Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

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GW28-e0459 Uric acid levels affect blood pressure control in elderly patients with hypertension: a retrospective cohort study with 3.9-year follow-up

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.07.496 ◽

2017 ◽

Vol 70 (16) ◽

pp. C137-C138

Author(s):

Mingyao Sun ◽

Fan Lin ◽

Pengli Zhu

Keyword(s):

Blood Pressure ◽

Uric Acid ◽

Cohort Study ◽

Elderly Patients ◽

Blood Pressure Control ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pressure Control

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Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia

BMJ Open ◽

10.1136/bmjopen-2016-015743 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015743 ◽

Cited By ~ 4

Author(s):

Derbew Fikadu Berhe ◽

Katja Taxis ◽

Flora M Haaijer-Ruskamp ◽

Afework Mulugeta ◽

Yewondwossen Tadesse Mengistu ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pressure Control ◽

Public Hospitals ◽

Multivariable Logistic Regression Analysis ◽

Treatment Intensification ◽

Treatment Regimens ◽

Ambulatory Patients

ObjectivesWe examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP).DesignA retrospective cohort study in six public hospitals, Ethiopia.ParticipantsAdult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital.OutcomeControlled BP (<140/90 mm Hg) and treatment intensification of patients with uncontrolled BP.ResultsThe study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant—positive—determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09).ConclusionsThe level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.

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A Comparison of Predictability of Physician-Diagnosed Dyslipidemia according to Increased Blood Pressure, Blood Sugar and Waist Circumference: A Nationwide Population-Based Retrospective Cohort Study

Korean Journal of Family Practice ◽

10.21215/kjfp.2017.7.1.137 ◽

2017 ◽

Vol 7 (1) ◽

pp. 137-143

Author(s):

Jun-Seok Choi ◽

Jong-Eun Lee ◽

Jeong-Eun Sang ◽

Kyung-Do Han ◽

Youn Huh ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Waist Circumference ◽

Blood Sugar ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based

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Eligibility and subsequent burden of cardiovascular disease of four strategies for blood pressure-lowering treatment: a retrospective cohort study

The Lancet ◽

10.1016/s0140-6736(19)31359-5 ◽

2019 ◽

Vol 394 (10199) ◽

pp. 663-671 ◽

Cited By ~ 7

Author(s):

Emily Herrett ◽

Sarah Gadd ◽

Rod Jackson ◽

Krishnan Bhaskaran ◽

Elizabeth Williamson ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Blood Pressure Lowering ◽

Pressure Lowering

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Retrospective cohort study of the relationship between systolic blood pressure variability and multiple sclerosis disability

BMJ Open ◽

10.1136/bmjopen-2019-034355 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034355 ◽

Cited By ~ 1

Author(s):

Myla D Goldman ◽

Seulgi Min ◽

Jennifer M Lobo ◽

Min-Woong Sohn

Keyword(s):

Multiple Sclerosis ◽

Blood Pressure ◽

Cohort Study ◽

Systolic Blood Pressure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Patient Reported ◽

The Relationship

ObjectiveTo examine the relationship between visit-to-visit systolic blood pressure (SBP) variability and patient-reported outcome measure of disability in multiple sclerosis (MS) patients.DesignA retrospective cohort study of individuals with MS who completed a patient-determined disease steps (PDDS) scale between 2011 and 2015 at an MS specialty clinic.ParticipantsIndividuals with MS for whom both a completed PDDS scale and ≥3 SBP measures within the prior 12 months of the survey were available.Main outcome measureParticipants were grouped into three classes of disability (no or mild (PDDS 0–1), moderate (2–3), severe (4–7)). SBP variability was calculated as within-subject SD using all SBP measures taken during the past 12 months. SBP variability was analysed by Tertile groups.ResultsNinety-two subjects were included in this analysis. Mean PDDS score was 2.22±1.89. Compared with subjects in Tertile 1 (lowest variability), the odds of being in a higher disability group was 3.5 times higher (OR=3.48; 95% CI: 1.08 to 11.25; p=0.037) in Tertile 2 and 5.2 times higher (OR=5.19; 95% CI: 1.53 to 17.61; p=0.008) in Tertile 3 (highest variability), independent of mean SBP, age, sex, race/ethnicity, body mass index and comorbidities (p for trend=0.008). Mean PDDS scores were 1.52±1.18 in Tertile 1, 2.73±1.02 in Tertile 2 and 2.42±0.89 in Tertile 3 after adjusting for the same covariates.ConclusionsOur results show a significant gradient relationship between SBP variability and MS-related disability. More research is needed to determine the underlying pathophysiological relationship between SBP variability and MS disability progression.

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Retrospective cohort study to characterise the blood pressure response to spironolactone in patients with apparent therapy-resistant hypertension using electronic medical record data

BMJ Open ◽

10.1136/bmjopen-2019-033100 ◽

2020 ◽

Vol 10 (5) ◽

pp. e033100

Author(s):

Megan Shuey ◽

Bradley Perkins ◽

Hui Nian ◽

Chang Yu ◽

James M Luther ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Resistant Hypertension ◽

Retrospective Cohort ◽

Density Lipoprotein ◽

Disease Stage ◽

Haemoglobin A1c ◽

Academic Medical Centre ◽

Change In Mean

ObjectiveIdentify blood pressure (BP) response to spironolactone in patients with apparent therapy-resistant hypertension (aTRH) using electronic medical records (EMRs) in order to estimate response in a real-world clinical setting.DesignDeveloped an algorithm to determine BP and electrolyte response to spironolactone for use in a retrospective cohort study.SettingAn academic medical centre in Nashville, Tennessee.PopulationPatients with aTRH prescribed spironolactone.Main outcome measuresBaseline BP and BP response, determined as the change in mean systolic BP (SBP) and diastolic BP (DBP) following spironolactone initiation. Additional response measures were serum sodium, potassium and creatinine, estimated glomerular filtration rate, haemoglobin A1c (HbA1c), glucose, high-density lipoprotein, low-density lipoprotein and triglycerides. Demographic characteristics included race, age, gender, body mass index (BMI), diabetes mellitus, chronic kidney disease stage 3, ischaemic heart disease and smoking.ResultsThe mean decreases in SBP and DBP were 8.1 and 3.4 mm Hg, consistent with clinical trial data. Using a mean decrease in SBP of 5 mm Hg or in DBP of 2 mm Hg to define ‘responders’, 30.3% of patients did not respond. In univariable analyses, responders had higher BMI, baseline SBP, DBP, sodium and HbA1c, and lower creatinine. In multivariable analysis, responders were older and had significantly higher BMI and baseline SBP and DBP, and lower potassium. Increases in potassium and creatinine following spironolactone were larger in responders. When BP was evaluated as a continuous variable, decreases in SBP and DBP correlated with baseline BP, decrease in sodium and increases in potassium and creatinine following spironolactone. The decrease in SBP was associated with decreasing glucose in European Americans.ConclusionsWe developed an algorithm to assess BP response to a commonly prescribed medication for aTRH using EMRs. Electrolyte changes associated with the BP response to spironolactone are consistent with its mechanism of action of blocking the mineralocorticoid receptor and decreasing epithelial sodium channel activity.

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