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Asayama K, Ohkubo T, Imai Y. In-office and out-of-office blood pressure measurement. J Hum Hypertens 2024; 38:477-485. [PMID: 33785904 PMCID: PMC8008215 DOI: 10.1038/s41371-021-00486-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 11/09/2022]
Abstract
Accurate blood pressure measurement is the key procedure for the diagnosis and treatment of hypertension. In-office and out-of-office blood pressure measurements both have advantages and weak points, and multifaceted blood pressure information in individuals should be appropriately obtained and assessed. Validation of blood pressure measurement devices has long been an important issue, and several consortiums have emerged to try address it. Clinical guidelines should meet the demands of the region in which they are applied, and out-of-office measurements have been widely stated and recommended in the recently published guidelines worldwide. Appropriate assessment of blood pressure should be performed routinely in order to provide timely and accurate evidence regarding hypertension under any situation, including an unexpected pandemic.
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Affiliation(s)
- Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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2
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Songprasert T, Kalampakorn S, Jirapongsuwan A, Leelacharas S. Effects of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers. Int J Occup Med Environ Health 2024; 37:194-204. [PMID: 38651322 PMCID: PMC11142398 DOI: 10.13075/ijomeh.1896.02260] [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: 07/01/2023] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES This study aims to evaluated the effectiveness of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers. MATERIAL AND METHODS This quasi-experimental study applied concept and process of participatory actionoriented training and self-management to guide the development of the intervention addressing improvement in hypertension management behaviors. A total of 104 intercity van drivers with uncontrolled hypertension in Thailand were recruited to participate in this program. The intervention group (N = 52) received PAOT program, while the control group (N = 52) received conventional program. Data on hypertension management behaviors, and blood pressure were measured at baseline, 1 month and 3 months after intervention. RESULTS At 3 months after intervention, hypertension management behavior, and systolic blood pressure were significantly different between 2 groups (p < 0.05). CONCLUSIONS This PAOT was found to be feasible and could potentially improve hypertension management, and blood pressure level of intercity van drivers. The program should be applied in further studies with other workplaces in both formal and informal sectors with different characteristics and other health issues. Int J Occup Med Environ Health. 2024;37(2):194-204.
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Affiliation(s)
- Thanawan Songprasert
- Mahidol University, Department of Public Health Nursing, Faculty of Public Health, Bangkok, Thailand
| | - Surintorn Kalampakorn
- Mahidol University, Department of Public Health Nursing, Faculty of Public Health, Bangkok, Thailand
| | - Ann Jirapongsuwan
- Mahidol University, Department of Public Health Nursing, Faculty of Public Health, Bangkok, Thailand
| | - Sirirat Leelacharas
- Mahidol University, School of Nursing, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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3
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Higashi Y, Kishimoto S. An Extended Follow-Up on Blood Pressure in a Patient With New-Onset Essential Hypertension: Early-Morning Home, Morning Home, and Office Readings. Cureus 2024; 16:e52520. [PMID: 38371123 PMCID: PMC10874287 DOI: 10.7759/cureus.52520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
The patient was a 63-year-old man with a 24-year history of hypertension. During long-term follow-up, when outpatient clinic blood pressure and morning blood pressure are well-regulated, exceptionally elevated early-morning blood pressure does not play a significant role in the development of hypertensive target organ disease or cardiovascular disease.
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Affiliation(s)
- Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
| | - Shinji Kishimoto
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JPN
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Li Y, Zhang D, Li W, Chen Z, Thapa J, Mu L, Zhu H, Dong Y, Li L, Pagán JA. The Health and Economic Impact of Expanding Home Blood Pressure Monitoring. Am J Prev Med 2023; 65:775-782. [PMID: 37187442 PMCID: PMC10592599 DOI: 10.1016/j.amepre.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Home blood pressure monitoring is more convenient and effective than clinic-based monitoring in diagnosing and managing hypertension. Despite its effectiveness, there is limited evidence of the economic impact of home blood pressure monitoring. This study aims to fill this research gap by assessing the health and economic impact of adopting home blood pressure monitoring among adults with hypertension in the U.S. METHODS A previously developed microsimulation model of cardiovascular disease was used to estimate the long-term impact of adopting home blood pressure monitoring versus usual care on myocardial infarction, stroke, and healthcare costs. Data from the 2019 Behavioral Risk Factor Surveillance System and the published literature were used to estimate model parameters. The averted cases of myocardial infarction and stroke and healthcare cost savings were estimated among the U.S. adult population with hypertension and in subpopulations defined by sex, race, ethnicity, and rural/urban area. The simulation analyses were conducted between February and August 2022. RESULTS Compared with usual care, adopting home blood pressure monitoring was estimated to reduce myocardial infarction cases by 4.9% and stroke cases by 3.8% as well as saving an average of $7,794 in healthcare costs per person over 20 years. Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared with non-Hispanic Whites, men, and urban residents. CONCLUSIONS Home blood pressure monitoring could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, and the benefits could be more pronounced in racial and ethnic minority groups and those living in rural areas. These findings have important implications in expanding home blood pressure monitoring for improving population health and reducing health disparities.
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Affiliation(s)
- Yan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Donglan Zhang
- Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, New York.
| | - Weixin Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhuo Chen
- Department of Health Policy & Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Janani Thapa
- Department of Health Policy & Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Lan Mu
- Department of Geography, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Haidong Zhu
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Yanbin Dong
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
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5
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Ali N, Faheem M, Ullah H, Shabana H, Kassem A, Ahmed MO, Elmahdi E. Atorvastatin as an Antihypertensive Agent: A Pilot Study. Cureus 2023; 15:e49532. [PMID: 38156151 PMCID: PMC10753094 DOI: 10.7759/cureus.49532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Hypertension (HTN) is among the most common causes of chronic disease burden, along with dyslipidemia. It is a prominent risk factor for cardiovascular and cerebrovascular morbidity and mortality. More often than not, HTN coexists with dyslipidemia. This study aimed to see the antihypertensive effect of statins (atorvastatin), as certain animal models have shown that statins have a voltage-gated calcium channel-blocking effect. Material and methods This was a randomized controlled trial done at the Ayub Hospital Complex in Abbottabad, Pakistan. After ethical approval, 120 patients with newly diagnosed hypertension belonging to either gender and aged 35 and above were enrolled in the trial. They were randomly divided into two groups, with each group comprising 60 patients. One group was administered amlodipine 5 mg per oral (PO) once a day, while the other group was given 5 mg of amlodipine PO plus 10 mg of atorvastatin PO. The patients were examined on a follow-up visit 14 days later, and blood pressure was recorded as per protocols. Results A total of 120 newly diagnosed patients were studied in this trial. The mean age was 51.07 years, with a standard deviation of ±6.15 years and a range of 41-60 years. There were 64 (53.3%) males and 56 (46.7%) females in the study. The mean systolic blood pressures (SBPs) and diastolic blood pressures (DBPs) in Group 2 (amlodipine 5 mg + atorvastatin 10 mg) were significantly lower than the patients in Group 1 (only amlodipine 5 mg) in the follow-up visit, which was 14 days after starting the medication (p≤0.05). Conclusion The addition of a lipid-lowering drug to an antihypertensive regimen results in a better lowering of blood pressure in hypertensive individuals.
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Affiliation(s)
- Niaz Ali
- Pharmacology, College of Medicine, Shaqra University, Shaqra, SAU
| | | | - Himayat Ullah
- Medicine, College of Medicine, Shaqra University, Shaqra, SAU
| | - Hosam Shabana
- Medicine, College of Medicine, Shaqra University, Shaqra, SAU
| | - Arafat Kassem
- Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Mahmoud O Ahmed
- Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Essam Elmahdi
- Internal Medicine, Faculty of Medicine, Mansoura University, Al Mansoura, EGY
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Hughes JP, Lee WY, Troxel AB, Heagerty PJ. Sample Size Calculations for Stepped Wedge Designs with Treatment Effects that May Change with the Duration of Time under Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023:10.1007/s11121-023-01587-1. [PMID: 37728810 PMCID: PMC10950842 DOI: 10.1007/s11121-023-01587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
The stepped wedge design is often used to evaluate interventions as they are rolled out across schools, health clinics, communities, or other clusters. Most models used in the design and analysis of stepped wedge trials assume that the intervention effect is immediate and constant over time following implementation of the intervention (the "exposure time"). This is known as the IT (immediate treatment effect) assumption. However, recent research has shown that using methods based on the IT assumption when the treatment effect varies over exposure time can give extremely misleading results. In this manuscript, we discuss the need to carefully specify an appropriate measure of the treatment effect when the IT assumption is violated and we show how a stepped wedge trial can be powered when it is anticipated that the treatment effect will vary as a function of the exposure time. Specifically, we describe how to power a trial when the exposure time indicator (ETI) model of Kenny et al. (Statistics in Medicine, 41, 4311-4339, 2022) is used and the estimand of interest is a weighted average of the time-varying treatment effects. We apply these methods to the ADDRESS-BP trial, a type 3 hybrid implementation study designed to address racial disparities in health care by evaluating a practice-based implementation strategy to reduce hypertension in African American communities.
