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Lee TA, King M, Young SW, Tsuyuki RT. Community Pharmacy-Based Blood Pressure Screening in Newfoundland and Labrador, Canada for World Hypertension Day 2022: A Cross-Sectional Study. CJC Open 2024; 6:728-734. [PMID: 38846443 PMCID: PMC11150944 DOI: 10.1016/j.cjco.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/08/2023] [Indexed: 06/09/2024] Open
Abstract
Background High blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day. Methods Data collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques. Results A total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model. Conclusions A large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.
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Affiliation(s)
- Tiffany A. Lee
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Melanie King
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Stephanie W. Young
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Ross T. Tsuyuki
- Faculty of Medicine (Cardiology), University of Alberta, Edmonton, Alberta, Canada
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Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martinez R, Gamarra A, Lombardi C, Parra N, Rodriguez L, Rodriguez Y, Brettler J. HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control. Curr Hypertens Rep 2024; 26:141-156. [PMID: 38041725 PMCID: PMC10904446 DOI: 10.1007/s11906-023-01286-w] [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] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. RECENT FINDINGS Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Norm R C Campbell
- Department of Medicine, Libin Cardiovascular Institute, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Donald J DiPette
- University of South Carolina and University of South Carolina School of Medicine, Columbia, SC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Natalia Parra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Yenny Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Department of Health Systems Science, Regional Hypertension Program, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA
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3
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Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martínez R, Gamarra A, Lombardi C, Parra N, Rodríguez L, Rodríguez Y, Brettler J. [HEARTS in the Americas: targeting health system change to improve population hypertension controlHEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população]. Rev Panam Salud Publica 2024; 48:e17. [PMID: 38464870 PMCID: PMC10924616 DOI: 10.26633/rpsp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose of review HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
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Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Norm R. C. Campbell
- Departamento de MedicinaInstituto Cardiovascular LibinUniversidad de CalgaryCalgaryAB T2N 1N4CanadáDepartamento de Medicina, Instituto Cardiovascular Libin, Universidad de Calgary, Calgary, AB T2N 1N4, Canadá.
| | - Donald J. DiPette
- Universidad de Carolina del SurFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaUniversidad de Carolina del Sur y Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América.
| | - Marc G. Jaffe
- Departamento de EndocrinologíaThe Permanente Medical GroupCentro Médico de San Francisco de Kaiser PermanenteSan FranciscoEstados Unidos de AméricaDepartamento de Endocrinología, The Permanente Medical Group, Centro Médico de San Francisco de Kaiser Permanente, San Francisco, Estados Unidos de América.
| | - Andrés Rosende
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Ramón Martínez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Cintia Lombardi
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Natalia Parra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Yenny Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Southern California Permanent Medical GroupDepartamento de Ciencias de Sistemas de SaludPrograma Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaSouthern California Permanent Medical Group, Departamento de Ciencias de Sistemas de Salud, Programa Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
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Cheung AK, Whelton PK, Muntner P, Schutte AE, Moran AE, Williams B, Sarafidis P, Chang TI, Daskalopoulou SS, Flack JM, Jennings G, Juraschek SP, Kreutz R, Mancia G, Nesbitt S, Ordunez P, Padwal R, Persu A, Rabi D, Schlaich MP, Stergiou GS, Tobe SW, Tomaszewski M, Williams KA, Mann JFE. International Consensus on Standardized Clinic Blood Pressure Measurement - A Call to Action. Am J Med 2023; 136:438-445.e1. [PMID: 36621637 PMCID: PMC10159895 DOI: 10.1016/j.amjmed.2022.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bryan Williams
- Department of Medicine, University College London, London, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University, Thessaloniki, Greece
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University Montreal, Canada
| | - John M Flack
- Department of Internal Medicine, Southern Illinois School of Medicine, Springfield, Ill
| | | | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA, Australia
| | - George S Stergiou
- Hypertension Centre STRIDE, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kim A Williams
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Johannes F E Mann
- KfH Kidney Center, Munich, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
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5
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Country experiences on the path to exclusive use of validated automated blood pressure measuring devices within the HEARTS in the Americas Initiative. J Hum Hypertens 2023; 37:120-125. [PMID: 35817799 PMCID: PMC9957722 DOI: 10.1038/s41371-022-00706-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022]
Abstract
The aim of the HEARTS in the Americas initiative is to promote the adoption of global best practices in the prevention and control of cardiovascular diseases, and improve the control of hypertension. HEARTS is being implemented in 21 countries and a diverse set of actions and measures are in progress to improve exclusive access in primary health care facilities to automated blood pressure measuring devices that have been validated for accuracy. The purpose of this manuscript is to illustrate these efforts, mainly in the regulatory and public procurement arena, and to present information on common challenges and solutions identified. Examples from six countries confirm the need for not only a robust regulatory framework to increase availability of validated automated blood pressure measuring devices but also a comprehensive strategic approach that involves relevant stakeholders, includes a multi-pronged approach and is associated with a national program to prevent and control non communicable diseases.
