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Zook HG, Cruz RS, Capesius TR, Haynes MC. Implementing Self-Measured Blood Pressure Monitoring With Clinical Support: A Qualitative Study of Federally Qualified Health Centers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:S107-S115. [PMID: 39041744 PMCID: PMC11268788 DOI: 10.1097/phh.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
CONTEXT Self-measured blood pressure monitoring (SMBP) with clinical support is effective at reducing blood pressure for people with hypertension. Although strengths and challenges around SMBP are well-documented, few studies describe the complexities of real-world implementation of SMBP with clinical support in the Federally Qualified Health Center (FQHC) setting. PROGRAM Between 2019 and 2023, the Ohio Department of Health funded the Ohio Association of Community Health Centers to manage a multiyear quality improvement (QI) project with 21 FQHCs. The project aimed to improve the identification and management of patients with hypertension, diabetes, and prediabetes. This study focuses on the activities implemented to provide SMBP support to patients with hypertension. IMPLEMENTATION FQHCs implemented clinical SMBP support using multiple roles, approaches, and resources. FQHCs established a process to identify patients eligible for SMBP support, provide blood pressure monitors, train patients on SMBP, track blood pressure readings, follow up with patients, and connect patients to resources. EVALUATION External evaluators interviewed 13 staff members within seven FQHCs from the QI project. Interviewed FQHCs were located across Ohio and represented urban, rural, suburban, and Appalachian areas. Clinical activities to support SMBP, facilitators, and barriers were identified with thematic analysis. The National Association of Community Health Centers SMBP Implementation Toolkit was used as a framework to assess SMBP activities. Facilitators included team-based care, health information technology capacity, funding for blood pressure monitors and staff time, leadership and staff support, and external support. Barriers included technology challenges, staffing shortages, low patient engagement, sustainability, and the COVID-19 pandemic. DISCUSSION This study demonstrates how FQHCs can use a variety of staff, processes, and resources to implement clinical SMBP support across a range of geographic regions. To facilitate this, FQHCs and patients may need more comprehensive insurance coverage of blood pressure monitors, reimbursement for staff time, and technology support.
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Fang J, Zhou W, Hayes DK, Wall HK, Wozniak G, Chung A, Loustalot F. Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic. Am J Hypertens 2024; 37:421-428. [PMID: 38483188 DOI: 10.1093/ajh/hpae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals. RESULTS Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state. CONCLUSIONS Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wen Zhou
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Alina Chung
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Liu X, Slone SE, Chen Y, Yeboah-Kordieh Y, Alharthi A, Amihere J, Moyo-Songonuga S, Lane T, Ostchega Y, Brady TM, Himmelfarb CR, Commodore-Mensah Y. Blood Pressure Measurements Obtained by Community-Dwelling Adults Are Similar to Nurse-Obtained Measurements: The SMART-BP Validate Study. Am J Hypertens 2024; 37:334-341. [PMID: 38219026 DOI: 10.1093/ajh/hpae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. METHODS This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. RESULTS We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n = 51) had a home BP monitor. Overall, there were no significant differences between nurse- and participant-obtained systolic BP (mean difference [MD]: -1.1; standard deviation [SD]: 8.0; P = 0.178) or diastolic BP (MD: -0.9; SD: 5.5; P = 0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD: -2.9; SD: 4.5; P = 0.010). All participants demonstrated satisfactory SMBP skills after the training. CONCLUSIONS Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making.
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Affiliation(s)
- Xiaoyue Liu
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | - Sarah E Slone
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | - Abeer Alharthi
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | | | - Tynetta Lane
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | - Tammy M Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, U.S
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, U.S
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, U.S
- Johns Hopkins University School of Medicine, Baltimore, U.S
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, U.S
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, U.S
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Newman N, Beyuo TK, Nartey BA, Segbedzi-Rich E, Pangori A, Moyer CA, Lori JR, Oppong SA, Lawrence ER. Facilitators and barriers to home blood pressure monitoring among pregnant women in Ghana: a mixed-methods analysis of patient perspectives. BMC Pregnancy Childbirth 2024; 24:208. [PMID: 38504214 PMCID: PMC10949704 DOI: 10.1186/s12884-024-06421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The benefit of home blood pressure monitoring during pregnancy and in low-resource settings is incompletely understood. The objective of this study was to explore the experiences, barriers, and facilitators of home blood pressure monitoring among pregnant women in Ghana. METHODS This concurrent triangulation mixed-methods study was conducted at an urban tertiary hospital in Ghana. Participants were recruited from adult pregnant women presenting for routine antenatal care. Upon enrollment, participants' demographics and history were collected. At the next study visit, participants received audiovisual and hands-on training on using an automatic blood pressure monitor; they then monitored and logged their blood pressure daily at home for 2-4 weeks. At the final study visit, verbally administered surveys and semi-structured interviews assessed participant's experiences. Quantitative data were analyzed using R version 4.2.2, and frequencies and descriptive statistics were calculated. Qualitative data were imported into DeDoose 9.0.78 for thematic analysis. RESULTS Of 235 enrolled participants, 194 completed surveys; of those, 33 completed in-depth interviews. Participants' mean age was 31.6 (SD 5.3) years, 32.1% had not previously given birth, and 31.1% had less than a senior high school education. On a 4-point Likert scale, the majority reported they "definitely" were able to remember (n = 134, 69.1%), could find the time (n = 124, 63.9%), had the energy (n = 157, 80.9%), could use the blood pressure monitor without problems (n = 155, 79.9%), and had family approval (n = 182, 96.3%) while engaging in home blood pressure monitoring. 95.88% (n = 186) believed that pregnant women in Ghana should monitor their blood pressure at home. Qualitative thematic analysis demonstrated that most participants liked home blood pressure monitoring because of increased knowledge of their health during pregnancy. While most participants found measuring their blood pressure at home doable, many faced challenges. Participants' experiences with five key factors influenced how easy or difficult their experience was: 1) Time, stress, and daily responsibilities; 2) Perceived importance of BP in pregnancy; 3) Role of family; 4) Capability of performing monitoring; 5) Convenience of monitoring. CONCLUSIONS Among pregnant women in urban Ghana, home blood pressure monitoring was perceived as positive, important, and doable; however, challenges must be addressed.
