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Bersch-Ferreira AC, Machado RHV, de Oliveira JS, Santos RHN, da Silva LR, Mota LGS, Pagano R, Sady ERR, Miyada DHK, Valeis N, Martins PN, de Almeida JC, Marchioni DML, Lara EMS, Gherardi-Donato ECS, Quinhoneiro D, Carvalho APPF, Machado MMA, Gedda LPF, Ferro CMB, Carvalho ACMS, Feoli AMP, Walker MS, Pinto SL, Silva KC, Bruscato NM, Moriguchi EH, Penafort AM, Santiago RA, Osório DRD, Rower HB, Barbosa MR, da Silva JGST, Weber B, Cavalcanti AB, Marcadenti A. Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial. J Hypertens 2024; 42:1173-1183. [PMID: 38690885 DOI: 10.1097/hjh.0000000000003703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.
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Affiliation(s)
- Angela C Bersch-Ferreira
- Hcor Teaching Institute, São Paulo
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | | | | | | | | | - Raira Pagano
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | | | | | - Pedro N Martins
- School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora
| | - Jussara C de Almeida
- Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Division of Nutrition and Dietetics, Hospital de Clínicas de Porto Alegre, Porto Alegre
| | - Dirce M L Marchioni
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo
| | | | | | - Driele Quinhoneiro
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto
| | - Ana Paula P F Carvalho
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Malaine M A Machado
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Lana P F Gedda
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Camila M B Ferro
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Ana Clara M S Carvalho
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Ana Maria P Feoli
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre
| | - Marthina S Walker
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre
| | - Sônia L Pinto
- Nutrition Course, Universidade Federal do Tocantins, Palmas
| | - Kellen C Silva
- Nutrition Course, Universidade Federal do Tocantins, Palmas
| | | | - Emilio H Moriguchi
- Instituto Moriguchi, Veranópolis
- Internal Medicine Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | | | | - Denise R D Osório
- Multiprofessional Outpatient Systemic Arterial Hypertension, Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre
| | - Helena B Rower
- Multiprofessional Outpatient Systemic Arterial Hypertension, Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre
| | - Marina R Barbosa
- Nutrition Course, School of Medicine, Universidade Federal de Uberlândia, Uberlândia
| | | | - Bernardete Weber
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | - Aline Marcadenti
- Hcor Research Institute, São Paulo
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
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Pemau RC, González-Palacios P, Kerr KW. How quality of life is measured in studies of nutritional intervention: a systematic review. Health Qual Life Outcomes 2024; 22:9. [PMID: 38267976 PMCID: PMC10809546 DOI: 10.1186/s12955-024-02229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases. METHODS We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion. RESULTS Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America. CONCLUSIONS Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.
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Affiliation(s)
| | - Patricia González-Palacios
- Department of Nutrition and Food Science, University of Granada, Granada, Spain
- Biomedical Research Institute (IBS), Granada, Spain
| | - Kirk W Kerr
- Abbott Nutrition, 2900 Easton Square Place, Columbus, OH, 43219, USA.
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Abrahamowicz AA, Ebinger J, Whelton SP, Commodore-Mensah Y, Yang E. Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control. Curr Cardiol Rep 2023; 25:17-27. [PMID: 36622491 PMCID: PMC9838393 DOI: 10.1007/s11886-022-01826-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To characterize the barriers and opportunities associated with racial and ethnic disparities in blood pressure (BP) control. RECENT FINDINGS Blood pressure (BP) control rates in the USA have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups, with non-Hispanic (NH) Black persons having 10% lower control rates compared to NH White counterparts. Many factors contribute to BP control including key social determinants of health (SDoH) such as health literacy, socioeconomic status, and access to healthcare as well as low awareness rates and dietary habits. Numerous pharmacologic and non-pharmacologic interventions have been developed to reduce racial and ethnic disparities in BP control. Among these, dietary programs designed to help reduce salt intake, faith-based interventions, and community-based programs have found success in achieving better BP control among people from racial and ethnic minority groups. Disparities in the prevalence and management of hypertension persist and remain high, particularly among racial and ethnic minority populations. Ongoing efforts are needed to address SDoH along with the unique genetic, social, economic, and cultural diversity within these groups that contribute to ongoing BP management inequalities.
