This review covers some of the evolutionary changes of clinical uses of β-blockers, the rationale for their use, some recent controversies surrounding their use for treatment of hypertension, and advantages of newer additions to the group.
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Affiliation(s)
- Shahid Akbar
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.,Address correspondence and reprint request to: Professor Shahid Akbar, Director, Research Center, Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, PO Box 6800, Buraidah 51452, Kingdom of Saudi Arabia. Tel. +966 (16) 3802267 Ext. 2330. E-mail:
| | - Mohammad S. Alorainy
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.
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Kostis JB, Sedjro JE, Cabrera J, Cosgrove NM, Pantazopoulos JS, Kostis WJ, Pressel SL, Davis BR. Visit-to-visit blood pressure variability and cardiovascular death in the Systolic Hypertension in the Elderly Program. J Clin Hypertens (Greenwich) 2013; 16:34-40. [PMID: 24325609 DOI: 10.1111/jch.12230] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/16/2013] [Accepted: 09/27/2013] [Indexed: 11/28/2022]
Abstract
Most studies of an association of visit-to-visit variability of blood pressure with increased risk of future adverse cardiovascular events are of short duration and rarely include a placebo group. Using data from the double-blind, placebo-controlled Systolic Hypertension in the Elderly Program, the authors examined mortality from cardiovascular causes up to 17 years of follow-up using the National Death Index. Visit-to-visit blood pressure variability was associated with cardiovascular death after adjustment for sex, age, serum creatinine, diabetes, body mass index, smoking status, left ventricular failure, and high-density lipoprotein cholesterol. The relationship was significantly stronger in the active treatment group compared with the placebo group. Although this could be the result of an effect of the medications used unrelated to visit-to-visit variability, the data are compatible with the hypothesis that inconsistent adherence leading to missing active medication doses may be an additional explanation for the relationship of visit-to-visit variability with cardiovascular death.
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Affiliation(s)
- John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Després F, Perreault S, Lalonde L, Forget A, Kettani FZ, Blais L. Impact of drug plans on adherence to and the cost of antihypertensive medications among patients covered by a universal drug insurance program. Can J Cardiol 2013; 30:560-7. [PMID: 24613090 DOI: 10.1016/j.cjca.2013.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/18/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This study aimed to assess the impact of the type of drug plan on adherence to antihypertensive medication treatment as well as the cost of these medications within universal drug insurance programs. METHODS To compare adherence to antihypertensive medication treatment and the cost of antihypertensive medications between adults with public and private drug insurance in the province of Québec, Canada, we reconstructed a matched retrospective cohort by linking data recorded in 3 administrative databases between March 2008 and May 2010. The cohort included 186 privately and 1747 publicly insured patients aged 18-64 years who were treated with 1 or 2 antihypertensive medications. Adherence measured with the proportion of days covered (PDC) over 1 year and the cost of antihypertensive medications were evaluated for new and prevalent users separately. RESULTS More than 70% of patients were 50-64 years old and 90% of the publicly and 72% of the privately insured patients were using only 1 antihypertensive medication. The mean PDC among new users of 1 antihypertensive medication was 58.8% for privately insured patients and 65.0% for publicly insured patients, but the difference was not statistically significant. However, privately insured patients treated with 2 antihypertensive medications were more likely to be adherent (PDC-P, 15.0%; 95% confidence interval, 7.0-24.0). Privately insured patients (CAD$41.52) had to pay significantly more for their antihypertensive medications than did publicly insured patients (CAD$32.21). CONCLUSIONS The cost of antihypertensive medications was higher for patients with private drug insurance, although adherence was similar in both groups. The results may reflect regulation of dispensing fees for publicly insured patients.
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Affiliation(s)
- François Després
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada; Endowment Pharmaceutical Chair, AstraZeneca in Respiratory Health, Montreal, Québec, Canada.
