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Del Pinto R, Agabiti Rosei C, Borghi C, Cipollini F, Cottone S, De Giorgi GA, Di Guardo A, Dugnani M, Fabris B, Giannattasio C, Giacchetti G, Minuz P, Mulè G, Nazzaro P, Parati G, Rattazzi M, Saladini F, Salvetti M, Sarzani R, Savoia C, Tocci G, Veglio F, Volpe M, Vulpis V, Baldini G, Ferri C, Muiesan ML. May Measure Month 2022 in Italy: A Focus on Fixed-dose Combination, Therapeutic Adherence, and Medical Inertia in a Nationwide Survey. High Blood Press Cardiovasc Prev 2024; 31:309-320. [PMID: 38825650 PMCID: PMC11161440 DOI: 10.1007/s40292-024-00642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/04/2024] [Indexed: 06/04/2024] Open
Abstract
INTRODUCTION Hypertension is the main risk factor for cardiovascular diseases (CVD). Notably, only about half of hypertensive patients manage to achieve the recommended blood pressure (BP) control. Main reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients' side, and therapeutic inertia on physicians' side. METHODS During the global BP screening campaign "May Measure Month" (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults ≥ 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures. RESULTS A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About half of participants were sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension. Most were not on a fixed-dose combination of antihypertensive drugs and did not regularly measure BP at home. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%). CONCLUSIONS This survey identified a remarkable degree of therapeutic inertia and poor patients' involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to identify areas of unsatisfactory management of hypertension, to increase risk factors' awareness in the population with the final purpose of reducing cardiovascular risk.
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Affiliation(s)
- Rita Del Pinto
- Department of Life, Health and Environmental Sciences, Internal Medicine unit, ESH Excellence Center, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Claudio Borghi
- ESH Excellence Center, Sant'Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Franco Cipollini
- San Jacopo Hospital, PIOT San Marcello Pistoiese, Pistoia, Italy
| | - Santina Cottone
- ESH Excellence Center, P. Giaccone Hospital, University of Palermo, Palermo, Italy
| | | | | | | | - Bruno Fabris
- Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Cristina Giannattasio
- ESH Excellence Center, Niguarda Hospital, University of Milano-Bicocca, Milan, Italy
| | | | - Pietro Minuz
- ESH Excellence Center, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - Giuseppe Mulè
- ESH Excellence Center, P. Giaccone Hospital, University of Palermo, Palermo, Italy
| | - Pietro Nazzaro
- Hypertension clinic A.M.Pirrelli, University of Bari, Bari, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Istituto Auxologico Italiano, IRCCS, St. Luke Hospital, Milan, Italy
| | - Marcello Rattazzi
- Hypertension clinic, Cà Foncello Hospital, University of Padua, Treviso, Italy
| | | | - Massimo Salvetti
- Department of Medical and Surgical Sciences, Spedali Civili, University of Brescia, Brescia, Italy
| | - Riccardo Sarzani
- ESH Excellence Center, IRCCS-INRCA, Università Politecnica delle Marche, Ancona, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine Department, Sapienza University, Rome, Italy
| | - Giuliano Tocci
- Clinical and Molecular Medicine Department, Sapienza University, Rome, Italy
| | - Franco Veglio
- Department Medical Sciences, ESH Excellence Center, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vito Vulpis
- Emergency Medicine, Hypertension and Cardiovascular Risk Unit-Policlinico Hospital, Bari, Italy
| | - Gianluca Baldini
- Department of Life, Health and Environmental Sciences, Internal Medicine unit, ESH Excellence Center, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, Internal Medicine unit, ESH Excellence Center, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
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Liu X, Slone SE, Chen Y, Yeboah-Kordieh Y, Alharthi A, Amihere J, Moyo-Songonuga S, Lane T, Ostchega Y, Brady TM, Himmelfarb CR, Commodore-Mensah Y. Blood Pressure Measurements Obtained by Community-Dwelling Adults Are Similar to Nurse-Obtained Measurements: The SMART-BP Validate Study. Am J Hypertens 2024; 37:334-341. [PMID: 38219026 DOI: 10.1093/ajh/hpae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. METHODS This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. RESULTS We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n = 51) had a home BP monitor. Overall, there were no significant differences between nurse- and participant-obtained systolic BP (mean difference [MD]: -1.1; standard deviation [SD]: 8.0; P = 0.178) or diastolic BP (MD: -0.9; SD: 5.5; P = 0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD: -2.9; SD: 4.5; P = 0.010). All participants demonstrated satisfactory SMBP skills after the training. CONCLUSIONS Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making.
