Factors influencing blood pressure: development of a risk model

Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam

Background

Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce.Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease.

Methods

A cross-sectional, correlational study design was employed among 182 participants coming to follow up at two tertiary hospitals in Vietnam. The participants were selected by a convenience sampling technique. Data were collected using Participant Demographic Information Form, Clinical Characteristics Form, Alcohol Use Disorders Identification Test, Pittsburgh Sleep Quality Index, Charlson Comorbidity Index, and an automated office oscillometric upper arm device. Descriptive statistics, Chi-square, Fisher's Exact Test, and binary logistic regression were used to analyze the data.

Results

63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets.

Conclusion

Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities.

Rate of uncontrolled blood pressure and its associated factors in patients with predialysis chronic kidney disease in Bali, Indonesia

Purpose

Hypertension is a key determinant for the development and progression of chronic kidney disease (CKD). The purpose of this study is to assess the rate of uncontrolled blood pressure (BP) and identify its associated factors in patients with predialysis CKD in Bali, Indonesia.

Design/methodology/approach

A cross-sectional study was conducted among 165 patients who attended the nephrology clinic in a central public hospital in Bali. Data were obtained by measuring BP at threshold 130/80 mmHg, as well as collected through standardized questionnaires. Univariate analysis was done using Chi-square test, and multivariate analyses were carried out using multiple logistic regression.

Findings

A total of 165 patients (111 males and 54 females) with predialysis CKD participated in this study. About 64% of the participants had uncontrolled BP. In multiple logistic regression, all selected variables significantly explained 63.2% of the variance in uncontrolled BP. However, low physical activity (odds ratio [OR] = 24.287, 95% confidence interval [CI]: 3.114–189.445), unhealthy dietary pattern (OR = 10.153, 95% CI: 2.770–37.210), as well as perceived moderate stress (OR = 4.365, 95% CI: 1.024-18.609) and high stress (OR = 10.978, 95% CI: 2.602–46.312) were significantly associated with uncontrolled BP.

Research limitations/implications

The study findings provide evidence for health care providers to improve BP control among patients with predialysis CKD.

Originality/value

Controlling BP among patients with predialysis CKD was poor. Lifestyle modification and stress management are keys to improving BP control.

Can we predict hypertension among preterm children?

Prematurity and low birth weight (LBW) cause hypertension (HTN), ischemic heart disease, and obesity in young adults. The objective of the study was to identify risk factors for the development of HTN in children born preterm or at a LBW and to assess pediatricians' awareness of the problem. A retrospective review of 160 cases was conducted. In total, 22% of babies born preterm/LBW developed HTN by age 15 years. The odds of developing HTN were 1.6 times greater for every one standard deviation increase in body mass index. Higher risk posses for those born small for gestational age and under 1000 g. Of the 35 cases of HTN identified, only 31% were recognized as abnormal by the primary care providers. The development of obesity and HTN appear related in preterm/LBW children. Awareness of prematurity or LBW as a risk factor for HTN should be raised among pediatric primary care providers.

Forearm and Upper-Arm Oscillometric Blood Pressure Comparison in Acutely III Adults

When patients’ upper arms are not accessible and/or when cuffs do not fit large upper arms, the forearm site is often used for blood pressure (BP) measurement. The purpose of this study is to compare forearm and upper-arm BPs in 70 acutely ill adults, admitted to a community hospital’s 14-bed ICU. Using Philips© oscillometric monitors, three repeated measures of forearm and upper-arm BPs are obtained with head of bed flat and with head of bed elevated at 30°. Arms are resting on the bed. Paired t tests show statistically significant differences in systolic BPs, diastolic BPs, and mean arterial pressures in the supine and head-elevated positions. Bland—Altman analyses indicate that forearm and upper-arm oscillometric BPs are not interchangeable in acutely ill adults.

'Pressure of life': ethnicity as a mediating factor in mid-life and older peoples' experience of high blood pressure

Hypertension is a common condition which disproportionately affects African Caribbean people in England, yet this experience is rarely reported in the literature. Whilst a body of literature exists that explores chronic illness experience, little attention is paid to hypertension, nor to ethnicity as a mediating concept in chronic illness experience. This paper explores the meaning and consequences of hypertension for African Caribbean people residing in England. The study conducted was a qualitative study, informed by the ethnographic tradition. The study methods included the conduct of two focus group interviews (10 participants), 21 in-depth interviews and five vignette interviews. Thirty-six people in total participated in the study, both men and women, aged between 37 and 82 years (median age = 59.5 years) in two English cities. The sample was generated by contacting GP surgeries, community groups and associations and included economically active and retired people. The narrative accounts provided illuminate the personal biographies of the mid-life and older participants in the study, providing evidence as to how issues such as ethnicity, migration, cultural adaptation, racism and discrimination may impact upon the chronic illness experience. Participants' understandings of their self-defined condition of high blood pressure differed greatly from medical conceptualisations of the condition of hypertension. The implications of the study are that in order to provide effective health and social care for individuals of African Caribbean origin with hypertension, care-providers require insight into how migration and cultural adaptation may create major disruption to an individual's life trajectory, to which the subsequent diagnoses of chronic illness are relative in terms of the individual's response and adaptation.