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6
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS in the Americas: a global example of using clinically validated automated blood pressure devices in cardiovascular disease prevention and management in primary health care settings. J Hum Hypertens 2023; 37:126-129. [PMID: 35273326 PMCID: PMC9957723 DOI: 10.1038/s41371-022-00659-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tammy M Brady
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norm R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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How to find and use validated blood pressure measuring devices. J Hum Hypertens 2023; 37:108-114. [PMID: 35778537 PMCID: PMC9957729 DOI: 10.1038/s41371-022-00718-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Clinically validated, automated arm-cuff blood pressure measuring devices (BPMDs) are recommended for BP measurement. However, most BPMDs available for purchase by consumers globally are not properly validated. This is a problem because non-validated BPMDs are less accurate and precise than validated ones, and therefore if used clinically could lead to misdiagnosis and mismanagement of BP. In response to this problem, several validated device lists have been developed, which can be used by clinicians and consumers to identify devices that have passed clinical validation testing. The purpose of this review is to describe the resources that are available for finding validated BPMDs in different world regions, to identify the differences between validated device lists, and describe current gaps and challenges. How to use validated BPMDs properly is also summarised.
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Khan Mamun MMR, Sherif A. Advancement in the Cuffless and Noninvasive Measurement of Blood Pressure: A Review of the Literature and Open Challenges. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010027. [PMID: 36671599 PMCID: PMC9854981 DOI: 10.3390/bioengineering10010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is a chronic condition that is one of the prominent reasons behind cardiovascular disease, brain stroke, and organ failure. Left unnoticed and untreated, the deterioration in a health condition could even result in mortality. If it can be detected early, with proper treatment, undesirable outcomes can be avoided. Until now, the gold standard is the invasive way of measuring blood pressure (BP) using a catheter. Additionally, the cuff-based and noninvasive methods are too cumbersome or inconvenient for frequent measurement of BP. With the advancement of sensor technology, signal processing techniques, and machine learning algorithms, researchers are trying to find the perfect relationships between biomedical signals and changes in BP. This paper is a literature review of the studies conducted on the cuffless noninvasive measurement of BP using biomedical signals. Relevant articles were selected using specific criteria, then traditional techniques for BP measurement were discussed along with a motivation for cuffless measurement use of biomedical signals and machine learning algorithms. The review focused on the progression of different noninvasive cuffless techniques rather than comparing performance among different studies. The literature survey concluded that the use of deep learning proved to be the most accurate among all the cuffless measurement techniques. On the other side, this accuracy has several disadvantages, such as lack of interpretability, computationally extensive, standard validation protocol, and lack of collaboration with health professionals. Additionally, the continuing work by researchers is progressing with a potential solution for these challenges. Finally, future research directions have been provided to encounter the challenges.
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Affiliation(s)
| | - Ahmed Sherif
- School of Computing Sciences and Computer Engineering, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
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9
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodríguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodríguez L, Piñeiro DJ, Martínez R, Sharman JE. [HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary careHEARTS nas Américas: inovações para melhorar a gestão do risco de hipertensão e de doenças cardiovasculares na atenção primária]. Rev Panam Salud Publica 2022; 46:e197. [PMID: 36284552 PMCID: PMC9578652 DOI: 10.26633/rpsp.2022.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 11/24/2022] Open
Abstract
Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.