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Affiliation(s)
- Xiaoyue Liu
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | - Sarah E Slone
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | - Abeer Alharthi
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | | | - Tynetta Lane
- Johns Hopkins University School of Nursing, Baltimore, U.S
| | | | - Tammy M Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, U.S
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, U.S
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, U.S
- Johns Hopkins University School of Medicine, Baltimore, U.S
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, U.S
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, U.S
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Myers O, Markossian T, Probst B, Hiura G, Habicht K, Egan B, Kramer H. Age and sex disparities in blood pressure control and therapeutic inertia: Impact of a quality improvement program. Am J Prev Cardiol 2024; 17:100632. [PMID: 38313770 PMCID: PMC10835122 DOI: 10.1016/j.ajpc.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Objective Hypertension quality improvement programs reduce uncontrolled blood pressure (BP) but impact may differ by sex and age. Methods This study examined uncontrolled BP, defined as a BP ≥ 140/90 mmHg, and therapeutic inertia, defined as absence of medication initiation or escalation during visits with uncontrolled BP, by sex and by age group (19-40, 41-65, 66-75, and 76+ years) during a 12 month follow-up period among 21, 861 patients with hypertension and ≥ two visits in primary care clinics enrolled in the American Medical Association (AMA) Measure Accurately, Act Rapidly, and Partner with Patients (MAP) BP hypertension quality improvement program. Results The mean age was 64.8 years (standard deviation [SD 12.8]) and ranged from 19 to 87 years; 53.6% were female. In age groups 19-40, 41-65, 66-75, 76-87 years, uncontrolled BP at the first clinic visit was present in 51.5%, 42.5%, 37.5% and 36.6% of males, respectively, and in 40.0%, 38.0%, 36.0% and 39.6% of females, respectively. Based on vital signs at the first vs. last clinic visit, the proportion of patients with uncontrolled BP in age groups 19-40, 41-65, 66-75 years declined by 19.4%, 13.5%, 10.1% and 8.7% in males, respectively, and 14.4%, 12.5%, 9.3%, and 8.4%, among females, respectively. Therapeutic inertia ranged from 66.5% and 75.9% of clinic visits among males and females age 19-40 years, to 85.6% and 84.9% of clinic visits among males and females age 76-87 years, respectively. The proportion of clinic visits with therapeutic inertia was lower among males vs. females across all age groups until age 76-87 years. Conclusion A quality improvement program improves BP control but declines in uncontrolled BP are larger and therapeutic inertia is lower for younger vs. older age groups and for males vs. females. More interventions are needed to reduce sex and age disparities in hypertension management.
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Affiliation(s)
- Olivia Myers
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Talar Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | - Beatrice Probst
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, United States
| | - Grant Hiura
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
| | | | - Brent Egan
- Improving Health Outcomes, American Medical Association, Greenville, SC, United States
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, United States
- Department of Medicine, Loyola University Chicago and Loyola University Medical Center, Maywood, IL, United States
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Molina de Salazar DI, Coca A, Alcocer L, Piskorz D. The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review. Am J Cardiovasc Drugs 2024; 24:197-209. [PMID: 38489104 PMCID: PMC10972912 DOI: 10.1007/s40256-024-00634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/17/2024]
Abstract
Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP > 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.
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Affiliation(s)
| | - Antonio Coca
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Luis Alcocer
- Mexican Institute of Cardiovascular Health, Mexico City, Mexico
| | - Daniel Piskorz
- Cardiovascular Research Center and Cardiology Institute, Rosario British Sanatorium, Rosario, Argentina
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Creegan D, McEvoy JW. Selected highlights in the updated treatment of hypertension. Trends Cardiovasc Med 2023:S1050-1738(23)00097-X. [PMID: 37981201 DOI: 10.1016/j.tcm.2023.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/30/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
Hypertension remains the leading international risk factor for cardiovascular disease and premature death but, despite effective treatments, hypertension remains significantly underdiagnosed and undertreated. In the present review paper, we provide a selected update on recent developments of interest in the management of hypertension. We focus on summarizing four topics that we believe are worth highlighting to a clinical audience: (1) the evidence and strong motivation for new lower systolic BP treatment targets; (2) new studies reporting on the efficacy of renal denervation in the management of hypertension; (3) interesting new data to inform the great salt debate; and (4), perhaps most importantly, pioneering new work highlighting the huge potential of multi-disciplinary care in the management of hypertension.