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Affiliation(s)
- James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA.
| | - Wen-Yu Lee
- Department of Population Health, Division of Biostatistics, New York University, New York, NY, USA
| | - Andrea B Troxel
- Department of Population Health, Division of Biostatistics, New York University, New York, NY, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
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Otieno P, Agyemang C, Wilunda C, Sanya RE, Iddi S, Wami W, Van Andel J, van der Kloet B, Teerling J, Siteyi A, Asiki G. Effect of Patient Support Groups for Hypertension on Blood Pressure among Patients with and Without Multimorbidity: Findings from a Cohort Study of Patients on a Home-Based Self-Management Program in Kenya. Glob Heart 2023; 18:28. [PMID: 37305067 PMCID: PMC10253234 DOI: 10.5334/gh.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Patient support group interventions have been widely used to manage chronic diseases in Kenya. However, the potential benefits of these groups on patient health outcomes, and how this is influenced by multimorbidity, have not been rigorously evaluated. Objective We assessed the effect of a patient support group intervention on blood pressure (BP) management and the potential moderating effect of multimorbidity among low- and middle-income patients with hypertension in Kenya. Methods We analysed data from a non-randomized, quasi-experimental study of 410 patients with hypertension on a home-based self-management program conducted from September 2019 to September 2020. The program included the formation and participation in patient support groups. Using a modified STEPS questionnaire, data were collected on BP, anthropometry and other measurements at enrolment and after 12 months of follow-up. Multimorbidity was defined as the simultaneous presence of hypertension and at least one or more related conditions with similar pathophysiology (concordant multimorbidity) or unrelated chronic conditions (discordant multimorbidity). Propensity score (PS) weighting was used to adjust for baseline differences among 243 patients who participated in the support groups and 167 who did not. We estimated the effects of patient support groups and moderating effects of multimorbidity on BP management using multivariable ordinary linear regression weighted by PS. Findings Participation in support groups significantly reduced systolic BP by 5.4 mmHg compared to non-participation in the groups [β = -5.4; 95% CI -1.9 to -8.8]. However, among participants in the support group intervention, the mean systolic BP at follow-up assessment for those with concordant multimorbidity was 8.8 mmHg higher than those with no multimorbidity [β = 8.8; 95% CI 0.8 to 16.8]. Conclusion Although patient support groups are potentially important adjuncts to home-based self-care, multimorbidity attenuates their effectiveness. There is a need to tailor patient support group interventions to match the needs of the people living with multimorbidity in low- and middle-income settings in Kenya.
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Affiliation(s)
- Peter Otieno
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, NL
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Calistus Wilunda
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Richard E. Sanya
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Samuel Iddi
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Welcome Wami
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, NL
| | | | | | | | | | - Gershim Asiki
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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8
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Hofmann G, Proença M, Degott J, Bonnier G, Lemkaddem A, Lemay M, Schorer R, Christen U, Knebel JF, Schoettker P. A novel smartphone app for blood pressure measurement: a proof-of-concept study against an arterial catheter. J Clin Monit Comput 2023; 37:249-259. [PMID: 35727426 PMCID: PMC9852190 DOI: 10.1007/s10877-022-00886-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Smartphones may provide a highly available access to simplified hypertension screening in environments with limited health care resources. Most studies involving smartphone blood pressure (BP) apps have focused on validation in static conditions without taking into account intraindividual BP variations. We report here the first experimental evidence of smartphone-derived BP estimation compared to an arterial catheter in a highly dynamic context such as induction of general anesthesia. We tested a smartphone app (OptiBP) on 121 patients requiring general anesthesia and invasive BP monitoring. For each patient, ten 1-min segments aligned in time with ten smartphone recordings were extracted from the continuous invasive BP. A total of 1152 recordings from 119 patients were analyzed. After exclusion of 2 subjects and rejection of 565 recordings due to BP estimation not generated by the app, we retained 565 recordings from 109 patients (acceptance rate 51.1%). Concordance rate (CR) and angular CR demonstrated values of more than 90% for systolic (SBP), diastolic (DBP) and mean (MBP) BP. Error grid analysis showed that 98% of measurement pairs were in no- or low-risk zones for SBP and MBP, of which more than 89% in the no-risk zone. Evaluation of accuracy and precision [bias ± standard deviation (95% limits of agreement)] between the app and the invasive BP was 0.0 ± 7.5 mmHg [- 14.9, 14.8], 0.1 ± 2.9 mmHg [- 5.5, 5.7], and 0.1 ± 4.2 mmHg [- 8.3, 8.4] for SBP, DBP and MBP respectively. To the best of our knowledge, this is the first time a smartphone app was compared to an invasive BP reference. Its trending ability was investigated in highly dynamic conditions, demonstrating high concordance and accuracy. Our study could lead the way for mobile devices to leverage the measurement of BP and management of hypertension.
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Affiliation(s)
- G Hofmann
- Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - M Proença
- CSEM, Centre Suisse d'Électronique et de Microtechnique, Neuchâtel, Switzerland
| | - J Degott
- Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Bonnier
- CSEM, Centre Suisse d'Électronique et de Microtechnique, Neuchâtel, Switzerland
| | - A Lemkaddem
- CSEM, Centre Suisse d'Électronique et de Microtechnique, Neuchâtel, Switzerland
| | - M Lemay
- CSEM, Centre Suisse d'Électronique et de Microtechnique, Neuchâtel, Switzerland
| | - R Schorer
- Department of Anesthesiology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - U Christen
- Biospectal SA, 1003, Lausanne, Switzerland
| | - J-F Knebel
- Biospectal SA, 1003, Lausanne, Switzerland
| | - P Schoettker
- Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Gupta A, Nagaraju SP, Bhojaraja MV, Swaminathan SM, Mohan PB. Hypertension in Chronic Kidney Disease: An Update on Diagnosis and Management. South Med J 2023; 116:237-244. [PMID: 36724542 DOI: 10.14423/smj.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertension (HTN) and chronic kidney disease (CKD) are pathophysiologic states that are intimately related, such that long-term HTN can lead to poor kidney function, and renal function decline can lead to worsening blood pressure (BP) control. HTN in CKD is caused by an interplay of factors, including salt and water retention, with extracellular volume expansion, sympathetic nervous system overactivity, renin-angiotensin-aldosterone system activation, and endothelial dysfunction. BP variability in the CKD population is significant, however, and thus requires close monitoring for appropriate management. With accumulating evidence, the diagnosis as well as management of HTN in CKD has been evolving in the last decade. In this comprehensive review based on current evidence and recommendations, we summarize the basics of pathophysiology, BP variability, diagnosis, and management of HTN in CKD with an emphasis on special populations with CKD.
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Affiliation(s)
- Ankur Gupta
- From the Department of Medicine, Whakatane Hospital, Whakatane, New Zealand
| | - Shankar Prasad Nagaraju
- the Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mohan V Bhojaraja
- the Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shilna Muttickal Swaminathan
- the Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pooja Basthi Mohan
- the Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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10
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Gorbunov VM. Position of 24-hour ambulatory blood pressure monitoring in modern practice. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Currently, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is the gold standard for diagnosing hypertension (HTN) and evaluating the effectiveness of antihypertensive therapy. The method provides information about some BP parameters that cannot be obtained in any other way. ABPM is reasonable in any patient with a documented increase in BP, especially if specific BP phenotypes are suspected: white coat HTN and masked HTN. Antihypertensive therapy under the ABPM, on average, is more economical and is not associated with overprescribing of drugs and their combinations. Based on the ABPM data, calculating a number of additional indicators of the 24-hour BP profile is possible, but their scope is still limited to the research field. In the conclusion on ABPM data, the results of office BP measurement and antihypertensive therapy should be indicated.