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Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Norm R.C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la ComunidadInstituto Cardiovascular Libin de AlbertaUniversidad de CalgaryCalgaryCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá.
| | - Gloria P. Giraldo Arcila
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Sonia Y. Angell
- Departamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns HopkinsBaltimoreEstados Unidos de AméricaDepartamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América.
| | - Cintia Lombardi
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Jeffrey W. Brettler
- Departamento de Ciencias de Sistemas de SaludFacultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaDepartamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| | - Yenny A. Rodríguez Morales
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Kenneth L. Connell
- Facultad de Ciencias Médicas, Campus de Cave HillUniversidad de las Indias OccidentalesSt MichaelBarbadosFacultad de Ciencias Médicas, Campus de Cave Hill, Universidad de las Indias Occidentales, St Michael, Barbados.
| | - Angelo Gamarra
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Donald J. DiPette
- Departamento de MedicinaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América.
| | - Andres Rosende
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Marc G. Jaffe
- Departamento de EndocrinologíaCentro Médico Kaiser Permanente de San FranciscoSan FranciscoEstados Unidos de AméricaDepartamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América.
| | - Libardo Rodríguez
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Daniel J. Piñeiro
- Departamento de Medicina Universidad de Buenos AiresBuenos AiresArgentinaDepartamento de Medicina Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ramón Martínez
- Departamento de Enfermedades No Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D. C.Estados Unidos de AméricaDepartamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - James E. Sharman
- Instituto Menzies de Investigación MédicaUniversidad de TasmaniaHobartAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia.
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10
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Rosende A, DiPette D, Brettler J, Rodríguez G, Zuniga E, Connell K, Ordunez P. HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care. Rev Panam Salud Publica 2022; 46:e125. [PMID: 36071921 PMCID: PMC9440731 DOI: 10.26633/rpsp.2022.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/16/2022] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT
Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension represents its main risk factor. However, population hypertension control rates in the Region are poor. Global Hearts is the World Health Organization's flagship initiative to reduce the burden of cardiovascular diseases. HEARTS in the Americas Initiative is its regional adaptation that seeks to be the cardiovascular disease risk management model, including hypertension and diabetes, in primary health care throughout the Americas by 2025.
HEARTS in the Americas is being implemented in 22 countries and over 2 095 primary care centers. All implementing countries have defined their treatment protocols, and HEARTS in the Americas has supported continuous improvement. Because WHO recently released the 2021 Guideline for the Pharmacological Treatment of Hypertension in Adults and HEARTS in the Americas introduced the key drivers for hypertension control, the initiative generated a methodology to help countries update and strengthen their treatment protocols.
This article describes the process of developing the treatment protocol appraisal checklist and defines the resulting clinical pathway. This tool can help countries and primary care centers to improve their protocols by identifying the improvement points and upgrading clinical pathways.
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Affiliation(s)
- Andres Rosende
- Pan American Health Organization, Washington, D.C., United States of America
| | - Donald DiPette
- University of South Carolina, Columbia, United States of America
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Los Angeles, United States of America
| | | | - Eric Zuniga
- University of Antofagasta, Antofagasta, Chile
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, D.C., United States of America
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11
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodriguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodriguez L, Piñeiro DJ, Martinez R, Sharman JE. HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary care. Rev Panam Salud Publica 2022; 46:e96. [PMID: 35855441 PMCID: PMC9288223 DOI: 10.26633/rpsp.2022.96] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Gloria P. Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Sonia Y. Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | - Yenny A. Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Kenneth L. Connell
- Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, St Michael, Barbados
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Donald J. DiPette
- Department of Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Marc G. Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Daniel J. Piñeiro
- Department of Medicine. University of Buenos Aires, Buenos Aires, Argentina
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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12
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS en las Américas: un ejemplo mundial del uso de dispositivos automatizados de medición de la presión arterial validados clínicamente en la prevención y el manejo de las enfermedades cardiovasculares en entornos de atención primaria de salud. Rev Panam Salud Publica 2022; 46:e50. [PMID: 35573113 PMCID: PMC9097929 DOI: 10.26633/rpsp.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-9871-6845
| | - Cintia Lombardi
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0001-7376-7243
| | - Dean S Picone
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0002-4760-1634
| | - Tammy M Brady
- Departamento de Pediatría División de Nefrología Escuela de Medicina de la Universidad Johns Hopkins Baltimore Estados Unidos de América Departamento de Pediatría, División de Nefrología, Escuela de Medicina de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-1315-6747