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Affiliation(s)
- Daniel Creegan
- University Hospital Galway and SAOLTA University Health Care Group, Galway, Ireland; School of Medicine, University of Galway, Ireland
| | - John W McEvoy
- University Hospital Galway and SAOLTA University Health Care Group, Galway, Ireland; School of Medicine, University of Galway, Ireland; National Institute for Prevention and Cardiovascular Health, Moyola Lane, Galway, H91 FF68, Ireland; Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA.
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Reyes KRL, Rader F. Long-Term Safety and Antihypertensive Effects of Renal Denervation: Current Insights. Integr Blood Press Control 2023; 16:59-70. [PMID: 37701066 PMCID: PMC10494925 DOI: 10.2147/ibpc.s392410] [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: 06/14/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023] Open
Abstract
Hypertension is the most potent modifiable risk factor for the development of cardiovascular morbidity and mortality worldwide. Nevertheless, blood pressure (BP) control on a broad scale appears to be insurmountable and has even worsened in the US. Barriers to sustained hypertension control are multifactorial and although lack of patient awareness and socioeconomic barriers to healthcare access may play a role, medication non-compliance and therapeutic inertia are major causes. Renal denervation (RDN) is a minimally invasive procedure that has been the subject of interest in clinical trials for more than a decade and although the first sham-controlled trial could not detect group difference between treated and untreated hypertensives, subsequent, better designed sham-controlled trials clearly demonstrated the BP lowering effect of RDN, as well as its safety. While to-date, RDN is not available for routine clinical practice, one major requirement for broad implementation is that the BP lowering effect is durable. Therefore, this review will summarize the available long-term data of the different RDN modalities with respect to both effectiveness and safety.
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Affiliation(s)
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Keehn L, Hall WL, Berry SE, Sanders TA, Chowienczyk P, Floyd CN. Reproducibility of sequential ambulatory blood pressure and pulse wave velocity measurements in normotensive and hypertensive individuals. J Hypertens 2022; 40:2528-2537. [PMID: 36204998 PMCID: PMC9640295 DOI: 10.1097/hjh.0000000000003290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Errors in blood pressure (BP) measurement account for a large proportion of misclassified hypertension diagnoses. Ambulatory blood pressure monitoring (ABPM) is often considered to be the gold standard for measurement of BP, but uncertainty remains regarding the degree of measurement error. The aim of this study was to determine reproducibility of sequential ABPM in a population of normotensive and well controlled hypertensive individuals. METHODS Individual participant data from three randomized controlled trials, which had recorded ABPM and carotid-femoral pulse wave velocity (PWV) at least twice were combined ( n = 501). We calculated within-individual variability of daytime and night-time BP and compared the variability between normotensive ( n = 324) and hypertensive ( n = 177) individuals. As a secondary analysis, variability of PWV measurements was also calculated, and multivariable linear regression was used to assess characteristics associated with blood pressure variability (BPV). RESULTS Within-individual coefficient of variation (CoV) for systolic BP was 5.4% (day) and 7.0% (night). Equivalent values for diastolic BP were 6.1% and 8.4%, respectively. No statistically significant difference in CoV was demonstrated between measurements for normotensive and hypertensive individuals. Within-individual CoV for PWV exceeded that of BP measurements (10.7%). BPV was associated with mean pressures, and BMI for night-time measurements. PWV was not independently associated with BPV. CONCLUSION The variability of single ABPM measurements will still yield considerable uncertainty regarding true average pressures, potentially resulting in misclassification of hypertensive status and incorrect treatment regimes. Repeated ABPM may be necessary to refine antihypertensive therapy.