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Knox GJ, Baker JS, Davies B, Rees A, Morgan K, Cooper SM, Brophy S, Thomas NE. Effects of a novel school-based cross-curricular physical activity intervention on cardiovascular disease risk factors in 11- to 14-year-olds: the activity knowledge circuit. Am J Health Promot 2013; 27:75-83. [PMID: 23113776 DOI: 10.4278/ajhp.110617-quan-258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study investigates cardiovascular disease risk factor response in adolescents following introduction of brisk walking into curriculum lessons. DESIGN Quasi-experimental. SETTING School-based. SUBJECTS An intervention group consisted of 115 (aged 12.4 ± 0.5 y) year eight participants, and 77 (aged 12.1 ± 1.1 y) year seven and year nine participants formed a control. INTERVENTION An 18-week cross-curricular physical activity intervention was implemented in one secondary school. MEASURES Adiposity variables, blood pressure, lipids, lipoproteins, glucose, insulin, high-sensitivity C-reactive protein, high-molecular-weight adiponectin, aerobic fitness, physical activity behavior, and diet were assessed preintervention and postintervention. ANALYSIS Dependent and independent t-tests. RESULTS Prevalence of elevated waist circumference (9.8% vs. 6.9%), systolic blood pressure (3.3% vs. 0%), triglycerides (2.5% vs. 1.2%), and reduced high density lipoprotein cholesterol (3.7% vs. 2.7%) decreased in the intervention group. Significant improvements in high density lipoprotein cholesterol to total cholesterol ratio (mean ± SD: 2% ± 4% [confidence interval (CI)(0.05) = 1% to 2%], t(80) = -3.5, p = .001) and glucose (-.1 ± .4 mmol/L [CI(0.05) = -.2% to 0%], t(79) = 3.2, p = .002) were evident for the intervention group. CONCLUSION The Activity Knowledge Circuit may prove to be a sustainable, effective, and cost-effective strategy to engage schoolchildren in physical activity on a daily basis. A longer-duration intervention is required to fully understand risk factor response in adolescents.
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Affiliation(s)
- Gareth J Knox
- School of Sport, University of Wales Institute Cardiff, Cyncoed Campus, United Kingdom.
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Berk M, Sarris J, Coulson CE, Jacka FN. Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl 2013:38-54. [PMID: 23586875 DOI: 10.1111/acps.12124] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37]. To provide clinically relevant recommendations for lifestyle modifications in depression, derived from a literature review. METHOD A search of pertinent literature was conducted up to August 2012 in the area of lifestyle factors and depression. A narrative review was then conducted. RESULTS There is evidence that level of physical activity plays a role in the risk of depression, and there is a large and validated evidence base for exercise as a therapeutic modality. Smoking and alcohol and substance misuse appear to be independent risk factors for depression, while the new epidemiological evidence supports the contention that diet is a risk factor for depression; good quality diets appear protective and poor diets increase risk. CONCLUSION Lifestyle modification, with a focus on exercise, diet, smoking and alcohol, may be of substantial value in reducing the burden of depression in individuals and the community.
