Labeling of hypertensive patients

Rationale and public health implications of changing CHD risk factor definitions

The definition of disease is central to the practice of medicine and to public health policy. Practice guidelines set standards for disease identification and treatment. Quality care is often defined as adherence to these guidelines. Over the past few years, the diagnostic thresholds for several common medical conditions have been lowered, resulting in a substantial expansion in the market for health care. The most recent guidelines for high blood pressure, high cholesterol, and impaired fasting glucose each define a high percentage of the adult population as in need of regular medical attention. Under the latest proposed thresholds, virtually the entire adult population qualifies for a chronic condition diagnosis. We evaluate the health and financial outcomes associated with changes in diagnostic thresholds for the prevention of three risk factors for cardiovascular disease and stroke: blood pressure, serum cholesterol, and fasting plasma glucose. Estimates of the numbers of people affected, the cost implications, and the overall public health consequences are offered.

The 2007 Canadian Hypertension Education Program recommendations: the scientific summary - an annual update

The present paper summarizes and highlights key messages of the 2007 Canadian Hypertension Education Program recommendations for the management and diagnosis of hypertension. This is the eighth annual update. Important new messages in the 2007 Canadian Hypertension Education Program recommendations emphasize the need for assessing adults with high normal blood pressure on an annual basis and reducing sodium in the diet of Canadians to less than 100 mmol/day. These new recommendations still need to be incorporated into the older but still important considerations for the diagnosis, management and treatment of patients with hypertension, namely, assessing blood pressure in all adults at all appropriate visits, expediting the diagnosis of hypertension, assessing and managing global cardiovascular risk, emphasizing that lifestyle modifications are the cornerstone of antihypertensive therapy, treating to target to achieve optimum cardiovascular risk reduction, using combinations of antihypertensive medications and lifestyle to achieve recommended targets and focusing on adherence to therapy. Minor changes in pharmacological therapies and some new recommendations on routine laboratory tests are discussed.

EUR-ASSESS Project Subgroup report on Methodology. Methodological guidance for the conduct of health technology assessment

Health technology assessment (HTA) is primarily concerned with the consequences (benefits and costs) of health care and health policy decisions. Because decision making is complex and outcomes are often uncertain, it is helpful to attempt to assess the consequences. The quality of decisions can be improved by a process that provides a consistent framework for identifying and assessing health technologies.

Effects of dietary fat feedback on behavioral and psychological variables

This paper reports on the immediate and delayed reactions to dietary fat consumption feedback. Subjects in our study received (1) personalized dietary fat feedback and (2) information about how to alter their fat consumption. Fat consumption was measured using a brief fat assessment instrument. Subjects were categorized into three risk groups: at or below, above, and significantly above the recommended level. Emotional, cognitive, and behavioral reactions were measured immediately after receiving feedback and at 1 month postfeedback. Subjects who received high fat feedback showed greater negative emotional distress in response to the feedback and stated that they knew less about high-fat foods than subjects receiving lower feedback. By the 1-month follow-up, subjects in the highest feedback condition were least likely to report intentions to lower their dietary fat. Interventions designed to alter dietary fat consumption should take into account the emotional and cognitive consequences of risk factor feedback.

Labelling in hypertension: a review of the behavioural and psychological consequences

Recent evidence has suggested that the detection and treatment of hypertension can result in adverse psychological and behavioural consequences. Furthermore, there is evidence to suggest that these consequences may outweigh the gains in the case of mild hypertension where the benefit of treatment has not yet been established. This paper reviews the literature to date regarding the behavioural and psychological changes which have occurred upon the detection and labelling of hypertension. In addition, an explanation is posed which may resolve some of the contradictory findings with regard to the phenomenon. Finally, a strategy to alleviate, or at least minimize, the deleterious labelling of individuals as "hypertensive" is proposed for testing in future experiments.