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Affiliation(s)
- Noah Newman
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, 48109, USA
| | - Titus K Beyuo
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana.
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana.
| | - Betty A Nartey
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Elorm Segbedzi-Rich
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Andrea Pangori
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI, 48109, USA
| | - Jody R Lori
- University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48104, USA
| | - Samuel A Oppong
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Meador M, Sachdev N, Anderson E, Roy D, Bay RC, Becker LH, Lewis JH. Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians. J Healthc Qual 2024; 46:109-118. [PMID: 38150376 PMCID: PMC10901219 DOI: 10.1097/jhq.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.
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Särnholm J, Kronish IM. Psychological Distress and Hypertension Diagnostic Testing: Is There Anything to Worry About? Am J Hypertens 2024; 37:18-20. [PMID: 37798140 PMCID: PMC10724523 DOI: 10.1093/ajh/hpad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Josefin Särnholm
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
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Bridi L, Albahsahli B, Bencheikh N, Baker DA, Godino JG, O'Laughlin KN, Al-Rousan T. Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study. BMC PRIMARY CARE 2023; 24:256. [PMID: 38036967 PMCID: PMC10687832 DOI: 10.1186/s12875-023-02215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Minoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension. METHODS A total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior. RESULTS Several barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members' support with home monitoring served as an important facilitator to SMBP. CONCLUSIONS There are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Lai JH, Gwini SM, Chen G, Long KM, Russell G, Schlaich MP, Stowasser M, Young MJ, Fuller PJ, Mori TA, Wolley M, Reid CM, Yang J. Willingness to be tested for a secondary cause of hypertension: a survey of the Australian general community. Intern Med J 2023; 53:1826-1836. [PMID: 36321804 DOI: 10.1111/imj.15955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Primary aldosteronism (PA) represents the most common and potentially curable cause of secondary hypertension. However, PA is not commonly screened for, and up to 34% of patients who screen positive do not complete the full diagnostic process. This suggests that the diagnostic process may pose a barrier to patients and may contribute to the under-diagnosis of PA. AIMS To evaluate the willingness of the Australian general public to undergo testing for secondary causes of hypertension and identify enablers or barriers to testing from the patients' perspective. METHODS An online survey containing questions on knowledge and attitudes towards hypertension, willingness to be tested and enablers/barriers towards testing was distributed to the Australian community. RESULTS Of 520 adult respondents (mean age 50.4 years, SD 27.3 years; 28.8% hypertensive; 56.0% female), the majority of non-hypertensive and hypertensive respondents (82.7% vs 70.0%; P = 0.03) were willing to undergo testing for a secondary cause of hypertension that involved blood and urine tests. Greater knowledge of hypertensive risk modification strategies and complications was predictive of willingness to be tested, whereas age, sex, education level, geographic location, socio-economic status and cardiovascular comorbidities were not. The top three barriers to testing included fear of a serious underlying condition, lack of belief in further testing and increased stress associated with further testing. CONCLUSION A high proportion of patients are willing to engage in testing for a secondary cause of hypertension. Education about the risks associated with hypertension and the testing process may overcome several barriers to testing.