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Affiliation(s)
| | | | - C. E. Coulson
- Department of Psychiatry; The University of Melbourne; Melbourne; Vic; Australia
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Yakiwchuk EM, Jorgenson D, Mansell K, Laubscher T, Lebras M, Blackburn DF. Collaborative Cardiovascular Risk Reduction in Primary Care II (CCARP II): Implementation of a systematic case-finding process for patients with uncontrolled risk factors. Can Pharm J (Ott) 2013; 146:284-92. [PMID: 24093040 PMCID: PMC3785192 DOI: 10.1177/1715163513499303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors. METHODS This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors. RESULTS Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed. DISCUSSION Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention. CONCLUSION Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
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Affiliation(s)
- Erin M Yakiwchuk
- College of Pharmacy & Nutrition (Yakiwchuk, LeBras, Jorgenson, Mansell, Blackburn), University of Saskatchewan, Saskatoon, Saskatchewan
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Liu S, Dunford SD, Leung YW, Brooks D, Thomas SG, Eysenbach G, Nolan RP. Reducing blood pressure with Internet-based interventions: a meta-analysis. Can J Cardiol 2013; 29:613-21. [PMID: 23618507 DOI: 10.1016/j.cjca.2013.02.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 01/19/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Elevated blood pressure is a leading risk factor for cardiovascular disease and mortality. Internet-based interventions (e-counselling) have the potential to deliver a wide range of preventive counselling services. The purpose of this review was to (1) assess the efficacy of e-counselling in reducing blood pressure and (2) identify key components of successful trials in order to highlight factors that may contribute significantly to blood pressure control. METHODS MEDLINE, PubMed, EMBASE, PsycINFO, and the Cochrane Library were searched up to June 2012 with the following key words: Web-based, Internet-based, e-counselling, mobile health, blood pressure, and hypertension. Trials were selected in which blood pressure was reported as a primary or secondary outcome and whose participants had baseline systolic and diastolic blood pressure within the prehypertensive (120-139/80-89 mm Hg) or hypertensive (≥ 140/90 mm Hg) range. RESULTS The search strategy identified 13 trials, and the mean reduction of systolic and diastolic blood pressure was -3.8 mm Hg (95% confidence interval [Cl], -5.63 to -2.06 mm Hg; P < 0.01) and -2.1 mm Hg (95% CI, -3.51 to -0.65 mm Hg; P < 0.05), respectively. The greatest magnitude of blood pressure reduction was found for interventions that lasted 6 months or longer, used 5 or more behavior change techniques, or delivered health messages proactively. CONCLUSION Research on preventive e-counselling for blood pressure reduction is at an early stage of development. This review provides preliminary evidence of blood pressure reduction with Internet-based interventions. Future studies need to evaluate the contribution of specific intervention components in order to establish a best practice e-counselling protocol that is efficacious in reducing blood pressure.
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Affiliation(s)
- Sam Liu
- Behavioural Cardiology Research Unit, University Health Network, Toronto, Ontario, Canada
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Feldman RD, Brass EP. From bad behaviour to bad biology: pitfalls and promises in the management of resistant hypertension. Can J Cardiol 2013; 29:549-56. [PMID: 23618504 DOI: 10.1016/j.cjca.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022] Open
Abstract
Control rates for hypertension have dramatically improved during the past 2 decades-especially in Canada. However, hypertension remains one of the top risk factors for premature death globally. Furthermore, one-third of Canadians with hypertension have not obtained adequate blood pressure control. Most of these patients have resistant hypertension with uncontrolled blood pressure despite therapy. The etiology of resistant hypertension is multifactorial but includes both behavioural and biological factors. Among behavioural factors, nonadherence on the part of patients and especially clinical inertia on the part of health care professionals are contributing causes. An understanding of the root causes underlying the failure to control an individual's blood pressure is central to optimal subsequent management. Further advances in blood pressure control rates in this group of patients will depend on improvements in health care delivery systems and the further development of innovative therapies. Drugs combining multiple antihypertensive agents in a single pill and the development of new technologies to lower blood pressure, primarily by disruption of the sympathetic nervous system, have the potential to be useful strategies in this effort.
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Affiliation(s)
- Ross D Feldman
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada.
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Fuller J. Rhetoric and argumentation: how clinical practice guidelines think. J Eval Clin Pract 2013; 19:433-41. [PMID: 23692224 DOI: 10.1111/jep.12037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) are an important source of justification for clinical decisions in modern evidence-based practice. Yet, we have given little attention to how they argue their evidence. In particular, how do CPGs argue for treatment with long-term medications that are increasingly prescribed to older patients? APPROACH AND RATIONALE: I selected six disease-specific guidelines recommending treatment with five of the medication classes most commonly prescribed for seniors in Ontario, Canada. I considered the stated aims of these CPGs and the techniques employed towards those aims. Finally, I reconstructed and logically analysed the arguments supporting recommendations for pharmacotherapy. ANALYSIS The primary function of CPGs is rhetorical, or persuasive, and their means of persuasion include both a display of their credibility and their argumentation. Arguments supporting pharmacotherapy recommendations for the target population follow a common inductive pattern: statistical generalization from randomized controlled trial (RCT) and meta-analysis evidence. Two of the CPGs also argue their treatment recommendations for older patients in this style, while three fail to justify pharmacotherapy specifically for the older population. DISCUSSION The arguments analysed lack the auxiliary assumptions that would warrant making a generalization about the clinical effectiveness of medications for the older population. Guidelines reason using simple induction, while ignoring important inferential gaps. Future guidelines should aspire to be well-reasoned rather than simply evidence-based; argue from a plurality of evidence; be wary of hasty inductions; appropriately limit the scope of their recommendations; and avoid making law-like, prescriptive generalizations.