100 or 30 years after Janeway or Bartter, Healthwatch helps avoid 'flying blind'

Longitudinal records of blood pressure (BP) and heart rate (HR) around the clock for days, weeks, months, years, and even decades obtained by manual self-measurements (during waking) and/or automatically by ambulatory monitoring reveal, in addition to well-known large within-day variation, also considerable day-to-day variability in most people, whether normotensive or hypertensive. As a first step, the circadian rhythm is considered along with gender differences and changes as a function of age to derive time-specified reference values (chronodesms), while reference values accumulate to also account for the circaseptan variation. Chronodesms serve for the interpretation of single measurements and of circadian and other rhythm parameters. Refined diagnoses can thus be obtained, namely MESOR-hypertension when the chronome-adjusted mean value (MESOR) of BP is above the upper limit of acceptability, excessive pulse pressure (EPP) when the difference in MESOR between the systolic (S) and diastolic (D) BP is too large, CHAT (circadian hyper-amplitude tension) when the circadian BP amplitude is excessive, DHRV (decreased heart rate variability) when the standard deviation (SD) of HR is below the acceptable range, and/or ecphasia when the overall high values recurring each day occur at an odd time (a condition also contributing to the risk associated with 'non-dipping'). A non-parametric approach consisting of a computer comparison of the subject's profile with the time-varying limits of acceptability further serves as a guide to optimize the efficacy of any needed treatment by timing its administration (chronotherapy) and selecting a treatment schedule best suited to normalize abnormal patterns in BP and/or HR. The merit of the proposed chronobiological approach to BP screening, diagnosis and therapy (chronotheranostics) is assessed in the light of outcome studies. Elevated risk associated with abnormal patterns of BP and/or HR variability, even when most if not all measurements lie within the range of acceptable values, becomes amenable to treatment as a critical step toward prevention (prehabilitation) to reduce the need for rehabilitation (the latter often after costly surgical intervention).

Addressing current challenges to cardiac rehabilitation care

Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a strong nurse-patient relationship. This relationship provides a foundation for meeting current healthcare challenges. Three challenges are presented and addressed through specific examples. The challenge of the changing cardiac rehabilitation population is addressed through the example of the heart failure patient. The challenge to create innovative programming is addressed through the example of the Therapeutic Rehabilitative Intensive Program, developed to meet the needs of people who live in communities without cardiac rehabilitation services. The challenge to measure outcomes is addressed through the example of choosing a blood pressure measurement method. In addressing each challenge, the role of the advanced practice nurse is described.

Resting and reactive blood pressure. Predictors of ambulatory blood pressure in older adults with hypertension

The study examined whether reactive change scores from a short blood pressure (BP) reactivity protocol, resting BP, or resting pulse pressure (PP) would be predictors of 24-hour ambulatory BP and BP load in cardiac patients. The study used a single-group design, with both an experimental clinical component and an observational field component. Both components used repeated measurement methods. The study population consisted of 45 adult patients with a mean age of 64.6 +/- 8.5 years who were diagnosed with cardiac disease in a cardiac rehabilitation program and who were taking anti-hypertensive medication. Blood pressure reactivity was operationalized with a speech protocol. During the speech protocol, BP was measured with an automatic device (Dinamap) while patients talked about their health and about their usual day. Twenty-four-hour ambulatory BP measurement followed the speech protocol. Resting systolic BP and resting PP were significant predictors of 24-hour ambulatory systolic BP, and resting systolic BP was a significant predictor of systolic BP load. No predictors were significant of 24-hour diastolic BP or diastolic BP load. Initial resting BP and PP may be used in clinical settings to assess hypertension management. Future studies are necessary to confirm the ability of resting BP to predict ambulatory BP and BP load in older adults who are medicated and hypertensive.

Results of a heart disease risk-factor screening among traditional college students

The author collected data on serum cholesterol, blood pressure, and self-reported health behavior in 226 college students aged 18 to 26 years. Twenty-nine percent had undesirable total cholesterol levels, 10% had high cholesterol, 10% had high systolic blood pressure, and 11% had high diastolic blood pressure. Half or more of the participants consumed a diet high in saturated fats, engaged in binge drinking, had a parental risk for high cholesterol or blood pressure, or reported they experienced elevated stress levels. Men had higher risk-factor levels than women. Findings from a regression analysis revealed that smoking, binge drinking, lack of cardiovascular exercise, and eating a high saturated-fat diet were predictive of undesirable cholesterol levels. Study limitations included self-selection of participants and single measurements of blood pressure and cholesterol. Trained students served as screeners in the program for providing an effective, low-cost screening intervention.