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Affiliation(s)
- Jordan H Lai
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Stella M Gwini
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Katrina M Long
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia - Royal Perth Hospital Campus, Perth, Western Australia, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine; Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
- Department of Nephrology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
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Kronish IM, Phillips E, Alcántara C, Carter E, Schwartz JE, Shimbo D, Serafini M, Boyd R, Chang M, Wang X, Razon D, Patel A, Moise N. A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring: The EMBRACE Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2334646. [PMID: 37747734 PMCID: PMC10520739 DOI: 10.1001/jamanetworkopen.2023.34646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023] Open
Abstract
Importance Few primary care patients complete guideline-recommended out-of-office blood pressure (BP) monitoring prior to having hypertension diagnosed. Objective To evaluate the effectiveness of a behavioral theory-informed, multifaceted implementation strategy on out-of-office BP monitoring (ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) among patients with new hypertension. Design, Setting, and Participants This 2-group, pre-post cluster randomized trial was conducted within a primary care network of 8 practices (4 intervention practices with 99 clinicians; 4 control practices with 55 clinicians) and 1186 patients (857 intervention; 329 control) with at least 1 visit with elevated office BP and no prior hypertension diagnosis between October 2016 and September 2017 (preimplementation period) or between April 2018 and March 2019 (postimplementation period). Data were analyzed from February to July 2023. Interventions Usual care (control group) or a multifaceted implementation strategy consisting of an accessible ABPM service; electronic health record (EHR) tools to facilitate test ordering; clinician education, reminders, and feedback relevant to out-of-office BP monitoring; nurse training on HBPM; and patient information handouts. Main Outcomes and Measures The primary outcome was patient completion of out-of-office BP monitoring within 6 months of an eligible visit. Secondary outcomes included clinician ordering of out-of-office BP monitoring. Blinded assessors extracted outcomes from the EHR. Results A total of 1186 patients (857 intervention; 329 control) were included, with a mean (SD) age of 54 (16) years; 808 (68%) were female, and 549 (48%) were Spanish speaking; among those with race and ethnicity documented, 123 (10%) were Black or African American, and 368 (31%) were Hispanic. Among intervention practices, the percentage of visits resulting in completed out-of-office BP monitoring increased from 0.6% (0% ABPM; 0.6% HBPM) to 5.7% (3.7% ABPM; 2.0% HBPM) between the preimplementation and postimplementation periods (P = .009). Among control practices, the percentage of visits resulting in completed out-of-office BP monitoring changed from 5.4% (0% ABPM; 5.4% HBPM) to 4.3% (0% ABPM; 4.3% HBPM) during the corresponding period (P = .94). The ratio of relative risks (RRs) of out-of-office BP monitoring in the postimplementation vs preimplementation periods for intervention vs control practices was 10.5 (95% CI, 1.9-58.0; P = .01). The ratio of RRs of out-of-office BP monitoring being ordered was 2.2 (95% CI, 0.8-6.3; P = .12). Conclusions and Relevance This study found that a theory-informed implementation strategy that included access to ABPM modestly increased out-of-office BP monitoring among patients with elevated office BP but no hypertension diagnosis. Trial Registration ClinicalTrials.gov Identifier: NCT03480217.
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Affiliation(s)
- Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | | | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Maria Serafini
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rebekah Boyd
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Melinda Chang
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Xiaohui Wang
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Dominic Razon
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Akash Patel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
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Fontil V, Khoong EC, Green BB, Ralston JD, Zhou C, Garcia F, McCulloch CE, Sarkar U, Lyles CR. Randomized trial protocol for remote monitoring for equity in advancing the control of hypertension in safety net systems (REACH-SNS) study. Contemp Clin Trials 2023; 126:107112. [PMID: 36738916 PMCID: PMC10132961 DOI: 10.1016/j.cct.2023.107112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-measured blood pressure monitoring (SMBP) is essential to effective management of hypertension. This study aims to evaluate effectiveness and implementation of SMBP that leverages: cellular-enabled home BP monitors without a need for Wi-Fi or Bluetooth; simple communication modalities such as text messaging to support patient engagement; and integration into existing team-based workflows in safety-net clinics. METHODS This study will be conducted with patients in San Francisco who are treated within a network of safety-net clinics. English and Spanish-speaking patients with diagnosed hypertension will be eligible for the trial if they have recent BP readings ≥140/90 mmHg and do not have co-morbid conditions that make home BP monitoring more complex to manage. This study will implement a three-arm randomized controlled trial to compare varying levels of implementation support: 1) cellular-enabled BP monitors (with minimal implementation support), 2) cellular-enabled BP monitors with protocol-based implementation support (text reminders for patients; aggregated BP summaries sent to primary care providers), and 3) cellular-enabled BP monitors and pharmacist-led support (pharmacist coaching and independent medication adjustments). RESULTS For the main analysis, we will use mixed effects linear regression to compare the change in primary outcome of systolic BP. Secondary outcomes include BP control (<140/90 mmHg), medication intensification, patient-reported outcomes, and implementation processes (i.e., engagement with the intervention). DISCUSSION This study will design and test a digital health intervention for use in marginalized populations treated within safety net settings, evaluating both effectiveness and implementation to advance more equitable health outcomes.
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Affiliation(s)
- Valy Fontil
- Institute for Health Excellence in Health Equity, New York University Grossman School of Medicine, United States of America; Department of Population Health, New York University Grossman School of Medicine, United States of America.