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Affiliation(s)
- V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
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11
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Xiong X, Lv G, Jiang X, Mansoor H, Lu K. Editorial: Family medicine and primary care: Best practice to achieve health equity for western and traditional Chinese medicine. Front Med (Lausanne) 2023; 9:1125981. [PMID: 36703884 PMCID: PMC9872148 DOI: 10.3389/fmed.2022.1125981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiangxiang Jiang
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Hend Mansoor
- College of Pharmacy, University of Kentucky, Lexington, KY, United States,Hend Mansoor ✉
| | - Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States,*Correspondence: Kevin Lu ✉
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12
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Thupakula S, Nimmala SSR, Ravula H, Chekuri S, Padiya R. Emerging biomarkers for the detection of cardiovascular diseases. Egypt Heart J 2022; 74:77. [PMID: 36264449 PMCID: PMC9584006 DOI: 10.1186/s43044-022-00317-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevalence of cardiovascular disease (CVD) has been continuously increasing, and this trend is projected to continue. CVD is rapidly becoming a significant public health issue. Every year there is a spike in hospital cases of CVD, a critical health concern in lower- and middle-income countries. Based on identification of novel biomarkers, it would be necessary to study and evaluate the diagnostic requirements or CVD to expedite early detection. Main body The literature review was written using a wide range of sources, such as well-known medical journals, electronic databases, manuscripts, texts, and other writings from the university library. After that, we analysed the specific markers of CVD and compiled a systematic review. A growing body of clinical research aims to identify people who are at risk for cardiovascular disease by looking for biomolecules. A small number of biomarkers have been shown to be useful and reliable in medicine. Biomarkers can be used for a variety of clinical applications, such as predicting heart disease risk, diagnosing disease, or predicting outcomes. As a result of the ability for a single molecule to act as a biomarker, its usefulness in medicine is expected to increase significantly. Conclusions Based on assessing the current trends in the application of CVD markers, we discussed and described the requirements for the application of CVD biomarkers in coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other cardiovascular illnesses. Furthermore, the current review focuses on biomarkers for CVD and the procedures that should be considered to establish the comprehensive nature of the expression of biomarkers for cardiovascular illness.
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Affiliation(s)
- Sreenu Thupakula
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Shiva Shankar Reddy Nimmala
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Haritha Ravula
- grid.18048.350000 0000 9951 5557Department of Plant Sciences, University of Hyderabad, Gopanpalle, Hyderabad, Telangana 500019 India
| | - Sudhakar Chekuri
- grid.412419.b0000 0001 1456 3750Department of Genetics, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
| | - Raju Padiya
- grid.412419.b0000 0001 1456 3750Department of Biochemistry, Osmania University, Amberpet, Hyderabad, Telangana 500007 India
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Ihm SH, Park JH, Kim JY, Kim JH, Kim KI, Lee EM, Lee HY, Park S, Shin J, Kim CH. Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum. Clin Hypertens 2022; 28:38. [PMID: 36180964 PMCID: PMC9526300 DOI: 10.1186/s40885-022-00218-1] [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: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Home blood pressure measurement (HBPM) has the advantage of measuring blood pressure (BP) multiple times over a long period. HBPM effectively diagnoses stress-induced transient BP elevations (i.e., white coat hypertension), insufficient BP control throughout the day (i.e., masked hypertension), and even BP variability. In most cases, HBPM may increase self-awareness of BP, increasing the compliance of treatment. Cumulative evidence has reported better improved predictive values of HBPM in cardiovascular morbidity and mortality than office BP monitoring. In this position paper, the Korean Society of Hypertension Home Blood Pressure Forum provides comprehensive information and clinical importance on HBPM.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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14
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Gyamfi J, Cooper C, Barber A, Onakomaiya D, Lee WY, Zanowiak J, Mansu M, Diaz L, Thompson L, Abrams R, Schoenthaler A, Islam N, Ogedegbe G. Needs assessment and planning for a clinic-community-based implementation program for hypertension control among blacks in New York City: a protocol paper. Implement Sci Commun 2022; 3:96. [PMID: 36068611 PMCID: PMC9450294 DOI: 10.1186/s43058-022-00340-z] [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: 07/28/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension (HTN) control among Blacks in the USA has become a major public health challenge. Barriers to HTN control exist at multiple levels including patient, physician, and the health system. Patients also encounter significant community-level barriers, such as poor linkage to social services that impact health (unstable housing, food access, transportation). We describe a multi-component needs assessment to inform the development, implementation, and evaluation of a program to improve HTN management within a large healthcare system in New York City (NYC). METHODS Guided by the Community-Based Participatory Research (CBPR) and Consolidated Framework for Implementation Research (CFIR) frameworks, data will be collected from four main sources: (1) quantitative surveys with health systems leadership, providers, and staff and with community-based organizations (CBOs) and faith-based organizations (FBOs); (2) qualitative interviews and focus groups with health systems leadership, providers, and staff and with CBOs and FBOs; (3) NYC Community Health Survey (CHS); and (4) New York University (NYU) Health system Epic Electronic Health Record (EHR) system. The data sources will allow for triangulation and synthesis of findings. DISCUSSION Findings from this comprehensive needs assessment will inform the development of a clinic-community-based practice facilitation program utilizing three multi-level evidence-based interventions (nurse case management, remote blood pressure (BP) monitoring, and social determinants of health (SDoH) support) integrated as a community-clinic linkage model for improved HTN control in Black patients. Integration of stakeholders' priorities, perspectives, and practices into the development of the program will improve adoption, sustainability, and the potential for scale-up. TRIAL REGISTRATION NCT05208450; registered on January 26, 2022.
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Affiliation(s)
- Joyce Gyamfi
- New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Claire Cooper
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Aigna Barber
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Wen-Yu Lee
- NYU Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer Zanowiak
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Moses Mansu
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA
| | - Laura Diaz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Linda Thompson
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Roger Abrams
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA
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15
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Liu Z, Zhou C, Wang H, He Y. Blood pressure monitoring techniques in the natural state of multi-scenes: A review. Front Med (Lausanne) 2022; 9:851172. [PMID: 36091712 PMCID: PMC9462511 DOI: 10.3389/fmed.2022.851172] [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: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Blood pressure is one of the basic physiological parameters of human physiology. Frequent and repeated measurement of blood pressure along with recording of environmental or other physiological parameters when measuring blood pressure may reveal important cardiovascular risk factors that can predict occurrence of cardiovascular events. Currently, wearable non-invasive blood pressure measurement technology has attracted much research attention. Several different technical routes have been proposed to solve the challenge between portability or continuity of measurement methods and medical level accuracy of measurement results. The accuracy of blood pressure measurement technology based on auscultation and oscillography has been clinically verified, while majority of other technical routes are being explored at laboratory or multi-center clinical demonstration stage. Normally, Blood pressure measurement based on oscillographic method outside the hospital can only be measured at intervals. There is a need to develop techniques for frequent and high-precision blood pressure measurement under natural conditions outside the hospital. In this paper, we discussed the current status of blood pressure measurement technology and development trends of blood pressure measurement technology in different scenarios. We focuses on the key technical challenges and the latest advances in the study of miniaturization devices based on oscillographic method at wrist and PTT related method at finger positions as well as technology processes. This study is of great significance to the application of high frequency blood pressure measurement technology.
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Affiliation(s)
- Ziyi Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Guangdong Transtek Medical Electronics Co., Ltd., Zhongshan, China
| | - Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hongwei Wang
- Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Hongwei Wang,
| | - Yong He
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Yong He,
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16
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Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement. Hypertens Res 2022; 45:1298-1309. [PMID: 35726086 PMCID: PMC9207424 DOI: 10.1038/s41440-022-00965-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders of pregnancy increase the risk of adverse maternal and fetal outcomes. In 2018, the Japanese classification of hypertensive disorders of pregnancy was standardized with those of other countries, and a hypertensive disorder of pregnancy was considered to be present if hypertension existed during pregnancy and up to 12 weeks after delivery. Strategies for the prevention of hypertensive disorders of pregnancy have become much clearer, but further research is needed on appropriate subjects and methods of administration, and these have not been clarified in Japan. Although guidelines for the use of antihypertensive drugs are also being studied and standardized with those of other countries, the use of calcium antagonists before 20 weeks of gestation is still contraindicated in Japan because of the safety concerns that were raised regarding possible fetal anomalies associated with their use at the time of their market launch. Chronic hypertension is now included in the definition of hypertensive disorders of pregnancy, and blood pressure measurement is a fundamental component of the diagnosis of hypertensive disorders of pregnancy. Out-of-office blood pressure measurements, including ambulatory and home blood pressure measurements, are important for pregnant and nonpregnant women. Although conditions such as white-coat hypertension and masked hypertension have been reported, determining their occurrence in pregnancy is complicated by the gestational week. This narrative review focused on recent reports on hypertensive disorders of pregnancy, including those related to blood pressure measurement and classification. ![]()
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Lu Y, Yu Z, Liu J, An Q, Chen C, Li Y, Wang Y. Assessing systemic vascular resistance using arteriolar pulse transit time based on multi-wavelength photoplethysmography. Physiol Meas 2022; 43. [PMID: 35697023 DOI: 10.1088/1361-6579/ac7841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/13/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Sympathetic nerve activity affects blood pressure by contracting the arteriole, which can increase systemic vascular resistance (SVR). Consequently, SVR is a key factor affecting blood pressure. However, a method for measuring SVR continuously is lacking. This paper formulated and experimentally validated a method that uses the arteriolar pulse transmit time (aPTT) to track changes in SVR. APPROACH multi-wavelength photoplethysmogram (PPG), electrocardiogram (ECG), and galvanic skin response (GSR) data were simultaneously gathered using a measurement system designed by this study. Blood perfusion was monitored by Laser Doppler. Least mean square (LMS) is an adaptive filtering algorithm. Our LMS-based algorithm formulated in this study was used to calculate the aPTT from the multi-wavelength PPGs. A cold stimulation experiment was conducted to verify the relationship between aPTT determined by algorithm and arteriole vasodilation. An emotinal stimulation experiment conducted, in which GSR was employed to further verify the relationship between aPTT and SVR. Twenty healthy young participants were asked to watch movie clips, which excited their sympathetic nerves. The dynamic time warping (DTW) distance is applied to evaluate between correlation of GSR and aPTT. MAIN RESULTS The changes in aPTT was extracted using our LMS-based method. During the recovery period after cold stimulation, aPTT decreased with the average slope of -0.19, while blood perfusion increased with the average slope of 0.72. Meanwhile, 70% participants' DTW distance's median between aPTT and GSR were significantly smaller than that between PTT and GSR during emotion stimulation. SIGNIFICANCE Our method uses aPTT, a continuous measurable parameter, to closely reflect SVR, as verified through experiments.