| | - Norm R C Campbell
- Departamentos de Medicina Fisiología y Farmacología y Ciencias de la Salud Comunitaria Instituto Cardiovascular Libin de Alberta Canadá Departamentos de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Canadá. Orcid: https://orcid.org/0000-0002-1093-4742
| | - Andrew E Moran
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América. Orcid: https://orcid.org/0000-0003-3554-0085
| | - Raj Padwal
- Departamento de Medicina Universidad de Alberta Edmonton Canadá Departamento de Medicina, Universidad de Alberta, Edmonton, Canadá. Orcid: https://orcid.org/0000-0003-3541-2817
| | - Andrés Rosende
- Departamento de Enfermedades No Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades No Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. Orcid: https://orcid.org/0000-0001-8173-0686
| | - Paul K Whelton
- Departamento de Epidemiología Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane Nueva Orleans Estados Unidos de América Departamento de Epidemiología, Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, Nueva Orleans, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-2225-383X
| | - James E Sharman
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0003-2792-0811
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13
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Hayer R, Kirley K, Cohen JB, Tsipas S, Sutherland SE, Oparil S, Shay CM, Cohen DL, Kabir C, Wozniak G. Using web-based training to improve accuracy of blood pressure measurement among health care professionals: A randomized trial. J Clin Hypertens (Greenwich) 2022; 24:255-262. [PMID: 35156756 PMCID: PMC8924996 DOI: 10.1111/jch.14419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
Accurate blood pressure measurement is crucial for proper screening, diagnosis, and monitoring of high blood pressure. However, providers are not aware of proper blood pressure measurement skills, do not master all the appropriate skills, or miss key steps in the process, leading to inconsistent or inaccurate readings. Training in blood pressure measurement for most providers is usually limited to a one-time brief demonstration during professional education coursework. The American Medical Association and the American Heart Association developed a 30-minute e-Learning module designed to refresh and improve existing blood pressure measurement knowledge and clinical skills among practicing providers. One hundred seventy-seven practicing providers, which included medical assistants, nurses, advanced practice providers, and physicians, participated in a multi-site randomized educational study designed to assess the effect of this e-Learning module on blood pressure measurement knowledge and skills. Participants were randomized 1:1 to either the intervention or control group. The intervention group followed a pre-post assessment approach, and the control group followed a test-retest approach. The initial assessment showed that participants in both the intervention and control groups correctly performed less than half of the 14 skills considered necessary to obtain an accurate blood pressure measurement (mean scores 5.5 and 5.9, respectively). Following the e-Learning module, the intervention group performed on average of 3.4 more skills correctly vs 1.4 in the control group (P < .01). Our findings reinforce existing evidence that errors in provider blood pressure measurements are highly prevalent and provide novel evidence that refresher training improves measurement accuracy.
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Affiliation(s)
- Rupinder Hayer
- Department of Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Kate Kirley
- Department of Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stavros Tsipas
- Department of Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Susan E Sutherland
- Department of Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina M Shay
- Global Epidemiology and RWE, Boehringer Ingelheim, Ingelheim, Germany
| | - Debbie L Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Kabir
- Aurora Research Institute, Aurora Health, Downers Grove, Illinois, USA
| | - Gregory Wozniak
- Department of Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
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14
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Sakhuja S, Jaeger BC, Akinyelure OP, Bress AP, Shimbo D, Schwartz JE, Hardy ST, Howard G, Drawz P, Muntner P. Potential impact of systematic and random errors in blood pressure measurement on the prevalence of high office blood pressure in the United States. J Clin Hypertens (Greenwich) 2022; 24:263-270. [PMID: 35137521 PMCID: PMC8925005 DOI: 10.1111/jch.14418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
The authors examined the proportion of US adults that would have their high blood pressure (BP) status changed if systolic BP (SBP) and diastolic BP (DBP) were measured with systematic bias and/or random error versus following a standardized protocol. Data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES; n = 5176) were analyzed. BP was measured up to three times using a mercury sphygmomanometer by a trained physician following a standardized protocol and averaged. High BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg. Among US adults not taking antihypertensive medication, 32.0% (95%CI: 29.6%,34.4%) had high BP. If SBP and DBP were measured with systematic bias, 5 mm Hg for SBP and 3.5 mm Hg for DBP higher and lower than in NHANES, the proportion with high BP was estimated to be 44.4% (95%CI: 42.6%,46.2%) and 21.9% (95%CI 19.5%,24.4%). Among US adults taking antihypertensive medication, 60.6% (95%CI: 57.2%,63.9%) had high BP. If SBP and DBP were measured 5 and 3.5 mm Hg higher and lower than in NHANES, the proportion with high BP was estimated to be 71.8% (95%CI: 68.3%,75.0%) and 48.4% (95%CI: 44.6%,52.2%), respectively. If BP was measured with random error, with standard deviations of 15 mm Hg for SBP and 7 mm Hg for DBP, 21.4% (95%CI: 19.8%,23.0%) of US adults not taking antihypertensive medication and 20.5% (95%CI: 17.7%,23.3%) taking antihypertensive medication had their high BP status re-categorized. In conclusions, measuring BP with systematic or random errors may result in the misclassification of high BP for a substantial proportion of US adults.