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, United States of America
| | - Crystal Zhou
- Division of Cardiology, University of California San Francisco, United States of America
| | - Faviola Garcia
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America; Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, United States of America; UCSF Center for Vulnerable Populations, San Francisco General Hospital, United States of America; Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
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11
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González-de Paz L, Kostov B, Freixa X, Herranz C, Lagarda E, Ortega M, Pérez E, Porcar S, Sánchez E, Serrato M, Vidiella I, Sisó-Almirall A. Cost-accuracy and patient experience assessment of blood pressure monitoring methods to diagnose hypertension: A comparative effectiveness study. Front Med (Lausanne) 2022; 9:827821. [DOI: 10.3389/fmed.2022.827821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
ObjectivesStudies of the diagnosis of hypertension have emphasized long-term cost-effectiveness analysis, but the patient experience and costs of blood pressure monitoring methods at the diagnosis stage remain unclear. We studied four diagnostic methods: a new 1 h-automated office blood pressure (BP) monitoring, office BP measurement, home BP monitoring, and awake-ambulatory BP monitoring.MethodsWe carried out a comparative effectiveness study of four methods of diagnosing hypertension in 500 participants with a clinical suspicion of hypertension from three primary healthcare (PHC) centers in Barcelona city (Spain). We evaluated the time required and the intrinsic and extrinsic costs of the four methods. The cost-accuracy ratio was calculated and differences between methods were assessed using ANOVA and Tukey’s honestly significant difference (HSD) post-hoc test. Patient experience data were transformed using Rasch analysis and re-scaled from 0 to 10.ResultsOffice BP measurement was the most expensive method (€156.82, 95% CI: 156.18–157.46) and 1 h-automated BP measurement the cheapest (€85.91, 95% CI: 85.59–86.23). 1 h-automated BP measurement had the best cost-accuracy ratio (€ 1.19) and office BP measurement the worst (€ 2.34). Home BP monitoring (8.01, 95% CI: 7.70–8.22), and 1 h-automated BP measurement (7.99, 95% CI: 7.80–8.18) had the greatest patient approval: 66.94% of participants would recommend 1 h-automated BP measurement as the first or second option.ConclusionThe relationship between the cost-accuracy ratio and the patient experience suggests physicians could use the new 1 h-automated BP measurement as the first option and awake-ambulatory BP monitoring in complicated cases and cease diagnosing hypertension using office BP measurement.
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12
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Wall HK, Streeter TE, Wright JS. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring. J Womens Health (Larchmt) 2022; 31:1380-1386. [PMID: 36154466 PMCID: PMC10028595 DOI: 10.1089/jwh.2022.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
More than 56 million women in the United States have hypertension, including almost one in five women of reproductive age. The prevalence of hypertensive disorders of pregnancy is on the rise, putting more women at risk for adverse pregnancy-related outcomes and atherosclerotic cardiovascular disease later in life. Hypertension can be better detected and controlled in women throughout their life course by supporting self-measured blood pressure monitoring. In this study, we present some potential strategies for strengthening our nation's ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring.
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Affiliation(s)
- Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor E Streeter
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nuckols VR, Stroud AK, Armstrong MK, Brandt DS, Santillan MK, Santillan DA, Pierce GL. Postpartum ambulatory and home blood pressure monitoring in women with history of preeclampsia: Diagnostic agreement and detection of masked hypertension. Pregnancy Hypertens 2022; 29:23-29. [PMID: 35671544 PMCID: PMC9645805 DOI: 10.1016/j.preghy.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/21/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
Women with a history of preeclampsia (hxPE) are at a four-fold higher risk for chronic hypertension after pregnancy compared with healthy pregnancy, but 'masked' hypertension cases are missed by clinical assessment alone. Twenty-four hour ambulatory blood pressure monitoring (ABPM) is the reference-standard for confirmation of hypertension diagnoses or detection of masked hypertension outside of clinical settings, whereas home blood pressure monitoring (HBPM) may represent a well-tolerated and practical alternative to ABPM in the postpartum period. The objectives of this study were to 1) assess concordance between ABPM and HBPM postpartum in women with a hxPE compared with healthy pregnancy controls and 2) evaluate HBPM in the detection of masked postpartum hypertension. Young women with a hxPE (N = 26) and controls (N = 36) underwent in-office, 24-h ABPM and 7-day HBPM 1-4 years postpartum. Chronic hypertension was more prevalent among women with a hxPE by all three blood pressure measures, but the prevalence of masked postpartum hypertension did not differ (36% vs 37%, P = 0.97). HBPM showed excellent agreement with ABPM (systolic: r = 0.78, intraclass coefficient [ICC] = 0.83; diastolic: r = 0.82, ICC = 0.88) and moderate concordance in classification of hypertension (κ = 0.54, P < 0.001). HBPM identified 21% of masked postpartum hypertension cases without false-positive cases, and HBPM measures among those with normotensive in-office readings could detect ABPM-defined masked hypertension (area under the curve [AUC] = 0.88 ± 0.06, P < 0.0001). The findings of the present study indicate that HBPM may be a useful screening modality prior or complementary to ABPM in the detection and management of postpartum hypertension.
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Affiliation(s)
- Virginia R Nuckols
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Amy K Stroud
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Matthew K Armstrong
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Debra S Brandt
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States; Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, United States
| | - Donna A Santillan
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States; Department of Internal Medicine, University of Iowa, Iowa City, IA, United States; Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, United States; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, United States.
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14
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Wall HK, Wright JS, Jackson SL, Daussat L, Ramkissoon N, Schieb LJ, Stolp H, Tong X, Loustalot F. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Addressing Barriers Beyond the Published Literature. Am J Hypertens 2022; 35:244-255. [PMID: 35259238 PMCID: PMC10061272 DOI: 10.1093/ajh/hpab170] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023] Open
Abstract
Hypertension is highly prevalent in the United States, and many persons with hypertension do not have controlled blood pressure. Self-measured blood pressure monitoring (SMBP), when combined with clinical support, is an evidence-based strategy for lowering blood pressure and improving control in persons with hypertension. For years, there has been support for widespread implementation of SMBP by national organizations and the federal government, and SMBP was highlighted as a primary intervention in the 2020 Surgeon General's Call to Action to Control Hypertension, yet optimal SMBP use remains low. There are well-known patient and clinician barriers to optimal SMBP documented in the literature. We explore additional high-level barriers that have been encountered, as broad policy and systems-level changes have been attempted, and offer potential solutions. Collective efforts could modernize data transfer and processing, improve broadband access, expand device coverage and increase affordability, integrate SMBP into routine care and reimbursement practices, and strengthen patient engagement, trust, and access.