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Affiliation(s)
- Jonathan Fuller
- Faculty of Medicine, University of Toronto, Ontario, Canada.
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Nguyen H, Odelola OA, Rangaswami J, Amanullah A. A review of nutritional factors in hypertension management. Int J Hypertens 2013; 2013:698940. [PMID: 23691281 PMCID: PMC3649175 DOI: 10.1155/2013/698940] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 03/15/2013] [Indexed: 12/18/2022] Open
Abstract
Hypertension is a major health problem worldwide. Its attendant morbidity and mortality complications have a great impact on patient's quality of life and survival. Optimizing blood pressure control has been shown to improve overall health outcomes. In addition to pharmacological therapies, nonpharmacological approach such as dietary modification plays an important role in controlling blood pressure. Many dietary components such as sodium, potassium, calcium, and magnesium have been studied substantially in the past decades. While some of these nutrients have clear evidence for their recommendation, some remain controversial and are still of ongoing study. Dietary modification is often discussed with patients and can provide a great benefit in blood pressure regulation. As such, reviewing the current evidence will be very useful in guiding patients and their physician and/or dietician in decision making. In this review article of nutritional factors in hypertension management, we aim to examine the role of nutritional factors individually and as components of whole dietary patterns.
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Affiliation(s)
- Ha Nguyen
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Olaide A. Odelola
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Janani Rangaswami
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Aman Amanullah
- Noninvasive Cardiology, Albert Einstein Medical Center, Clinical Professor of Medicine, Jefferson Medical College of Thomas Jefferson University, 5501 Old York Road, HB-3, Philadelphia, PA 19141, USA
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Hackam DG, Quinn RR, Ravani P, Rabi DM, Dasgupta K, Daskalopoulou SS, Khan NA, Herman RJ, Bacon SL, Cloutier L, Dawes M, Rabkin SW, Gilbert RE, Ruzicka M, McKay DW, Campbell TS, Grover S, Honos G, Schiffrin EL, Bolli P, Wilson TW, Feldman RD, Lindsay P, Hill MD, Gelfer M, Burns KD, Vallée M, Prasad GVR, Lebel M, McLean D, Arnold JMO, Moe GW, Howlett JG, Boulanger JM, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Trudeau L, Petrella RJ, Milot A, Stone JA, Drouin D, Lavoie KL, Lamarre-Cliche M, Godwin M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk GB, Burgess E, Lewanczuk R, Dresser GK, Penner SB, Hegele RA, McFarlane PA, Sharma M, Reid DJ, Tobe SW, Poirier L, Padwal RS. The 2013 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2013; 29:528-42. [PMID: 23541660 DOI: 10.1016/j.cjca.2013.01.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 12/26/2022] Open
Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be < 150 mm Hg (Grade C) rather than < 140 mm Hg as recommended for younger patients. We also discuss 2 additional topics at length (the pharmacological treatment of mild hypertension and the possibility of a diastolic J curve in hypertensive patients with coronary artery disease). In light of several methodological limitations, a recent systematic review of 4 trials in patients with stage 1 uncomplicated hypertension did not lead to changes in management recommendations. In addition, because of a lack of prospective randomized data assessing diastolic BP thresholds in patients with coronary artery disease and hypertension, no recommendation to set a selective diastolic cut point for such patients could be affirmed. However, both of these issues will be examined on an ongoing basis, in particular as new evidence emerges.