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Affiliation(s)
- Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Jeemon P, Séverin T, Amodeo C, Balabanova D, Campbell NRC, Gaita D, Kario K, Khan T, Melifonwu R, Moran A, Ogola E, Ordunez P, Perel P, Piñeiro D, Pinto FJ, Schutte AE, Wyss FS, Yan LL, Poulter NR, Prabhakaran D. World Heart Federation Roadmap for Hypertension - A 2021 Update. Glob Heart 2021; 16:63. [PMID: 34692387 PMCID: PMC8447967 DOI: 10.5334/gh.1066] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for local adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential Medicines' list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the 'Roadmap for raised BP' as 'Roadmap for hypertension' by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidence-based, inexpensive BP-lowering agents.
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Affiliation(s)
- Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandum, IN
| | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, BR
| | | | | | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, RO
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Shimotsuke, Tochigi, JP
| | | | | | - Andrew Moran
- Columbia University and Resolve to Save Lives, New York, US
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, US
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine and World Heart Federation, Geneva, GB
| | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | - Aletta E. Schutte
- University of New South Wales; The George Institute for Global Health, Sydney, AU
| | - Fernando Stuardo Wyss
- Cardiovascular Technology and Services of Guatemala – CARDIOSOLUTIONS, Guatemala, GT
| | | | | | - Dorairaj Prabhakaran
- London School of Hygiene & Tropical Medicine, London, GB
- Public Health Foundation of India, Gurugram, IN
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16
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Brouwers S, Sudano I, Kokubo Y, Sulaica EM. Arterial hypertension. Lancet 2021; 398:249-261. [PMID: 34019821 DOI: 10.1016/s0140-6736(21)00221-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
Arterial hypertension is the most important contributor to the global burden of disease; however, disease control remains poor. Although the diagnosis of hypertension is still based on office blood pressure, confirmation with out-of-office blood pressure measurements (ie, ambulatory or home monitoring) is strongly recommended. The definition of hypertension differs throughout various guidelines, but the indications for antihypertensive therapy are relatively similar. Lifestyle adaptation is absolutely key in non-pharmacological treatment. Pharmacologically, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, calcium channel blockers, and diuretics are the first-line agents, with advice for the use of single-pill combination therapy by most guidelines. As a fourth-line agent, spironolactone should be considered. The rapidly evolving field of device-based therapy, especially renal denervation, will further broaden therapeutic options. Despite being a largely controllable condition, the actual rates of awareness, treatment, and control of hypertension are disappointingly low. Further improvements throughout the process of patient screening, diagnosis, treatment, and follow-up need to be urgently addressed.