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Affiliation(s)
- Yiqian Lu
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, 518055, CHINA
| | - Zengjie Yu
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, Guangdong, 518055, CHINA
| | - Jikui Liu
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, 518055, CHINA
| | - Qi An
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, 518055, CHINA
| | - Cong Chen
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, 518055, CHINA
| | - Ye Li
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, Guangdong, 518055, CHINA
| | - Yishan Wang
- SIAT, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, P.R.China, Shenzhen, Guangdong, 518055, CHINA
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18
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Utility of Obesity Indicators for Predicting Hypertension among Older Persons in Limpopo Province, South Africa. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In view of the epidemic proportions of obesity in South Africa and its relationship to cardiometabolic diseases, such as hypertension, a cross sectional study was conducted to investigate the utility of obesity indicators for predicting hypertension among older persons (≥60 years, n = 350) in the Limpopo Province of South Africa. The WHO STEPwise approach was used to collect data on demographic and lifestyle factors. Anthropometrics and blood pressure were measured according to the standard procedures. Receiver operating characteristic curves (ROC) were used to investigate and compare the ability of obesity indicators to predict overall hypertension and either increased systolic (SBP) or increased diastolic (DBP) blood pressure. The area under the ROC curve (AUC) was used to assess a certain indicator’s potential to predict overall hypertension and either increased SBP or increased DBP. Multivariate logistic regression analysis was used to determine the relationship of hypertension with obesity indicators. The mean age of the participants was 69 years (±SD = 7), and hypertension (46%), general obesity (36%) and abdominal obesity (57%) were prevalent among older persons. The obesity indicator body mass index (BMI) (AUC = 0.603 (0.52; 0.69)) was the best predictor of hypertension in older men. Waist circumference (WC) (AUC = 0.640 (0.56; 0.72)) and waist-to-height ratio (WHtR) (AUC = 0.605 (0.52; 0.69)) were better predictors of hypertension than BMI and waist-to-hip ratio (WHR) in older women. After adjustment for risk factors, only WC (AOR = 1.22 (1.16; 1.79)) was significantly associated with hypertension in older women, proposing WC as a screening tool for the prediction of hypertension in South African older women.
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19
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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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20
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Diagnostic accuracy of mercurial versus digital blood pressure measurement devices: a systematic review and meta-analysis. Sci Rep 2022; 12:3363. [PMID: 35233077 PMCID: PMC8888622 DOI: 10.1038/s41598-022-07315-z] [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: 09/23/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in published studies. Searches were conducted in PubMed, Cochrane, EBSCO, EMBASE and Google Scholar host databases using the specific search strategy and filters from 1st January 2000 to 3rd April 2021. We included studies reporting data on the sensitivity or specificity of blood pressure measured by digital devices and mercury sphygmomanometer used as the reference standard. Studies conducted among children, special populations, and specific disease groups were excluded. We considered published manuscripts in the English language only. The risk of bias and applicability concerns were assessed based on the author's judgment using the QUADAS2 manual measurement evaluation tool. Based on the screening, four studies were included in the final analysis. Sensitivity, specificity, diagnostic odds ratio (DOR), and 95% confidence interval were estimated. The digital blood pressure monitoring has a moderate level of accuracy and the device can correctly distinguish hypertension with a pooled estimate sensitivity of 65.7% and specificity of 95.9%. After removing one study, which had very low sensitivity and very high specificity, the pooled sensitivity estimate was 79%, and the specificity was 91%. The meta-analysis of DOR suggests that the digital blood pressure monitor had moderate accuracy with a mercury sphygmomanometer. This will provide the clinician and patients with accurate information on blood pressure with which diagnostic and treatment decisions could be made.
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21
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Vincent-Doe A, Sneed R, Jordan T, Key K, Bailey RS, Jefferson BB, Sanders RPE, Brewer A, Scott JB, Calvin K, Summers M, Farmer B, Johnson-Lawrence V. Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2022; 14:10. [PMID: 35734421 PMCID: PMC9207767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned. Methods The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages. Results We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change. Lessons Learned Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts. Discussion Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches. Conclusion Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.
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Affiliation(s)
| | - Rodlescia Sneed
- Division of Public Health, Michigan State University, Flint, MI
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI
| | - Kent Key
- Division of Public Health, Michigan State University, Flint, MI,Community Based Organization Partners, Flint, MI
| | - Rev. Sarah Bailey
- Bridges to the Future, Flint, MI,Community Based Organization Partners, Flint, MI
| | | | | | - Allysoon Brewer
- Division of Public Health, Michigan State University, Flint, MI
| | - Jamil B. Scott
- Division of Public Health, Michigan State University, Flint, MI,National Human Genome Research Institute, National Institute of Health
| | - Kahlil Calvin
- Division of Public Health, Michigan State University, Flint, MI
| | - Monicia Summers
- Division of Public Health, Michigan State University, Flint, MI
| | - Bridget Farmer
- Division of Public Health, Michigan State University, Flint, MI
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22
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Nagaraju SP, Shenoy SV, Rao IR, Bhojaraja MV, Rangaswamy D, Prabhu RA. Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review. Int J Nephrol Renovasc Dis 2022; 15:1-16. [PMID: 35177924 PMCID: PMC8843793 DOI: 10.2147/ijnrd.s343582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is extremely common all over the world and is strongly linked to cardiovascular disease (CVD). The great majority of CKD patients have hypertension, which raises the risk of cardiovascular disease (CVD), end-stage kidney disease, and mortality. Controlling hypertension in patients with CKD is critical in our clinical practice since it slows the course of the disease and lowers the risk of CVD. As a result, accurate blood pressure (BP) monitoring is crucial for CKD diagnosis and therapy. Three important guidelines on BP thresholds and targets for antihypertensive medication therapy have been published in the recent decade emphasizing the way we measure BP. For both office BP and out-of-office BP measuring techniques, their clinical importance in the management of hypertension has been well defined. Although BP measurement is widely disseminated and routinely performed in most clinical settings, it remains unstandardized, and practitioners frequently fail to follow the basic recommendations to avoid measurement errors. This may lead to misdiagnosis and wrong management of hypertension, especially in CKD patients. Here, we review presently available all BP measuring techniques and their use in clinical practice and the recommendations from various guidelines and research gaps emphasizing CKD patients.
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Affiliation(s)
- Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
- Correspondence: Mohan V Bhojaraja, Email
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
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Haynes N, Ezekwesili A, Nunes K, Gumbs E, Haynes M, Swain J. "Can you see my screen?" Addressing Racial and Ethnic Disparities in Telehealth. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:23. [PMID: 34900074 PMCID: PMC8647517 DOI: 10.1007/s12170-021-00685-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
Purpose of Review Telehealth is an innovative approach with great potential to bridge the healthcare delivery gap, especially for underserved communities. While minority populations represent a target audience that could benefit significantly from this modern solution, little of the existing literature speaks to its acceptability, accessibility, and overall effectiveness in underserved populations. Here, we review the various challenges and achievements of contemporary telehealth and explore its impact on care delivery as an alternative or adjunct to traditional healthcare delivery systems. Recent Findings Given the COVID-19 pandemic, there has been a rapid acceleration in telemedicine adoption. Recent studies of telemedicine utilization during the pandemic reveal stark disparities in telemedicine modality use based on race, socioeconomic status, geography, and age. Summary While telehealth has great potential to overcome healthcare obstacles, the digital divide stands as a challenge to equitable telehealth and telemedicine adoption. Achieving health equity in telehealth will require the mobilization of resources, financial incentives, and political will among hospital systems, insurance companies, and government officials.