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Affiliation(s)
- Daniel G Hackam
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.
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Renal tissue oxygenation in essential hypertension and chronic kidney disease. Int J Hypertens 2013; 2013:696598. [PMID: 23509612 PMCID: PMC3590788 DOI: 10.1155/2013/696598] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 01/09/2013] [Indexed: 01/13/2023] Open
Abstract
Animal studies suggest that renal tissue hypoxia plays an important role in the development of renal damage in hypertension and renal diseases, yet human data were scarce due to the lack of noninvasive methods. Over the last decade, blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), detecting deoxyhemoglobin in hypoxic renal tissue, has become a powerful tool to assess kidney oxygenation noninvasively in humans. This paper provides an overview of BOLD-MRI studies performed in patients suffering from essential hypertension or chronic kidney disease (CKD). In line with animal studies, acute changes in cortical and medullary oxygenation have been observed after the administration of medication (furosemide, blockers of the renin-angiotensin system) or alterations in sodium intake in these patient groups, underlining the important role of renal sodium handling in kidney oxygenation. In contrast, no BOLD-MRI studies have convincingly demonstrated that renal oxygenation is chronically reduced in essential hypertension or in CKD or chronically altered after long-term medication intake. More studies are required to clarify this discrepancy and to further unravel the role of renal oxygenation in the development and progression of essential hypertension and CKD in humans.
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Pruijm M, Hofmann L, Zanchi A, Maillard M, Forni V, Muller ME, Wuerzner G, Vogt B, Stuber M, Burnier M. Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes. Diabetes Res Clin Pract 2013; 99:136-44. [PMID: 23245807 DOI: 10.1016/j.diabres.2012.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/23/2012] [Accepted: 11/08/2012] [Indexed: 12/20/2022]
Abstract
AIM To assess whether blockade of the renin-angiotensin system (RAS), a recognized strategy to prevent the progression of diabetic nephropathy, affects renal tissue oxygenation in type 2 diabetes mellitus (T2DM) patients. METHODS Prospective randomized 2-way cross over study; T2DM patients with (micro)albuminuria and/or hypertension underwent blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) at baseline, after one month of enalapril (20 mgqd), and after one month of candesartan (16 mgqd). Each BOLD-MRI was performed before and after the administration of furosemide. The mean R₂* (=1/T₂*) values in the medulla and cortex were calculated, a low R₂* indicating high tissue oxygenation. RESULTS Twelve patients (mean age: 60 ± 11 years, eGFR: 62 ± 22 ml/min/1.73 m(2)) completed the study. Neither chronic enalapril nor candesartan intake modified renal cortical or medullary R₂* levels. Furosemide significantly decreased cortical and medullary R₂* levels suggesting a transient increase in renal oxygenation. Medullary R₂* levels correlated positively with urinary sodium excretion and systemic blood pressure, suggesting lower renal oxygenation at higher dietary sodium intake and blood pressure; cortical R₂* levels correlated positively with glycemia and HbA1c. CONCLUSION RAS blockade does not seem to increase renal tissue oxygenation in T2DM hypertensive patients. The response to furosemide and the association with 24 h urinary sodium excretion emphasize the crucial role of renal sodium handling as one of the main determinants of renal tissue oxygenation.