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Affiliation(s)
- Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lura Daussat
- Practice Support Unit, Public Health Informatics Institute, Decatur, Georgia, USA
| | - Nar Ramkissoon
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Linda J Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Haley Stolp
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Munyungula J, Shakwane S. Self-monitoring of blood pressure for preeclampsia patients: Knowledge and attitudes. Curationis 2021; 44:e1-e8. [PMID: 34636622 PMCID: PMC8517804 DOI: 10.4102/curationis.v44i1.2195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/28/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Preeclampsia is one of the causes of maternal deaths and is also responsible for complications such as premature births worldwide. In South Africa, hypertensive disorders cause 14% of all maternal deaths. Evidence indicates that it may be beneficial to empower women to monitor their blood pressure (BP) in the comfort of their homes. Objectives The purpose of this study was to explore and describe preeclampsia patients’ knowledge and attitudes towards the self-monitoring of their BP. Method An exploratory, descriptive and contextual qualitative research study was conducted. Fourteen preeclampsia patients were purposively sampled and participated in the study. In-depth semi-structured interviews were used to collect data. Data were analysed using the thematic analytic approach. Results The knowledge and attitudes towards the self-monitoring of blood pressure (SMBP) were explored. Four themes emerged, namely understanding of hypertension disorders during pregnancy, openness on self-monitoring at home, its hindrances and benefits. The participants portrayed limited understanding and knowledge of preeclampsia, yet they had positive attitudes towards monitoring BP themselves and were open and willing to do self-monitoring at home. Conclusion The use of SMBP may relieve overcrowding in public healthcare institutions. Encouraging patients to participate in self-monitoring could promote active participation and a positive outlook on their pregnancies. The unavailability and unaffordability of the equipment may pose a challenge to women with a low socioeconomic status.
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Affiliation(s)
- Johanna Munyungula
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa; and, Council of Medical Schemes, Pretoria.
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Gondi S, Ellis S, Gupta M, Ellerbeck E, Richter K, Burns J, Gupta A. Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study. PLoS One 2021; 16:e0255578. [PMID: 34415946 PMCID: PMC8378703 DOI: 10.1371/journal.pone.0255578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. METHODS We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. RESULTS All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. CONCLUSION PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.
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Affiliation(s)
- Saahith Gondi
- Department of Biology, Wake Forest University, Winston-Salem, NC, United States of America
| | - Shellie Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Mallika Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Kimber Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jeffrey Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
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17
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Affiliation(s)
- Teck K Khong
- Clinical Pharmacology, St George's, University of London, London, UK
| | - Henry Fok
- Clinical Pharmacology, St George's, University of London, London, UK.,Clinical Pharmacology, King's College British Heart Foundation Centre, London, UK
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18
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Khaddage SJ, Patterson JA, Sargent LJ, Price ET, Dixon DL. Sex and Age Differences in Ambulatory Blood Pressure Monitoring Tolerability. Am J Hypertens 2021; 34:335-338. [PMID: 33180905 DOI: 10.1093/ajh/hpaa182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical practice guidelines endorse using ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. However, ABPM is not always tolerated by patients, and differences between individuals according to age and sex remain unexplored. METHODS This is a post hoc analysis of a prospective, single-arm clinical trial (NCT03920956) that evaluated the feasibility of an ABPM service provided at 2 community pharmacies. Tolerability was assessed using a previously published survey, which included 7 yes/no questions and 8 answered on a scale of 0-10. Descriptive statistics and Chi-square analyses were used to summarize the data for the patient surveys and to describe sex and age differences in device tolerability. RESULTS Of the 52 subjects enrolled, 50 (96%) completed the survey; half were female with a mean (SD) age of 57.5 years (15.8). Chi-square analyses showed that compared with their male counterparts, females were more likely to find the monitor cumbersome to wear (76.2% vs. 40%, P = 0.014). Subjects under 55 years of age were more likely to be disturbed by the noise of the monitor during driving (38.1% vs. 4.2%, P = 0.005) and at other times (35.0% vs. 8.3%, P = 0.029), and to find the monitor embarrassing to wear (33.3% vs. 7.1%, P = 0.019). CONCLUSIONS Although ABPM was generally well-tolerated overall, we did identify age and sex differences in tolerability. These factors should be considered to ensure patient acceptance and tolerability of ABPM.
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Affiliation(s)
- Sarah J Khaddage
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Julie A Patterson
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lana J Sargent
- Department of Pharmacotherapy and Outcomes Science, Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elvin T Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy and Outcomes Science, Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
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Current state of affairs: A study regarding diagnosis, treatment and use of home blood pressure monitoring for hypertension in pregnancy. Pregnancy Hypertens 2021; 24:96-99. [PMID: 33770589 DOI: 10.1016/j.preghy.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
Guidelines for management of hypertension (HTN) in pregnancy have evolved to recommend "tight" control and increased use of home blood pressure (BP) monitoring. This survey-based study examined the preferred methods for diagnosing, investigating and managing HTN in pregnancy among two groups of prenatal care providers at a tertiary care hospital: Family Physicians and Obstetricians. The response rate was 75%. Obstetricians were significantly more likely to use home BP monitoring while Family Physicians were significantly more likely to use 24-hour ambulatory BP monitoring to aid with diagnosis (p = 0.008). For surveillance, more Obstetricians believed home BP monitoring was validated in pregnancy (78.3% vs 42.9%, p = 0.02) and were more likely to monitor HTN with home readings compared to Family Physicians (91.7% vs 64.3%, p = 0.02). Family Physicians were significantly more likely to target "tight" BP control compared to Obstetricians (93.8% vs 72%, p = 0.03). This single centre study demonstrated relatively high uptake of newer BP target recommendations in pregnancy, however there remains a significant variation in the use of home BP monitoring for diagnosis and surveillance of HTN in pregnancy between the two specialties.