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Affiliation(s)
- Norrisa Haynes
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA USA
| | - Agnes Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kathryn Nunes
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA
| | - Edvard Gumbs
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA USA
| | | | - JaBaris Swain
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA USA
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24
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Kario K, Hoshide S, Nagai M, Okawara Y, Kanegae H. Sleep and cardiovascular outcomes in relation to nocturnal hypertension: the J-HOP Nocturnal Blood Pressure Study. Hypertens Res 2021; 44:1589-1596. [PMID: 34331030 DOI: 10.1038/s41440-021-00709-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
There is a lack of data on how nighttime blood pressure (BP) might modify the relationship between sleep duration and cardiovascular disease (CVD) risk. Self-reported sleep duration data were available for 2253/2562 patients from the J-HOP Nocturnal BP study; of these, 2236 had complete follow-up data (mean age 63.0 years, 83% using antihypertensive drugs). CVD outcomes included stroke, coronary artery disease (CAD), and atherosclerotic CVD (ASCVD [stroke + CAD]). Associations between sleep duration and nighttime home BP (measured using a validated, automatic, oscillometric device) were determined. During a mean follow-up of 7.1 ± 3.8 years, there were 133 ASCVD events (52 strokes and 81 CAD events). Short sleep duration (<6 versus ≥6 and <9 h/night) was significantly associated with the risk of ASCVD (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.07-3.22), especially stroke (HR 2.47, 95% CI 1.08-5.63). When nighttime systolic BP was <120 mmHg, those with a sleep duration <6 versus ≥6 and <9 h/night had a significantly higher risk of ASCVD and CAD events (HR [95% CI] 3.46 [1.52-7.92] and 3.24 [1.21-8.69], respectively). Even patients with "optimal" sleep duration (≥6 and <9 h/night) were at significantly higher risk of stroke when nighttime systolic BP was uncontrolled (HR [95% CI] 2.76 [1.26-6.04]). Adding sleep duration and nighttime BP to a base model with standard CVD risk factors significantly improved model performance for stroke (C-statistic 0.795, 95% CI 0.737-0.856; p = 0.038). These findings highlight the importance of both optimal sleep duration and control of nocturnal hypertension for reducing the risk of CVD, especially stroke. Clinical Trial registration: URL: http://www.umin.ac.jp/icdr/index.html . Unique identifier: UMIN000000894.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Genki Plaza Medical Center for Health Care, Tokyo, Japan
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Xiao H, Li H, Dong L, Song X, Wu Y, Wei H, Shang W, Tian M, Dong J. Correlation between home systolic blood pressure variability and cognitive impairment in maintenance hemodialysis patients. Semin Dial 2021; 35:129-137. [PMID: 34585445 PMCID: PMC9293001 DOI: 10.1111/sdi.13017] [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: 01/03/2021] [Revised: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
Introduction To investigate the correlation between home blood pressure variability and cognitive function in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD were included. Their home blood pressure on nondialysis days within 1 week was collected. All patients were assessed with the Montreal Cognitive Assessment scale, according to which the patients were divided into cognitive impairment (CI) group and non‐CI group, and the differences between two groups were compared. Results A total of 224 patients were included in the study, of which 168 had CI (75%). Compared with non‐CI group, patients in CI group had larger variability of systolic blood pressure (SBPV) (8.4 [6.7, 10.6]% vs. 6.9 [4.9, 8.8]%, P < 0.001). The smooth fitting curve (OR = 1.2, 95% CI [1.1–1.4], P < 0.001) and trend test (P for trend = 0.004) showed that the risk of CI raised with the increase of SBPV. The patients were further divided into tertiles according to the SBPV. We also found a gradual increase in the proportion of incident CI in the three tertiles. Multiple logistic regression analysis showed that age, shorter years of education, less frequency of hemodialysis, and greater SBPV were the dependent risk of CI. Conclusion In conclusion, greater SBPV indicates higher risk of cognitive impairment in MHD patients.
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Affiliation(s)
- Huihui Xiao
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, China.,Department of internal medicine, Jianghan University, Wuhan, Hubei, China
| | - Hua Li
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohong Song
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yang Wu
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Honglan Wei
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weifeng Shang
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ming Tian
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Junwu Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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26
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Thijs L, Asayama K, Maestre GE, Hansen TW, Buyse L, Wei DM, Melgarejo JD, Brguljan-Hitij J, Cheng HM, de Souza F, Gilis-Malinowska N, Kawecka-Jaszcz K, Mels C, Mokwatsi G, Muxfeldt ES, Narkiewicz K, Odili AN, Rajzer M, Schutte AE, Stolarz-Skrzypek K, Tsai YW, Vanassche T, Vanholder R, Zhang ZY, Verhamme P, Kruger R, Mischak H, Staessen JA. Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial: rational and protocol. Blood Press 2021; 30:269-281. [PMID: 34461803 PMCID: PMC9412130 DOI: 10.1080/08037051.2021.1952061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypertension and diabetes cause chronic kidney disease (CKD) and diastolic left ventricular dysfunction (DVD) as forerunners of disability and death. Home blood pressure telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling prevention. METHODS UPRIGHT-HTM (Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform [NCT04299529]) is an investigator-initiated 5-year clinical trial with patient-centred design, which will randomise 1148 patients to be recruited in Europe, sub-Saharan Africa and South America. During the whole study, HTM data will be collected and freely accessible for patients and caregivers. The UPP, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention), but only at trial closure in 50% (control). The hypothesis is that early knowledge of the UPP risk profile will lead to more rigorous risk factor management and result in benefit. Eligible patients, aged 55-75 years old, are asymptomatic, but have ≥5 CKD- or DVD-related risk factors, preferably including hypertension, type-2 diabetes, or both. The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Demonstrating that combining UPP with HTM is feasible in a multicultural context and defining the molecular signatures of early CKD and DVD are secondary endpoints. EXPECTED OUTCOMES The expected outcome is that application of UPP on top of HTM will be superior to HTM alone in the prevention of CKD and DVD and associated complications and that UPP allows shifting emphasis from treating to preventing disease, thereby empowering patients.
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Affiliation(s)
- Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Gladys E Maestre
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Tine W Hansen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Luk Buyse
- Sports Medicine, Brussels Health Campus, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jana Brguljan-Hitij
- Department of Internal Medicine, Division of Hypertension, University Medical Centre, Ljubljana, Slovenia
| | - Hao-Min Cheng
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Fabio de Souza
- Cardiology Section, Department of Specialized Medicine, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Carina Mels
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Gontse Mokwatsi
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Elisabeth S Muxfeldt
- Department of Internal Medicine, Hypertension Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Augustine N Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Yi-Wen Tsai
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Thomas Vanassche
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.,Department of Nephrology, University Hospital Ghent, Ghent, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruan Kruger
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Narita K, Hoshide S, Kanegae H, Kario K. Seasonal Variation in Masked Nocturnal Hypertension: The J-HOP Nocturnal Blood Pressure Study. Am J Hypertens 2021; 34:609-618. [PMID: 33245326 DOI: 10.1093/ajh/hpaa193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/09/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about seasonal variation in nighttime blood pressure (BP) measured by a home device. In this cross-sectional study, we sought to assess seasonal variation in nighttime home BP using data from the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. METHODS In this study, 2,544 outpatients (mean age 63 years; hypertensives 92%) with cardiovascular risks underwent morning, evening, and nighttime home BP measurements (measured at 2:00, 3:00, and 4:00 am) using validated, automatic, and oscillometric home BP devices. RESULTS Our analysis showed that nighttime home systolic BP (SBP) was higher in summer than in other seasons (summer, 123.3 ± 14.6 mmHg vs. spring, 120.7 ± 14.8 mmHg; autumn, 121.1 ± 14.8 mmHg; winter, 119.3 ± 14.0 mmHg; all P<0.05). Moreover, we assessed seasonal variation in the prevalence of elevated nighttime home SBP (≥120 mmHg) in patients with non-elevated daytime home SBP (average of morning and evening home SBP <135 mmHg; n = 1,565), i.e., masked nocturnal hypertension, which was highest in summer (summer, 45.6% vs. spring, 27.2%; autumn, 28.8%; winter, 24.9%; all P<0.05). Even in intensively controlled morning home SBP (<125 mmHg), the prevalence of masked nocturnal hypertension was higher in summer (summer, 27.4% vs. spring, 14.2%; autumn, 8.9%; winter, 9.0%; all P<0.05). The urine albumin-creatinine ratio in patients with masked nocturnal hypertension tended to be higher than that in patients with non-elevated both daytime and nighttime SBP throughout each season. CONCLUSIONS The prevalence of masked nocturnal hypertension was higher in summer than other seasons and the difference proved to be clinically meaningful.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Department of Cardiovascular Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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28
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Arrieta A, Woods J, Wozniak G, Tsipas S, Rakotz M, Jay S. Return on investment of self-measured blood pressure is associated with its use in preventing false diagnoses, not monitoring hypertension. PLoS One 2021; 16:e0252701. [PMID: 34143817 PMCID: PMC8213192 DOI: 10.1371/journal.pone.0252701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 05/20/2021] [Indexed: 01/14/2023] Open
Abstract
Previous research indicates that patient self-measured blood pressure (SMBP) is a cost-effective strategy for improving hypertension (HTN) diagnosis and control. However, it is unknown which specific uses of SMBP produce the most value. Our goal is to estimate, from an insurance perspective, the return-on-investment (ROI) and net present value associated with coverage of SMBP devices when used (a) only to diagnose HTN, (b) only to select and titrate medication, (c) only to monitor HTN treatment, or (d) as a bundle with all three uses combined. We employed national sample of claims data, Framingham risk predictions, and published sensitivity-specificity values of SMBP and clinic blood-pressure measurement to extend a previously-developed local decision-analytic simulation model. We then used the extended model to determine which uses of SMBP produce the most economic value when scaled to the U.S. adult population. We found that coverage of SMBP devices yielded positive ROIs for insurers in the short-run and at lifetime horizon when the three uses of SMBP were considered together. When each use was evaluated separately, positive returns were seen when SMBP was used for diagnosis or for medication selection and titration. However, returns were negative when SMBP was used exclusively to monitor HTN treatment. When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million false positive HTN diagnoses, thereby improving quality of care while saving insurance plans $254 per member. A strong economic case exists for insurers to cover the cost of SMBP devices, but it matters how devices are used.