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Affiliation(s)
- Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium; Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Isabella Sudano
- University Heart Center, Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elisabeth M Sulaica
- Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
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17
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Farahani S, Farahani I, Burckhardt BB, Monser K, Laeer S. The Development of an Educational Video on Blood Pressure Measurement for Pharmacy Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:655-663. [PMID: 34163281 PMCID: PMC8215688 DOI: 10.2147/amep.s302728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION High blood pressure is an important worldwide health issue. Pharmacists can perform multifaceted tasks in hypertension management such as measuring blood pressure. In a time where the use of educational videos in health professions education has increased, an educational video might be an option for teaching blood pressure measurement skills to pharmacy students. This project aimed to develop an educational video tailored to pharmacy students on oscillometric blood pressure measurement in a community pharmacy setting that can be used as a self-instruction video. METHODS The video was created with support from the university's multimedia center. The video development was roughly divided into pre-production, production, and post-production. Students' satisfaction with and perception of the video was surveyed. RESULTS An 11-minute 33-second self-instruction video in the German language on proper oscillometric blood pressure measurement tailored for pharmacy students was created. Along with descriptive slides, the video delineates the necessary steps of blood pressure measurement in a community pharmacy setting in a role-play, to support students in communication with the patient. Results of a survey on the satisfaction and perception of the video from thirty-seven pharmacy students were included in the analysis and revealed that the video was well accepted by pharmacy students. Moreover, approximately 95% responded that instructional videos should be included in future pharmacy education. CONCLUSION We successfully developed an educational video on oscillometric blood pressure measurement for a community pharmacy setting. This work is a valuable form of support for faculty members, who intend to develop educational videos. This might be of interest especially during the coronavirus disease 2019 (COVID-19) pandemic, where distance learning has become highly relevant.
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Affiliation(s)
- Samieh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Imaneh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Bjoern B Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Karin Monser
- Multimedia Center, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
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18
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John O, Campbell NR, Brady TM, Farrell M, Varghese C, Velazquez Berumen A, Velez Ruiz Gaitan LA, Toffelmire N, Ameel M, Mideksa M, Jaffe MG, Schutte AE, Khan T, Lopez Meneses LP. The 2020 "WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices With Cuff". Hypertension 2021; 77:806-812. [PMID: 33517681 PMCID: PMC7884242 DOI: 10.1161/hypertensionaha.120.16625] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023]
Abstract
High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.
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Affiliation(s)
- Oommen John
- From the George Institute for Global Health, University of New South Wales, New Delhi, India (O.J.)
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India (O.J.)
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (N.R.C.C.)
| | - Tammy M. Brady
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (T.M.B.)
| | - Margret Farrell
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY (M.F.)
| | - Cherian Varghese
- Cross Cutting Lead, Non-Communicable Diseases and Special Initiatives (C.V.), World Health Organization, Geneva, Switzerland
| | - Adriana Velazquez Berumen
- Team Lead Medical Devices and In Vitro Diagnostics (A.V.B.), World Health Organization, Geneva, Switzerland
| | | | - Nicola Toffelmire
- Department of Non-Communicable Diseases (N.T.), World Health Organization, Geneva, Switzerland
| | - Mohammad Ameel
- Healthcare Technology Division, National Health Systems Resource Centre, Baba Gangnath Marg, Munirka, New Delhi, India (M.A.)
| | - Mulugeta Mideksa
- Biomedical Engineer, Medical Service Directorat, Federal Ministry of Health, Ethiopia (M.M.)
| | - Marc G. Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, CA (M.G.J.)
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales (A.E.S.)
- George Institute for Global Health, Sydney, Australia (A.E.S.)
| | - Taskeen Khan
- Department of Non-Communicable Diseases (T.K.), World Health Organization, Geneva, Switzerland
- Public Health Medicine Specialist, University of Pretoria, Hatfield, South Africa (T.K.)