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Affiliation(s)
- Louise Keehn
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas’ Hospital
| | - Wendy L. Hall
- Department of Nutritional Sciences, Franklin-Wilkins Building, King's College London, London, UK
| | - Sarah E. Berry
- Department of Nutritional Sciences, Franklin-Wilkins Building, King's College London, London, UK
| | - Thomas A.B. Sanders
- Department of Nutritional Sciences, Franklin-Wilkins Building, King's College London, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas’ Hospital
| | - Christopher N. Floyd
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas’ Hospital
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Rader F, Kirtane AJ, Wang Y, Daemen J, Lurz P, Sayer J, Saxena M, Levy T, Scicli AP, Thackeray L, Azizi M, Weber MA. Durability of blood pressure reduction after ultrasound renal denervation: three-year follow-up of the treatment arm of the randomised RADIANCE-HTN SOLO trial. EUROINTERVENTION 2022; 18:e677-e685. [PMID: 35913759 PMCID: PMC10241283 DOI: 10.4244/eij-d-22-00305] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 08/16/2023]
Abstract
BACKGROUND While the blood pressure (BP)-lowering effect of renal denervation (RDN) has been established, long-term durability is a key prerequisite for a broader clinical implementation. AIMS Our aims were to assess the long-term durability of the office BP (OBP)-lowering efficacy, antihypertensive medication (AHM) use, and safety of ultrasound RDN (uRDN). METHODS Four weeks after withdrawal of AHM, patients with untreated daytime ambulatory BP ≥135/85 mmHg and <170/105 mmHg were randomised to uRDN (n=74) or sham (n=72) in the RADIANCE-HTN SOLO trial. Initiation of AHM was encouraged for home BP >135/85 mmHg following primary endpoint ascertainment at 2 months. Patients and physicians were unblinded at 6 months. Results: Fifty-one of 74 patients (age: 53.9±11 years; 67% men) originally randomised to uRDN completed the 36-month follow-up. Initial screening OBP upon study entry was 145/92±14/10 mmHg on a mean of 1.2 AHM (range: 0-2.0). Baseline OBP after AHM washout was 154/99±13/8 mmHg. At 36 months, patients were on an average of 1.3 AHM (range: 0-3.0) with 8 patients on no AHM. OBP decreased by 18/11±15/9 mmHg from baseline to 36 months (p<0.001 for both). Overall, OBP control (<140/90 mmHg) improved from 29.4% at screening to 45.1% at 36 months (p=0.059). For patients uncontrolled at screening (n=36), systolic OBP decreased by 10.8 mmHg (p<0.001) at 36 months on similar AHM (p=0.158). CONCLUSIONS The safety and effectiveness of uRDN was durable to 36 months, with reduced OBP and improved OBP control despite a similar starting medication burden. No new uRDN-related long-term safety concerns were identified.
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Affiliation(s)
- Florian Rader
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Terry Levy
- Royal Bournemouth Hospital, Bournemouth, UK
| | | | | | - Michel Azizi
- Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France; INSERM, CIC1418, Paris, France
| | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
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Sánchez Peinador C, Torras Borrell J, Castillo Moraga MJ, Egocheaga Cabello MI, Rodríguez Villalón X, Turégano Yedro M, Gamarra Ortiz J, Domínguez Sardiña M, Pallarés Carratalá V. [Optimizing blood pressure control through telemedicine in Primary Care in Spain (Iniciativa Óptima): Results from a Delphi study]. Aten Primaria 2022; 54:102353. [PMID: 35588550 PMCID: PMC9119825 DOI: 10.1016/j.aprim.2022.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo Representantes de los grupos de trabajo de hipertensión o enfermedad cardiovascular de las Sociedades Españolas de Médicos de Atención Primaria (MAP) [SEMERGEN], de Medicina Familiar y Comunitaria [semFYC] y de Médicos Generales y de Familia [SEMG] realizaron un estudio Delphi para validar con un panel de MAP expertos en hipertensión una propuesta de recomendaciones para optimizar la teleconsulta en pacientes hipertensos. Materiales y métodos Estudio Delphi basado en un cuestionario online con 59 recomendaciones, elaborado en base a la bibliografía relacionada disponible y a la experiencia clínica aportada por los autores. Resultados Un total de 118 MAP participaron en dos rondas del cuestionario (98,3% de los invitados), alcanzándose el consenso en 53/62 sentencias (85%). El equipo de Atención Primaria debe seleccionar a los pacientes hipertensos candidatos a realizar la consulta telemática proactivamente, informando de la cita con antelación. Al iniciar la consulta telemática, se recomienda explicar el motivo y los objetivos de la misma, y realizar la anamnesis preguntando por signos y síntomas de empeoramiento de la enfermedad, tratamientos actuales y adherencia a los mismos. En pacientes con una automedida de la presión arterial (AMPA) ≤ 135/85 mmHg se recomienda pautar una nueva cita telemática en 3-6 meses. Por el contrario, en pacientes asintomáticos que reporten una AMPA ≥ 135/85 mmHg se recomienda la monitorización ambulatoria de la presión arterial, modificar el tratamiento, o derivar al paciente a visita presencial o al hospital en caso de signos o síntomas de alarma. Conclusiones La teleconsulta puede complementar la consulta presencial, constituyendo un elemento más a tener en cuenta para el adecuado control de los pacientes hipertensos.