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Affiliation(s)
- Alejandro Arrieta
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - John Woods
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stavros Tsipas
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Michael Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, United States of America
| | - Stephen Jay
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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[Practice of home blood pressure monitoring in a population of hypertensive patients in subsaharan Africa]. Ann Cardiol Angeiol (Paris) 2021; 71:1-5. [PMID: 34130806 DOI: 10.1016/j.ancard.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate home blood pressure monitoring (HBPM) practice among treated hypertensive patients in a subsaharan Africa setting. PATIENTS AND METHODS Cross-sectional observational study over a five-month period from April 30 to September 30, 2019. The survey was carried out among treated hypertensive patients aged at least 18-years-old, received in outpatient consultations department at the Abidjan Heart Institute during the study period. We assessed the rate of patients performing HBPM, and compared characteristics and rate of blood pressure control between patients according to the realization of HBPM. RESULTS Three hundred hypertensive patients (mean age 59.2±12.0 years, sex ratio 1.4) were included. Of these, 68.3% reported to have information about HBPM. In 42.3% of cases, patients had an electronic blood pressure device at home, the majority of which were devices with arm cuffs (65.3%). The study showed that 40.3% of the patients had received education on hBPSM, most commonly provided by practitioners (71.9%). Among our population study, 36.3% performed HBPM, of whom only 13.8% according to the 3-day standardised protocol. In multivariate analysis, HBPM appeared to be an independent factor associated with better blood pressure control. CONCLUSION HBPM is rarely used by patients with hypertension in our practice. Most of the patients do not receive education about HBPM and adequate training in order to perform it routinely.
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Hassanein M, Kumwenda MJ, Hemida K, Clark K, Roberts J, Pritchard Jones C, Gandham S, Swidan A, Mallappa H, Hobson P. Structured hypertension education program for people with type 2 diabetes, the SHED study. Diabetes Res Clin Pract 2021; 175:108773. [PMID: 33766695 DOI: 10.1016/j.diabres.2021.108773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES There is enough evidence that patient education and lifestyle modification has shown benefits in diabetes care, however the evidence is less for improving care of hypertension. Our study is the first in the UK to assess the impact of a structured hypertension education program in subjects with type 2 diabetes. DESIGN Prospective randomised controlled study. SETTING AND INTERVENTION From a diabetes clinic in a district and general hospital in UK 132 participants were equally randomised into intervention group and control group. Intervention included a once weekly education session for 4 weeks together with home blood pressure monitoring and dose changes in antihypertensives. Base line data was recorded with follow up after 3 and 6 months. RESULTS More participants achieved target BP in the intervention group versus control. This difference appeared early at the 3rd months (48.8% versus 20.4% respectively, p = 0.007) and remained at the 6th month (58.1% versus 20.4% respectively, p < 0.001). The change in number of pills was significantly lower in the intervention group. The mean increase in antihypertensive pills was 0.22 ± 0.48 (13 ± 30% increase) in the intervention group versus 0.62 ± 0.68 (41 ± 60% increase) in the routine group (p = 0.014), denoting less need to escalate treatment. CONCLUSION We demonstrated that our structured education program has led to a significantly higher percentage of participants achieving the BP target, early after intervention, together with a significant reduction in the number of antihypertensive pills.
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Affiliation(s)
- Mohamed Hassanein
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK; Dubai Hospital Dubai, Dubai, United Arab Emirates
| | | | - Kamel Hemida
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK; Alexandria University, Faculty of Medicine, Medical Department, Alexandria, Egypt
| | - Kirstin Clark
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK.
| | - Julie Roberts
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK.
| | | | - Sri Gandham
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK.
| | - Ahmed Swidan
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK; Alexandria University, Faculty of Medicine, Medical Department, Alexandria, Egypt
| | | | - Peter Hobson
- Glan Clwyd Hospital, Renal and Diabetes, Rhyl, Denbighshire, UK.
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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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Sharma K, Desai HD. Role of Self-Measured Home Blood Pressure Monitoring (HBPM) and Effectiveness of Telemedicine During the Era of COVID-19 Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1071-1073. [PMID: 33718780 PMCID: PMC7943330 DOI: 10.1007/s42399-021-00852-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Kamal Sharma
- grid.414133.00000 0004 1767 9806Department of Cardiology, UN Mehta Institute of Cardiology and Research Center, BJMC, Ahmedabad, India
| | - Hardik D. Desai
- Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, 370001 Gujarat India
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Tomitani N, Hoshide S, Kario K. Self-measured worksite blood pressure and its association with organ damage in working adults: Japan Morning Surge Home Blood Pressure (J-HOP) worksite study. J Clin Hypertens (Greenwich) 2021; 23:53-60. [PMID: 33283972 PMCID: PMC8029969 DOI: 10.1111/jch.14122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 02/01/2023]
Abstract
The effects of elevations in blood pressure (BP) on worksite stress as an out-of-office BP setting have been evaluated using ambulatory BP monitoring but not by self-measurement. Herein, we determined the profile of self-measured worksite BP in working adults and its association with organ damage in comparison with office BP and home BP measured by the same home BP monitoring device. A total of 103 prefectural government employees (age 45.3 ± 9.0 years, 77.7% male) self-measured their worksite BP at four timepoints (before starting work, before and after a lunch break, and before leaving the workplace) and home BP in the morning, evening, and nighttime (at 2, 3, and 4 a.m.) each day for 14 consecutive days. In the total group, the average worksite systolic BP (SBP) was significantly higher than the morning home SBP (129.1 ± 14.3 vs. 124.4 ± 16.4 mmHg, p = .026). No significant difference was observed among the four worksite SBP values. Although the average worksite BP was higher than the morning home BP in the study participants with office BP < 140/90 mmHg (SBP: 121.4 ± 9.4 vs. 115.1 ± 10.4 mmHg, p < .001, DBP: 76.0 ± 7.7 vs. 72.4 ± 8.4 mmHg, p = .013), this association was not observed in those with office BP ≥ 140/90 mmHg or those using antihypertensive medication. Worksite SBP was significantly correlated with the left ventricular mass index evaluated by echocardiography (r = 0.516, p < .0001). The self-measurement of worksite BP would be useful to unveil the risk of hypertension in working adults who show normal office and home BP.
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Affiliation(s)
- Naoko Tomitani
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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Zuo HJ, Ma JX, Wang JW, Chen XR. Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension. BMC Public Health 2020; 20:1770. [PMID: 33228626 PMCID: PMC7686714 DOI: 10.1186/s12889-020-09901-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. Methods Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. Results Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. Conclusion The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09901-0.
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Affiliation(s)
- Hui-Juan Zuo
- Department of community health research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No.2 Road Anzhenli, Chaoyang District, Beijing, 100029, China.
| | - Ji-Xiang Ma
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Jin-Wen Wang
- Department of community health research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No.2 Road Anzhenli, Chaoyang District, Beijing, 100029, China
| | - Xiao-Rong Chen
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
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Agrawal S, Fledderjohann J, Ghosh S. Risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake among older adults in India: Findings from the WHO SAGE data. Glob Public Health 2020; 16:1771-1785. [PMID: 33091324 DOI: 10.1080/17441692.2020.1836246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Visual impairments have a substantial impact on the well-being of older people, but their impact among older adults in low- and middle-income countries is under-researched. We examined risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake in India. Cross-sectional data from the nationally representative WHO SAGE data (2007-2008) for India were analysed. We focused on a sub-sample of 6558 adults aged 50+, applying descriptive statistics and logistic regression. Nearly 1-in-5 respondents self-reported diagnosed cataracts, more than three-fifths (62%; n = 3879) reported cataract symptoms, and over half (51.8%) underwent surgery. Increasing age, self-reported diabetes, arthritis, low visual acuity, and moderate or severe vision problems were factors associated with self-reported diagnosed cataracts. Odds of cataract symptoms were higher with increasing age and among those with self-reported arthritis, depressive symptoms, low visual acuity, and with moderate or severe vision problems. Odds of cataract surgery were also higher with increasing age, self-reported diabetes, depressive symptoms, and among those with low visual acuity. A public health approach of behavioural modification, well-structured national outreach eye care services, and inclusion of local basic eye care services are recommended.