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19
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Campbell NRC, Ordunez P, Giraldo G, Rodriguez Morales YA, Lombardi C, Khan T, Padwal R, Tsuyuki RT, Varghese C. WHO HEARTS: A Global Program to Reduce Cardiovascular Disease Burden: Experience Implementing in the Americas and Opportunities in Canada. Can J Cardiol 2020; 37:744-755. [PMID: 33310142 DOI: 10.1016/j.cjca.2020.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
Globally, cardiovascular diseases (CVDs) are the leading cause of death. Viewed as a threat to the global economy, the United Nations included reducing noncommunicable diseases, including CVDs, in the 2030 sustainable development goals, and the World Health Assembly agreed to a target to reduce noncommunicable diseases 25% by the year 2025. In response, the World Health Organisation led the development of HEARTS, a technical package to guide governments in strengthening primary care to reduce CVDs. HEARTS recommends a public health and health system approach to introduce highly simplified interventions done systematically at a primary health care level and has a focus on hypertension as a clinical entry point. The HEARTS modules include healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, CVD risk-based management, team-based care, systems for monitoring, and an implementation guide. There are early positive global experiences in implementing HEARTS. Led by the Pan American Health Organisation, many national governments in the Americas are adopting HEARTS and have shown early success. Unfortunately, in Canada hypertension control is declining in women since 2010-2011 and the dramatic reductions in rates of CVD seen before 2010 have flattened when age adjusted and increased for rates that are not age adjusted, and there are marked increases in absolute numbers of Canadians with adverse CVD outcomes. Several steps that Canada could take to enhance hypertension control are outlined, the core of which is to implement a strong governmental nongovernmental collaborative strategy to prevent and control CVDs, focusing on HEARTS.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Gloria Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Yenny A Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Taskeen Khan
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ross T Tsuyuki
- Departments of Pharmacology and Medicine (Cardiology) and EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cherian Varghese
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
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20
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Picone DS, Padwal R, Campbell NRC, Boutouyrie P, Brady TM, Olsen MH, Delles C, Lombardi C, Mahmud A, Meng Y, Mokwatsi GG, Ordunez P, Phan HT, Pucci G, Schutte AE, Sung K, Zhang X, Sharman JE. How to check whether a blood pressure monitor has been properly validated for accuracy. J Clin Hypertens (Greenwich) 2020; 22:2167-2174. [PMID: 33017506 PMCID: PMC8030032 DOI: 10.1111/jch.14065] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
Hypertension guidelines recommend that blood pressure (BP) should be measured using a monitor that has passed validation testing for accuracy. BP monitors that have not undergone rigorous validation testing can still be cleared by regulatory authorities for marketing and sale. This is the situation for most BP monitors worldwide. Thus, consumers (patients, health professionals, procurement officers, and general public) may unwittingly purchase BP monitors that are non-validated and more likely to be inaccurate. Without prior knowledge of these issues, it is extremely difficult for consumers to distinguish validated from non-validated BP monitors. For the above reasons, the aim of this paper is to provide consumers guidance on how to check whether a BP monitor has been properly validated for accuracy. The process involves making an online search of listings of BP monitors that have been assessed for validation status. Only those monitors that have been properly validated are recommended for BP measurement. There are numerous different online listings of BP monitors, several are country-specific and two are general (international) listings. Because monitors can be marketed using alternative model names in different countries, if a monitor is not found on one listing, it may be worthwhile cross-checking with a different listing. This information is widely relevant to anyone seeking to purchase a home, clinic, or ambulatory BP monitor, including individual consumers for use personally or policy makers and those procuring monitors for use in healthcare systems, and retailers looking to stock only validated BP monitors.
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Affiliation(s)
- Dean S. Picone
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | - Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health SciencesO’Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
| | - Pierre Boutouyrie
- Department of PharmacologyEuropean Georges Pompidou HospitalAssistance Publique Hôpitaux de ParisInserm UMR 970Université de ParisParisFrance
| | - Tammy M. Brady
- Division of Pediatric NephrologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Michael Hecht Olsen
- Department of Internal MedicineHolbaek HospitalHolbaekDenmark
- Centre for Individualized Medicine in Arterial DiseasesDepartment of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Christian Delles
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Cintia Lombardi
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | - Azra Mahmud
- King Abdul Aziz Cardiac CenterKing Abdul Aziz Medical CityRiyadhSaudi Arabia
- National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center & King Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
| | - Yaxing Meng
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
| | - Gontse G. Mokwatsi
- Hypertension in Africa Research Team (HART)North‐West UniversityPotchefstroomSouth Africa
- Medical Research Council Unit for Hypertension and Cardiovascular DiseaseNorth‐West UniversityPotchefstroomSouth Africa
| | - Pedro Ordunez
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | - Hoang T. Phan
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
- Pham NgocThach University of MedicineHo Chi Minh CityVietnam
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University HospitalDepartment of MedicineUniversity of PerugiaPerugiaItaly
| | - Aletta E. Schutte
- Hypertension in Africa Research Team (HART)North‐West UniversityPotchefstroomSouth Africa
- Medical Research Council Unit for Hypertension and Cardiovascular DiseaseNorth‐West UniversityPotchefstroomSouth Africa
- School of Public Health and Community MedicineUniversity of New South WalesThe George Institute for Global HealthSydneyAustralia
| | - Ki‐Chul Sung
- Division of CardiologyDepartment of Internal MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
| | | | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
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