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20
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Accuracy of abbreviated protocols for unattended automated office blood pressure measurements, a retrospective study. PLoS One 2021; 16:e0248586. [PMID: 33720945 PMCID: PMC7959338 DOI: 10.1371/journal.pone.0248586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background Blood pressure measurement (BPM) is one of the most often performed procedures in clinical practice, but especially office BPM is prone to errors. Unattended automated office BPM (AOBPM) is somewhat standardised and observer-independent, but time and space consuming. We aimed to assess whether an AOBPM protocol can be abbreviated without losing accuracy. Design In our retrospective single centre study, we used all AOBPM (AOBPM protocol of the SPRINT study), collected over 14 months. Three sequential BPM (after 5 minutes of rest, spaced 2 minutes) were automatically recorded with the patient alone in a quiet room resulting in three systolic and diastolic values. We compared the mean of all three (RefProt) with the mean of the first two (ShortProtA) and the single first BPM (ShortProtB). Results We analysed 413 AOBPM sets from 210 patients. Mean age was 52±16 years. Mean values for RefProt were 128.3/81.3 mmHg, for ShortProtA 128.4/81.4 mmHg, for ShortProtB 128.8/81.4 mmHg. Mean difference and limits of agreement for RefProt vs. ShortProtA and ShortProtB were -0.1±4.2/-0.1±2.8 mmHg and -0.5±8.1/-0.1±5.3 mmHg, respectively. With ShortProtA, 83% of systolic and 92% of diastolic measurements were within 2 mmHg from RefProt (67/82% for ShortProtB). ShortProtA or ShortProtB led to no significant hypertensive reclassifications in comparison to RefProt (p-values 0.774/1.000/1.000/0.556). Conclusion Based on our results differences between the RefProt and ShortProtA are minimal and within acceptable limits of agreement. Therefore, the automated procedure may be shorted from 3 to 2 measurements, but a single measurement is insufficient.
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21
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Reliability of Office, Home, and Ambulatory Blood Pressure Measurements and Correlation With Left Ventricular Mass. J Am Coll Cardiol 2021; 76:2911-2922. [PMID: 33334418 DOI: 10.1016/j.jacc.2020.10.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Determining the reliability and predictive validity of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) can inform which is best for diagnosing hypertension and estimating risk of cardiovascular disease. OBJECTIVES This study aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons. METHODS The Improving the Detection of Hypertension (IDH) study, a community-based observational study, enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram. Mean age was 41.2 ± 13.1 years, 59.5% were women, 25.5% African American, and 64.0% Hispanic. RESULTS The reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89. After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE]: 1.48) and 3.92 (SE: 2.14) g/m2 higher LVMI, respectively. After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI. CONCLUSIONS OBP, HBP, and ABP assess somewhat distinct parameters. Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI. These data suggest that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.
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Roy D, Meador M, Sasu N, Whelihan K, Lewis JH. Are Community Health Center Patients Interested in Self-Measured Blood Pressure Monitoring (SMBP) - And Can They Do It? Integr Blood Press Control 2021; 14:19-29. [PMID: 33603456 PMCID: PMC7886240 DOI: 10.2147/ibpc.s285007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/16/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Self-measured blood pressure monitoring (SMBP) helps diagnose and manage hypertension from outside the clinic, which has implications for patient empowerment and outcomes, continuity of care, and resilience in care communities catering to vulnerable populations. Methods We instituted a protocol for SMBP among hypertensive patients at 9 community health centers in 3 states and administered questionnaires to patients before and after the protocol was instituted to assess knowledge and engagement with disease management, beliefs and attitudes towards, and experience doing SMBP. Questionnaires included 16 items designed to evaluate patient perceptions and beliefs about SMBP. These included a series of questions using a 5-point Likert scale, binary questions related to their perceived ability to comply with specific SMBP guidelines and open-ended questions to obtain descriptions of experiences with SMBP. Results The pre-questionnaire was completed by 478 patients and the post-questionnaire was completed by 372. Seventy-seven percent of respondents knew their ideal blood pressure and their engagement with blood pressure management increased significantly (p=0.0024) after completing the protocol. Additionally, 85% of respondents said that they had a positive experience doing SMBP. Open-ended responses revealed insight regarding why patients chose to do SMBP and factors patients appreciated about SMBP. Discussion When trained properly and supported, community health center patients are capable of and motivated to perform accurate SMBP. Our study provides evidence that health center patients can follow detailed SMBP protocols and monitor their own blood pressure from the safety of their homes, which is critical to their care continuum, particularly in days of a pandemic.