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Affiliation(s)
| | | | - Shreeparna Ghosh
- Immunization Technical Support Unit-Ministry of Health and Family Welfare, John Snow India Private Ltd., New Delhi, India
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A pharmacist intervention for monitoring and treating hypertension using bidirectional texting: PharmText BP. Contemp Clin Trials 2020; 98:106169. [PMID: 33038500 DOI: 10.1016/j.cct.2020.106169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND New approaches are needed to better monitor blood pressure (BP) between physician visits, especially for patients in rural areas or for those who lack transportation. We have developed a custom-built bi-directional texting platform for home BP measurements that can then be managed by clinical pharmacists located remotely. The purpose of this study is to evaluate whether the BP texting approach combined with a pharmacist-based intervention improves BP management and to determine if the approach is cost effective. METHODS This study is a randomized, prospective trial in four primary care offices that serve patients in rural areas. Subjects will receive standardized research BP measurements at baseline, 6 and 12 months. The primary outcome will be differences between the intervention and control group in mean systolic BP at 12 months. Secondary outcomes will include systolic BP at 6 months; diastolic BP at 6 and 12 months, number of medication changes and costs. CONCLUSIONS This study plans to enroll subjects through 2022, follow-up will be completed in 2023 and results will be available in 2024. This study will provide information on whether a combined approach using texting of home BP values and a pharmacist-based telehealth services can improve BP control.
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 982] [Impact Index Per Article: 245.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Koopman RJ, Canfield SM, Belden JL, Wegier P, Shaffer VA, Valentine KD, Jain A, Steege LM, Patil SJ, Popescu M, LeFevre ML. Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs. BMC Med Inform Decis Mak 2020; 20:195. [PMID: 32811489 PMCID: PMC7432548 DOI: 10.1186/s12911-020-01194-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023] Open
Abstract
Background Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness. Methods A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management. Results Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure ‘story’ and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care. Conclusions Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users’ needs, and addressing additional stakeholders’ needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.
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Affiliation(s)
- Richelle J Koopman
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA.
| | - Shannon M Canfield
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Jeffery L Belden
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Pete Wegier
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Akshay Jain
- Department of Electrical & Computer Engineering, University of Missouri-Columbia, Columbia, MO, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Sonal J Patil
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Mihail Popescu
- Department of Health Management & Informatics, University of Missouri-Columbia, Columbia, MO, USA
| | - Michael L LeFevre
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
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Ritchey MD, Wall HK, George MG, Wright JS. US trends in premature heart disease mortality over the past 50 years: Where do we go from here? Trends Cardiovasc Med 2020; 30:364-374. [PMID: 31607635 PMCID: PMC7098848 DOI: 10.1016/j.tcm.2019.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
Despite the premature heart disease mortality rate among adults aged 25-64 decreasing by 70% since 1968, the rate has remained stagnant from 2011 on and, in 2017, still accounted for almost 1-in-5 of all deaths among this age group. Moreover, these overall findings mask important differences and continued disparities observed by demographic characteristics and geography. For example, in 2017, rates were 134% higher among men compared to women and 87% higher among blacks compared to whites, and, while the greatest burden remained in the southeastern US, almost two-thirds of all US counties experienced increasing rates among adults aged 35-64 during 2010-2017. Continued high rates of uncontrolled blood pressure and increasing prevalence of diabetes and obesity pose obstacles for re-establishing a downward trajectory for premature heart disease mortality; however, proven public health and clinical interventions exist that can be used to address these conditions.
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Affiliation(s)
- Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-1, Atlanta, GA 30341, United States.
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-1, Atlanta, GA 30341, United States
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-1, Atlanta, GA 30341, United States
| | - Janet S Wright
- Office of the Surgeon General, US Department of Health and Human Services, 200 Independence Avenue, SW, Suite 701H, Washington, DC 20201, United States
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van den Heuvel JFM, Lely AT, Huisman JJ, Trappenburg JCA, Franx A, Bekker MN. SAFE@HOME: Digital health platform facilitating a new care path for women at increased risk of preeclampsia - A case-control study. Pregnancy Hypertens 2020; 22:30-36. [PMID: 32717653 DOI: 10.1016/j.preghy.2020.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In women at risk of developing preeclampsia, we evaluated the use of a digital health platform for telemonitoring blood pressure and symptoms combined with a minimal antenatal visit schedule. STUDY DESIGN A case-control study for women with chronic hypertension, history of preeclampsia, or maternal cardiac or kidney disease. A care path was designed with reduced visits enhanced with a digital platform (SAFE@HOME) for daily blood pressure and symptom monitoring starting from 16 weeks of gestation. Home-measurements were monitored in-hospital by obstetric professionals, taking actions upon alarming results. This prospective SAFE@HOME group was compared to a retrospective control group managed without self-monitoring. MAIN OUTCOME MEASURES Primary: healthcare consumption (number of antenatal visits, ultrasounds, admissions and diagnostics), user experiences of the platform. Secondary: maternal and perinatal outcomes. RESULTS Baseline characteristics of the SAFE@HOME (n = 103) and control group (n = 133) were comparable. In the SAFE@HOME group, antenatal visits (mean 13.7 vs 16.0, p < 0.001) and ultrasounds (6.3 vs 7.4, p = 0.005) were lower compared to the control group. Admissions for hypertension or suspected preeclampsia were significantly fewer in the SAFE@HOME group (2.9% versus 13.5%, p = 0.004). Telemonitoring participants were highly satisfied using the platform. No differences were observed for maternal and perinatal outcomes. CONCLUSIONS Our care path including blood pressure telemonitoring for women at risk of preeclampsia allows fewer antenatal visits, ultrasounds and hypertension-related admissions. We observed no differences in perinatal outcomes. These results suggest that telemonitoring of blood pressure is feasible in a high-risk pregnant population and has the potential to profoundly change antenatal care.
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Affiliation(s)
- Josephus F M van den Heuvel
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
| | - Jolijn J Huisman
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
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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: 177] [Impact Index Per Article: 44.3] [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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Nocturnal blood pressure measured by home devices: evidence and perspective for clinical application. J Hypertens 2020; 37:905-916. [PMID: 30394982 DOI: 10.1097/hjh.0000000000001987] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Studies using ambulatory blood pressure (BP) monitoring have shown that BP during night-time sleep is a stronger predictor of cardiovascular outcomes than daytime ambulatory or conventional office BP. However, night-time ambulatory BP recordings may interfere with sleep quality because of the device cuff inflation and frequency of measurements. Hence, there is an unmet need for obtaining high quality BP values during sleep. In the last two decades, technological development of home BP devices enabled automated BP measurements during night-time. Preliminary data suggest that nocturnal home BP measurements yield similar BP values and show good agreement in detecting nondippers when compared with ambulatory BP monitoring. Thus, nocturnal home BP measurements might be a reliable and practical alternative to ambulatory BP monitoring to evaluate BP during sleep. As the use of home BP devices is widespread, well accepted by users and has relatively low cost, it may prove to be more feasible and widely available for routine clinical assessment of nocturnal BP. At present, however, data on the prognostic relevance of nocturnal BP measured by home devices, the optimal measurement schedule, and other methodological issues are lacking and await further investigation. This article offers a systematic review of the current evidence on nocturnal home BP, highlights the remaining research questions, and provides preliminary recommendations for application of this novel approach in BP management.
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Kabutoya T, Ohmori T, Fujiwara T, Kario K. Combination therapy with an Xa inhibitor and antihypertensive agent improved anticoagulant activity in patients with nonvalvular atrial fibrillation: the hypertension and atrial fibrillation treated by rivaroxaban for the morning and night with sYnergy with calcium antagonists (HARMONY) study. Clin Exp Hypertens 2020; 42:365-370. [PMID: 31542950 DOI: 10.1080/10641963.2019.1665678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Anticoagulant activity and blood pressure increase in the morning. The aim of this study was to evaluate changes of anticoagulant activity, blood pressure and target organ damage in patients with nonvalvular atrial fibrillation (AF) given combination treatment with Xa inhibitor and antihypertensive agent.Methods: We enrolled 72 patients with nonvalvular AF. Rivaroxaban (10-15 mg) was continuously administered once daily over 8 weeks (study period I). For subjects (n = 50) who exhibited uncontrolled morning hypertension (home systolic blood pressure [SBP]≥125 mmHg) at the end of study period I (at 8 weeks), nifedipine CR (20-40 mg) was added at bedtime, and rivaroxaban administration was continued an additional 8 weeks. We assessed prothrombin fragment 1 + 2 (optimal range: 69-229 pmol/L) and D-dimer (negative D-dimer measurement: <1.0 μg/mL).Results: The percentage of patients with optimal-range prothrombin fragment 1 + 2 was significantly increased at 4 weeks compared to baseline (70.8% vs. 86.1%, p = .033). In period II, office and home morning SBP were reduced at 12 compared to 8 weeks (office SBP: 135.2 ± 15.7 vs. 125.6 ± 18.4mmHg, p < .001; home morning SBP: 133.5 ± 10.5 vs. 119.9 ± 12.1mmHg, p<.001).The percentage of patients with negative D-dimer was increased at 8 weeks compared to baseline (92% vs. 100%, p = .044), and remained at 100% at 16 weeks.Conclusions: Xa inhibitor therapy improved anticoagulant activity, and additional antihypertensive therapy maintained the anticoagulant activity in patients with nonvalvular AF.