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Affiliation(s)
- Menno Pruijm
- Service of Nephrology, University Hospital, Lausanne, Switzerland
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Chen Q, Zhang X, Gu J, Wang T, Zhang Y, Zhu S. General practitioners' hypertension knowledge and training needs: a survey in Xuhui district, Shanghai. BMC FAMILY PRACTICE 2013; 14:16. [PMID: 23351010 PMCID: PMC3565892 DOI: 10.1186/1471-2296-14-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/21/2013] [Indexed: 11/10/2022]
Abstract
Background Hypertension prevalence is high in China, while patients’ levels of hypertension awareness, treatment and control are low. General practitioners’ knowledge and training relating to hypertension prevention may be an important related factor. We aimed to investigate general practitioners’ knowledge of hypertension prevention and potential training needs. Methods A questionnaire survey was conducted among all general practitioners at five community health service centers selected by convenience sampling. A total of 160 questionnaires were distributed and 147 were returned (response rate 91.9%) The questionnaire included general information; 12 subjective questions on health promotion, education and training needs; and 19 objective questions in 5 domains (epidemiology, diagnosis, treatment, referral and community management) measuring knowledge of hypertension prevention and treatment. Results The major difficulties in health education practice for general practitioners were poor patient compliance (77.6%) and lack of medical consultation time (49.0%). The average accuracy rate of hypertension prevention knowledge was 49.2%, ranging from 10.5% to 94.7%. The factors associated with accuracy rate were physician’s education level (medical university vs. professional school, β = 13.3, P = 0.003), and type of center (training base vs. community healthcare center, β = 12.3, P < 0.0001). Most physicians (87.8%) reported being willing to attend training courses regularly and the preferred frequency was once every 2 ~ 3 months (53.5%). The preferred course was medical treatment of hypertension (82.3%) and the most favored training approach was expert lectures (80.3%). Conclusions The knowledge level of hypertension prevention is low among general practitioners in urban settings. Physicians working in community clinics where they participate in a series of teaching, assessing and evaluating systems for hypertension prevention perform better than those in general healthcare centers who lack specific training. Continuing hypertension education is urgently needed to ensure that physicians in general practice are aware of and adhere to the national hypertension prevention guidelines.
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Affiliation(s)
- Qian Chen
- General Practice Department, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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Larochelle P, Kollmannsberger C, Feldman RD, Schiffrin EL, Poirier L, Patenaude F, Ruether D, Myers M, Bjarnason G. Hypertension management in patients with renal cell cancer treated with anti-angiogenic agents. ACTA ACUST UNITED AC 2012; 19:202-8. [PMID: 22876146 DOI: 10.3747/co.19.972] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inhibitors of the vascular endothelial growth factor (vegf-is) signalling pathway have fundamentally changed the treatment of metastatic renal cell carcinoma (mrcc). Hypertension is one of the most common side effects of vegf-is and has been reported with almost every vegf-i used for treatment to date. The exact mechanism of vegf-i-induced hypertension appears complex and multifactorial, and it remains to be fully explained. No randomized clinical trials are available to guide the management of hypertension during vegf-i treatment in mrcc patients. The guiding principles suggested here summarize the consensus of opinions on the diagnosis and management of vegf-i-induced hypertension during treatment of mrcc obtained from an expert working group composed of 4 Canadian medical oncologists and 5 Canadian hypertension specialists. The Canadian Hypertension Education Program guidelines, available literature, and expert opinion were used to develop the guiding principles.