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Affiliation(s)
| | - Joseph Ebinger
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Eugene Yang
- Division of Cardiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356005, Seattle, WA, 98195, USA.
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Cacari Stone L, Sanchez V, Bruna SP, Muhammad M, Zamora Mph C. Social Ecology of Hypertension Management Among Latinos Living in the U.S.-Mexico Border Region. Health Promot Pract 2021; 23:650-661. [PMID: 33709805 DOI: 10.1177/1524839921993044] [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: 11/15/2022]
Abstract
INTRODUCTION While a growing body of research examines individual factors affecting the prevalence and management of hypertension among Latinos, less is known about how socioecological factors operate to determine health and affect implementation of interventions in rural communities. METHOD We conducted eight focus groups to assess perceived risks and protective factors associated with managing hypertension among Latino adults and their family members living in two rural/frontier counties in the U.S.-Mexico border region. This analysis is part of a larger study, Corazon por la Vida (Heart for Life), which involved multiple data collection strategies to evaluate the effectiveness of a primary care and a promotora de salud intervention to manage hypertension. RESULTS Of the 49 focus group participants, 70% were female and 30% were male, 39% were Spanish-only speakers, and 84% had hypertension. Participants' ages ranged between 18 and 75 years, and 63% reported annual incomes below $30,000. Drawing from a social-ecological framework to analyze focus group data, four major themes and subthemes emerged as factors facilitating or inhibiting disease management: (1) individual (emotional burdens, coping mechanisms), (2) social relationships (family as a source of support, family as a source of stress), (3) health system (trust/mistrust, patient-provider communication), and (4) environment (lack of access to safe exercise environment, lack of affordable food). CONCLUSION Our findings are relevant to public health practitioners, researchers, and policymakers seeking to shift from individual level or single interventions aimed at improving treatment-modality adherence to multilevel or multiple interventions for rural Latino communities.
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Langabeer JR, Henry TD, Perez Aldana C, DeLuna L, Silva N, Champagne-Langabeer T. Effects of a Community Population Health Initiative on Blood Pressure Control in Latinos. J Am Heart Assoc 2018; 7:e010282. [PMID: 30608203 PMCID: PMC6404212 DOI: 10.1161/jaha.118.010282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertension remains one of the most important, modifiable cardiovascular risk factors. Yet, the largest minority ethnic group (Hispanics/Latinos) often have different health outcomes and behavior, making hypertension management more difficult. We explored the effects of an American Heart Association–sponsored population health intervention aimed at modifying behavior of Latinos living in Texas. Methods and Results We enrolled 8071 patients, and 5714 (65.7%) completed the 90‐day program (58.5 years ±11.7; 59% female) from July 2016 to June 2018. Navigators identified patients with risk factors; initial and final blood pressure (BP) readings were performed in the physician's office; and interim home measurements were recorded telephonically. The intervention incorporated home BP monitoring, fitness and nutritional counseling, and regular follow‐up. Primary outcomes were change in systolic BP and health‐related quality of life. Using a univariate paired‐samples pre–post design, we found an average 5.5% (7.6‐mm Hg) improvement in systolic BP (139.1 versus 131.5, t=10.32, P<0.001). Quality of life measured by the European quality of life 5‐dimension visual analog scale improved from 0.79 to 0.82 (t=31.03, P<0.001). After multivariate regression analyses, improvements in quality of life and overall body mass index were significantly associated with reductions in systolic BP. Conclusions A noninvasive, population health initiative that encourages routine engagement in patients’ own BP control was associated with improvements in systolic BP and quality of life for this largely Latino community.
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Affiliation(s)
- James R Langabeer
- 1 School of Biomedical Informatics The University of Texas Health Science Center Houston TX
| | - Timothy D Henry
- 2 Division of Cardiology Cedar-Sinai Smidt Heart Institute Los Angeles CA
| | - Carlos Perez Aldana
- 1 School of Biomedical Informatics The University of Texas Health Science Center Houston TX
| | - Larissa DeLuna
- 3 SouthWest Affiliate American Heart Association San Antonio TX
| | - Nora Silva
- 3 SouthWest Affiliate American Heart Association San Antonio TX
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