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Affiliation(s)
- Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke-shi, Japan
| | - Tsukasa Ohmori
- Department of Biochemistry, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke-shi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke-shi, Japan
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Wang J, Bu P, Chen L, Chen X, Chen Y, Cheng W, Chu S, Cui Z, Dai Q, Feng Y, Jiang X, Jiang Y, Li W, Li Y, Li Y, Lin J, Liu J, Mu J, Peng Y, Song L, Sun N, Wang Y, Xi Y, Xie L, Xue H, Yu J, Yu W, Zhang Y, Zhu Z. 2019 Chinese Hypertension League guidelines on home blood pressure monitoring. J Clin Hypertens (Greenwich) 2020; 22:378-383. [PMID: 31891454 PMCID: PMC8029889 DOI: 10.1111/jch.13779] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
In China, automated blood pressure monitors have been readily available for home use. Home blood pressure monitoring has been indispensable in the management of hypertension. There is therefore a need to establish guidelines for home blood pressure monitoring on the basis of the 2012 consensus document. In this guidelines document, the committee put forward recommendations on the selection and calibration of blood pressure measuring devices, the frequency (times) and duration (days) of blood pressure measurement, and the diagnostic threshold of home blood pressure.
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Affiliation(s)
- Ji‐Guang Wang
- Ruijin HospitalRuijin Hospital NorthThe Shanghai Institute of HypertensionShanghai Jiaotong University School of MedicineShanghaiChina
| | - Pei‐Li Bu
- Qilu HospitalShandong UniversityJinanChina
| | | | - Xin Chen
- Ruijin Hospital NorthShanghai Jiaotong University School of MedicineShanghaiChina
| | | | - Wen‐Li Cheng
- Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Shao‐Li Chu
- Ruijin Hospital NorthShanghai Jiaotong University School of MedicineShanghaiChina
| | | | - Qiu‐Yan Dai
- Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | | | | | | | - Wei‐Hua Li
- First HospitalXiamen UniversityXiamenChina
| | - Yan Li
- The Shanghai Institute of HypertensionShanghaiChina
| | - Yong Li
- Huashan HospitalFudan UniversityShanghaiChina
| | - Jin‐Xiu Lin
- First HospitalFujian Medical UniversityFuzhouChina
| | - Jing Liu
- Renmin HospitalPeking UniversityBeijingChina
| | - Jian‐Jun Mu
- First HospitalXi'an Jiaotong UniversityXi'anChina
| | | | - Lei Song
- Fuwai HospitalChinese Academy of Medical SciencesBeijingChina
| | | | - Yan Wang
- The Shanghai Institute of HypertensionShanghaiChina
| | - Yang Xi
- Renmin HospitalPeking UniversityBeijingChina
| | - Liang‐Di Xie
- First HospitalFujian Medical UniversityFuzhouChina
| | - Hao Xue
- People's Liberation Army General HospitalBeijingChina
| | - Jing Yu
- Second HospitalLanzhou UniversityLanzhouChina
| | - Wei Yu
- Zhejiang HospitalHangzhouChina
| | - Yu‐Qing Zhang
- Fuwai HospitalChinese Academy of Medical SciencesBeijingChina
| | - Zhi‐Ming Zhu
- Daping HospitalArmy Medical UniversityChongqingChina
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Matsumoto C, Tomiyama H, Kimura K, Shiina K, Kamei M, Inagaki H, Chikamori T, Yamshina A. Modulation of blood pressure-lowering effects of dark chocolate according to an insulin sensitivity-randomized crossover study. Hypertens Res 2020; 43:575-578. [DOI: 10.1038/s41440-020-0395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 02/05/2023]
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Day-to-day blood pressure variability is associated with lower cognitive performance among the Japanese community-dwelling oldest-old population: the SONIC study. Hypertens Res 2019; 43:404-411. [PMID: 31853044 DOI: 10.1038/s41440-019-0377-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/10/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Abstract
Although high blood pressure (BP) and BP variability have been reported to be associated with cognitive impairment, few studies have investigated the association between home BP (HBP) and cognitive function in the oldest-old. The aim of this study was to evaluate whether the value of and the day-to-day variability in HBP was associated with cognitive function in a Japanese community-dwelling oldest-old population. Among 111 participants aged 85-87 years, cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). HBP was measured two times every morning for a median of 30 days. The value of and variability in HBP were calculated as the average and coefficient of variation (CV) of the measurements, respectively. The associations of HBP variability with MoCA-J were examined using multiple linear regression models. Of 111 participants, 47.7% were men, and 64.0% were taking medications for hypertension. The mean HBP was 141.9 ± 14.8/72.2 ± 8.4 mmHg, and the mean CV of HBP was 6.7 ± 1.9/6.8 ± 2.4. The mean total MoCA-J score was 22.9 ± 3.5. The MoCA-J score was significantly lower with increasing CVs of both systolic BP (b = -0.36, p = 0.034) and diastolic BP (b = -0.26, p = 0.046) after adjustment for possible confounding factors. The value of HBP was not associated with MoCA-J. In the community-dwelling oldest-old population, higher day-to-day HBP variability, but not the value of HBP, was associated with cognitive impairment. When measuring HBP, attention should be paid not only to the values but also to their variations.
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Kario K, Kanegae H, Tomitani N, Okawara Y, Fujiwara T, Yano Y, Hoshide S. Nighttime Blood Pressure Measured by Home Blood Pressure Monitoring as an Independent Predictor of Cardiovascular Events in General Practice. Hypertension 2019; 73:1240-1248. [PMID: 31006331 PMCID: PMC6510323 DOI: 10.1161/hypertensionaha.118.12740] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We developed an innovative automated home blood pressure (BP) monitoring method that measures BP while asleep repeatedly over several days. Our aim was to assess the predictive ability of nighttime BP obtained using the home BP device for incident cardiovascular disease (CVD) in general practice patients. We used data from the nationwide practice-based J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP Study, which recruited 2545 Japanese with a history of or risk factors for CVD (mean age 63 years; antihypertensive medication use 83%). The associations between nighttime home BPs (measured at 2:00, 3:00, and 4:00 am using validated, automatic, and oscillometric home BP devices) and incident CVD, including coronary disease and stroke events, were assessed with Cox proportional hazards models. The mean±SD office, morning home, and nighttime home systolic BP (SBP)/diastolic BP were 140±15/82±10, 137±15/79±10, and 121±15/70±9 mm Hg, respectively. During a follow-up of 7.1±3.8 years (18,116 person-years), 152 CVD events occurred. A 10-mm Hg increase of nighttime home SBP was associated with an increased risk of CVD events (hazard ratios [95% CIs]: 1.201 [1.046-1.378]), after adjustments for covariates including office and morning home SBPs. The model fit assessed by the change in Goodness-of-Fit was improved when we added nighttime home SBP into the base models including office and morning home SBPs (Δ6.838 [5.6%]; P=0.009). This is among the first and largest nationwide practice-based study demonstrating that nighttime SBP obtained using a home device is a predictor of incident CVD events, independent of in-office and morning in-home SBP measurement. Clinical Trial Registration- URL: http://www.umin.ac.jp/icdr/index.html . Unique identifier: UMIN000000894.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan (K.K., H.K., N.T., T.F., S.H.).,JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
| | - Hiroshi Kanegae
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan (K.K., H.K., N.T., T.F., S.H.).,Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Naoko Tomitani
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan (K.K., H.K., N.T., T.F., S.H.).,JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
| | - Yukie Okawara
- JMU Center of Global Home and Ambulatory BP Analysis (GAP), Tochigi, Japan (Y.O.)
| | - Takeshi Fujiwara
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan (K.K., H.K., N.T., T.F., S.H.).,JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
| | - Yuichiro Yano
- JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
| | - Satoshi Hoshide
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan (K.K., H.K., N.T., T.F., S.H.).,JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
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Affiliation(s)
- Lawrence R Krakoff
- From the Lauder Cardiovascular Center, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e426-e483. [PMID: 30354655 DOI: 10.1161/cir.0000000000000597] [Citation(s) in RCA: 360] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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50
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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