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Affiliation(s)
- P Larochelle
- Institut de recherches cliniques de Montréal, Montreal, QC
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45
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Sumar I, Kassam F, Dormuth C, Wright JM. Time course for blood pressure lowering of angiotensin-converting-enzyme inhibitors. Hippokratia 2012. [DOI: 10.1002/14651858.cd010053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Imran Sumar
- University of British Columbia; Faculty of Medicine; Vancouver BC Canada
| | - Farah Kassam
- University of British Columbia; Faculty of Medicine; Vancouver BC Canada
| | - Colin Dormuth
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 210 - 1110 Government St Victoria BC Canada V8W 1Y2
| | - James M Wright
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
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Effects of long-term intake of lactotripeptides on cardiovascular risk factors in hypertensive subjects. Eur J Clin Nutr 2012; 66:843-9. [PMID: 22617279 DOI: 10.1038/ejcn.2012.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Lactobacillus helveticus LBK-16H-fermented milk products containing tripeptides isoleucine-proline-proline and valine-proline-proline lower blood pressure in hypertensive subjects using office and home blood pressure registration. The present study was aimed to evaluate the effects of two doses of these lactotripeptides on 24-h ambulatory blood pressure and lipidomics profiles in mildly hypertensive subjects. SUBJECTS/METHODS In a randomized, double-blind, placebo-controlled parallel group study, 89 mildly hypertensive subjects ingested, after a 1-month run-in period, a fermented milk drink with 5 mg per day of lactotripeptides during 3 months, and a milk drink with 50 mg per day of lactotripeptides for the following 3 months, or a placebo milk drink without lactotripeptides. Ambulatory blood pressure (24 h) was recorded at baseline and at the end of the intervention periods. Lipidomics profiles were characterized before and after the 6-month intervention. RESULTS After the second intervention period (50 mg per day of lactotripeptides), systolic and diastolic 24-h blood pressures decreased significantly in the peptide, but not in the placebo group. However, the treatment effects -2.6 mm Hg (95% confidence interval (CI): -5.7 to 0.4) in systolic and -1.3 mm Hg (95% CI: -3.4 to 0.8) in diastolic blood pressure did not reach statistic significance. Ingestion of 5 mg per day of lactotripeptides for 3 months did not lower blood pressure. The peptide group was dominated by decrease in multiple phospholipids (PL). CONCLUSIONS Ingestion of fermented milk with daily dose of 50 mg of lactotripeptides appears to lower elevated blood pressure slightly from the baseline, but not significantly compared with the placebo group and to induce significant decreases in multiple PL.
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Hypertonie und Ernährung. Herz 2012; 38:153-62. [DOI: 10.1007/s00059-012-3613-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 02/07/2023]
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Cook WK, Cherpitel CJ. Access to health care and heavy drinking in patients with diabetes or hypertension: implications for alcohol interventions. Subst Use Misuse 2012; 47:726-33. [PMID: 22432456 PMCID: PMC3328624 DOI: 10.3109/10826084.2012.665558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between health care access and heavy drinking in patients with hypertension and diabetes. Using a sample of 7,428 US adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed. Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol interventions may be more effective if targeted at patients with chronic conditions adversely affected by drinking. Future research needs to investigate factors facilitating such interventions.
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Affiliation(s)
- Won Kim Cook
- Alcohol Research Group, Public Health Institute, Emeryville, California 94608, USA.
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Daskalopoulou SS, Khan NA, Quinn RR, Ruzicka M, McKay DW, Hackam DG, Rabkin SW, Rabi DM, Gilbert RE, Padwal RS, Dawes M, Touyz RM, Campbell TS, Cloutier L, Grover S, Honos G, Herman RJ, Schiffrin EL, Bolli P, Wilson T, Feldman RD, Lindsay MP, Hemmelgarn BR, Hill MD, Gelfer M, Burns KD, Vallée M, Prasad GVR, Lebel M, McLean D, Arnold JMO, Moe GW, Howlett JG, Boulanger JM, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Trudeau L, Bacon SL, Petrella RJ, Milot A, Stone JA, Drouin D, Lamarre-Cliché M, Godwin M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk G, Burgess E, Lewanczuk R, Dresser GK, Penner B, Hegele RA, McFarlane PA, Sharma M, Campbell NRC, Reid D, Poirier L, Tobe SW. The 2012 Canadian Hypertension Education Program Recommendations for the Management of Hypertension: Blood Pressure Measurement, Diagnosis, Assessment of Risk, and Therapy. Can J Cardiol 2012; 28:270-87. [PMID: 22595447 DOI: 10.1016/j.cjca.2012.02.018] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 01/13/2023] Open
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Rodríguez Pérez MC, Cabrera de León A, Morales Torres RM, Domínguez Coello S, Alemán Sánchez JJ, Brito Díaz B, González Hernández A, Almeida González D. Factores asociados al conocimiento y el control de la hipertensión arterial en Canarias. Rev Esp Cardiol 2012; 65:234-40. [DOI: 10.1016/j.recesp.2011.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 09/29/2011] [Indexed: 10/14/2022]
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