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Affiliation(s)
- Carmen Sánchez Peinador
- Centro de Salud Cantalejo, Cantalejo, Segovia, España; Grupo de Trabajo de ECV de SEMG, España
| | - Joan Torras Borrell
- CAP Sant Llàtzer, Terrassa, Barcelona, España; Coordinador del grupo de HTA de la Societat Catalana de Medicina Familiar i Comunitària, CAMFIC, España; Grupo de Trabajo de HTA de SEMFYC, España.
| | - María José Castillo Moraga
- Centro de Salud Sanlúcar Barrio Bajo, Sanlúcar de Barrameda, Cádiz, España; Grupo de Trabajo de HTA y ECV de SEMERGEN, España
| | | | | | - Miguel Turégano Yedro
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Centro de Salud Aldea Moret, Cáceres, España
| | - Javier Gamarra Ortiz
- Grupo de Trabajo de ECV de SEMG, España; CS Medina Rural, Medina del Campo, Valladolid, España
| | | | - Vicente Pallarés Carratalá
- Grupo de Trabajo de HTA y ECV de SEMERGEN, España; Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
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Latest hypertension research to inform clinical practice in Asia. Hypertens Res 2022; 45:555-572. [DOI: 10.1038/s41440-022-00874-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
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Dixon DL, Baker WL, Buckley LF, Salgado TM, Van Tassell BW, Carter BL. Effect of a Physician/Pharmacist Collaborative Care Model on Time in Target Range for Systolic Blood Pressure: Post Hoc Analysis of the CAPTION Trial. Hypertension 2021; 78:966-972. [PMID: 34397278 PMCID: PMC8415522 DOI: 10.1161/hypertensionaha.121.17873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text. Longer time in target range (TTR) for systolic blood pressure (SBP) is associated with a lower risk of cardiovascular events. Team-based care improves SBP control but its effect on the consistency of SBP control over time is unknown. This post hoc analysis used data from a cluster-randomized trial of a physician/pharmacist collaborative model that randomized medical offices to either a 9- or 24-month pharmacist intervention or control group. TTR for SBP was calculated using linear interpolation and an SBP range of 110 to 130 mm Hg. TTR is reported as median values and group comparisons assessed using the Kruskal-Wallis test. Of the 625 participants enrolled, 524 had 9-month and 366 had 24-month SBP data. Participants were a median 59 years old, 59% female, and 52% minority. After 24 months, the median TTR for SBP was 31.9% and 29.8% for the 9- and 24-month intervention groups, respectively, compared with 19% in the control group (P=0.0068). This observation persisted in the subgroup of participants with diabetes or chronic kidney disease and minorities. A longer TTR was not associated with an increased risk of adverse drug events. Time to first observed SBP in the target range was shorter in the intervention group compared with control (270 versus 365 days; P=0.0047). A physician/pharmacist collaborative care model achieved longer TTR for SBP compared with control (usual care).
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Affiliation(s)
- Dave L Dixon
- Center for Pharmacy Practice Innovation (D.L.D., T.M.S.), Virginia Commonwealth University School of Pharmacy, Richmond, VA.,Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - William L Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT (W.L.B.)
| | - Leo F Buckley
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA (L.F.B.)
| | - Teresa M Salgado
- Center for Pharmacy Practice Innovation (D.L.D., T.M.S.), Virginia Commonwealth University School of Pharmacy, Richmond, VA.,Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA (B.L.C.)
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