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Affiliation(s)
- Debosree Roy
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Margaret Meador
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Nana Sasu
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Kate Whelihan
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Joy H Lewis
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
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How Should We Measure and Deal with Office Blood Pressure in 2021? Diagnostics (Basel) 2021; 11:diagnostics11020235. [PMID: 33546474 PMCID: PMC7913758 DOI: 10.3390/diagnostics11020235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 12/19/2022] Open
Abstract
Arterial hypertension is a major risk factor for cardiovascular disease worldwide. Office blood pressure measurements (OBPMs) are still recommended for diagnosis and follow-up by all major guidelines; however, the recommended procedures differ significantly. In analogy, major outcome studies usually apply OBPMs, again, with a variety of procedures. This variety of OBPM procedures complicates the comparability between studies and challenges daily clinical practice. In this narrative review, we compile the most recent recommendations for office blood pressure measurement together with the major limitations and strategies and how these could be overcome.
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Xavier M, Jéromine T, Guillaume PH, Gilles T, Sylvaine BG, Aurélien M, Philippe V. Home blood-pressure measurement for the diagnosis and monitoring of arterial hypertension by French general practitioners: a cross-sectional survey in the Auvergne region. BMC FAMILY PRACTICE 2021; 22:7. [PMID: 33397318 PMCID: PMC7780393 DOI: 10.1186/s12875-020-01358-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022]
Abstract
Background Home blood-pressure measurement (HBPM) is recommended for the diagnosis of hypertension and monitoring of patients with hypertension. Since 2013, the French National Health Insurance Body (FNHIB) has promoted HBPM to general practitioners (GPs). The objective of the study was to evaluate the practice of HBPM by French GPs to diagnose and monitor hypertension, 3 years after the beginning of the FNHIB campaign. Methods We conducted a postal survey from 7 March to 31 May 2016. All of the 1040 GPs practising in the Auvergne region in France were invited to participate, using a self-reporting questionnaire. We obtained information on the characteristics of the GPs, and their practice regarding the use of HBPM. Use of HBPM was reported as “never, occasionally, regularly and systematically”. Frequency of HBMP use was analysed using multivariate ordered logistic regression model. Results A total of 569 (54.7%) GPs responded to the survey. They were 50.3 (± 11.5) years old, 241 (43.0%) were female, and 352 (62.7%) worked in urban areas. Among them, 530 (94.5%) reported the use of HBPM for diagnosis and 519 (92.5%) for monitoring hypertension. To diagnose hypertension, younger GPs (OR = 0.97; 95% CI: 0.95–0.98), GPs practising in a group (OR = 1.45; 95% CI: 1.00–2.10) and in an MHC (OR = 2.09; 95% CI: 1.15–3.78), as compared to GPs with individual practices, and Clinical Tutors, as compared to non-Clinical Tutors, (OR = 1.92; 95% CI: 1.33–2.79) reported more frequent use of HBPM. To manage hypertension, female GPs, as compared to male GPs, (OR=1.47; 95% CI: 1.04–2.06), younger GPs (OR = 0.98; 95% CI: 0.97–0.99), and Clinical Tutors (OR = 1.90; 95% CI: 1.31–2.75) reported more frequent use of HBPM. Conclusions Our survey reveals that 3 years after the introduction of the FNHIB incentives, the use of HBPM by participating GPs to diagnose and manage hypertension is well established. A larger survey of GPs from other regions would make it possible to verify whether our results can be extrapolated to France as a whole. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01358-9.
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Affiliation(s)
- Mangiavillano Xavier
- Department of General Medicine, UFR Medicine, Clermont Auvergne University, 28, place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Tréfond Jéromine
- Department of General Medicine, UFR Medicine, Clermont Auvergne University, 28, place Henri Dunant, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Unité de recherche ACCePPT, Clermont-Ferrand, France
| | | | - Tanguy Gilles
- Department of General Medicine, UFR Medicine, Clermont Auvergne University, 28, place Henri Dunant, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Unité de recherche ACCePPT, Clermont-Ferrand, France
| | - Bœuf-Gibot Sylvaine
- Department of General Medicine, UFR Medicine, Clermont Auvergne University, 28, place Henri Dunant, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Unité de recherche ACCePPT, Clermont-Ferrand, France
| | - Mulliez Aurélien
- Clinical Research and Innovation Delegation, Clermont-Ferrand University Hospital, 58 Rue Montalembert, 63003, Clermont-Ferrand, France
| | - Vorilhon Philippe
- Department of General Medicine, UFR Medicine, Clermont Auvergne University, 28, place Henri Dunant, 63000, Clermont-Ferrand, France. .,Université Clermont Auvergne, Unité de recherche ACCePPT, Clermont-Ferrand, France. .,Clinical Research and Innovation Delegation, Clermont-Ferrand University Hospital, 58 Rue Montalembert, 63003, Clermont-Ferrand, France.
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Moise N, Phillips E, Carter E, Alcantara C, Julian J, Thanataveerat A, Schwartz JE, Ye S, Duran A, Shimbo D, Kronish IM. Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study. Implement Sci 2020; 15:63. [PMID: 32771002 PMCID: PMC7414682 DOI: 10.1186/s13012-020-01017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components. The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis. Methods/design The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics. Conclusions The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs. Trial registration Clinicaltrials.gov, NCT03480217, Registered on 29 March 2018
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, 1320 York Avenue, New York, NY, 10021, USA
| | - Eileen Carter
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.,Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Andrea Duran
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
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Bryant KB, Sheppard JP, Ruiz-Negrón N, Kronish IM, Fontil V, King JB, Pletcher MJ, Bibbins-Domingo K, Moran AE, McManus RJ, Bellows BK. Impact of Self-Monitoring of Blood Pressure on Processes of Hypertension Care and Long-Term Blood Pressure Control. J Am Heart Assoc 2020; 9:e016174. [PMID: 32696695 PMCID: PMC7792261 DOI: 10.1161/jaha.120.016174] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes. Methods and Results We pooled individual participant data from 4 randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, SD 9.5), male (53.9%), and predominantly white (95.6%); mean baseline BP was 151.8/85.0 mm Hg. Compared with usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% CI 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mm Hg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to 5 years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively. Conclusions One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at 5 years; continuing SMBP for 5 years could further improve BP control.
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Affiliation(s)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
| | | | | | - Valy Fontil
- University of California at San Francisco CA
| | | | | | | | | | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
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Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation 2020; 142:e42-e63. [PMID: 32567342 DOI: 10.1161/cir.0000000000000803] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
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Evaluation of the joint nurse scientist role across academia and practice. Nurs Outlook 2020; 68:261-269. [PMID: 32278443 DOI: 10.1016/j.outlook.2019.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/11/2019] [Accepted: 10/01/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mapped with the guiding principles of academic-practice partnerships (APPs) outlined by the American Association of Colleges of Nursing and the American Organization for Nursing Leadership, a joint nurse scientist role between a nursing school and acute care facility at a large academic health center was developed and characterized by a PhD-prepared nurse appointed in a research role across organizations. To date, eight faculty are now appointed across the School and four health systems. PURPOSE Describe outcomes, facilitators and vulnerabilities of the joint nurse scientist role. METHODS Review of administrative records. DISCUSSION Outcomes include the 1) conduct and dissemination of joint research, 2) translation of evidence into practice, 3) development of educational programs for health system nurses, 4) scholarly activities among health system nurses, and 5) improved visibility and valuation of the PhD-prepared nurse. Role facilitators include those previously reported for APPs, the joint nurse scientists' ability to broker opportunities across settings, and the evolving nature of the role. Role vulnerabilities pertain to the negotiation of workload, promotion, and institutional priorities. CONCLUSION The joint nurse scientist role fosters shared scholarly successes across academia and service.
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Chudek A, Owczarek AJ, Ficek J, Almgren-Rachtan A, Chudek J. Lower utilization of home blood pressure monitoring in younger, poorly educated hypertensive males – real-life data. Blood Press 2019; 29:95-102. [PMID: 31691573 DOI: 10.1080/08037051.2019.1684818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna Chudek
- Department of Pharmacovigilance, Europharma Rachtan Co. Ltd, Katowice, Poland
| | - Aleksander Jerzy Owczarek
- Department of Statistics (Department of Instrumental Analysis), Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Joanna Ficek
- Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Adebanjo MA, Oluwasanu MM, Arulogun OS. Hypertension Knowledge and Willingness of Government Officials in a Southwestern Nigerian City to Self-Monitor Blood Pressure. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:39-46. [PMID: 31216257 DOI: 10.1177/0272684x19857431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-monitoring of blood pressure (BP) is indispensable for the prevention and management of hypertension. Attitude and willingness to self-monitor BP have not been well investigated in Nigeria. This study investigated hypertension knowledge, attitude, and willingness of government officials in a southwestern Nigerian city to self-monitor BP. The study was a descriptive cross-sectional survey and 280 respondents completed a pretested, semistructured questionnaire. Data were analyzed using descriptive statistics and χ2 test. Mean age was 35.7 ± 10.6 years, 57.5% were women and 72.1% had tertiary education. Majority (65.7%) had poor knowledge about hypertension, only 1.8% recognized its symptomless nature. Majority (77.9%) had positive attitude toward being trained to self-monitor BP, while 82.1% were willing to buy self-monitoring devices. Hypertension knowledge was associated with age and marital status ( p < .05), while attitude was associated with willingness to self-monitor BP ( p < .05). Population-wide, educational interventions should be intensified to improve hypertension knowledge and enhance skills to self-monitor BP.
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Affiliation(s)
- Moses A Adebanjo
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Mojisola M Oluwasanu
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Oyedunni S Arulogun
- 1 Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
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Abstract
PURPOSE OF REVIEW To review data supporting the use of home blood pressure monitoring (HBPM) and provide practical guidance to clinicians wishing to incorporate HBPM into their practice. RECENT FINDINGS HBPM more accurately reflects the risk of cardiovascular events than office blood pressure measurement. In addition, there is high-quality evidence that HBPM combined with clinical support improves blood pressure control. Therefore, HBPM is increasingly recommended by guidelines to confirm the diagnosis of hypertension and evaluate the efficacy of blood pressure-lowering medications. Nevertheless, HBPM use remains low due to barriers from the patient, clinician, and healthcare system level. Understanding these barriers is crucial for developing strategies to effectively implement HBPM into routine clinical practice. HBPM is a valuable adjunct to office blood pressure measurement for diagnosing hypertension and guiding antihypertensive therapy. Following recommended best practices can facilitate the successful implementation of HBPM and impact how hypertension is managed in the primary care setting.
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