Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120–140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials

ObjectiveTo investigate to what extent patients with inflammatory arthritis (IA) follow recommendations given in a secondary care nurse-led cardiovascular (CV) risk screening consultation to consult their general practitioner (GP) to reduce their CV risk and whether their socioeconomic status (SES) affects adherence.MethodsAdults with IA who had participated in a secondary care screening consultation from July 2012 to July 2015, based on the EULAR recommendations, were identified. Patients were considered to have high CV risk if they had risk Systematic COronary Risk Evaluation (SCORE) ≥5%, according to the European SCORE model or systolic blood pressure ≥145 mmHg, total cholesterol ≥8 mmol/L, LDL cholesterol ≥5 mmol/L, HbA1c ≥42 mmol/mol or fasting glucose ≥6 mmol/L. The primary outcome was a consultation with their GP and at least one action focusing on CV risk factors within 6 weeks after the screening consultation.ResultsThe study comprised 1265 patients, aged 18–85 years. Of these, 336/447 (75%) of the high-risk patients and 580/819 (71%) of the low-risk patients had a GP consultation. 127/336 (38%) of high-risk patients and 160/580 (28%) of low-risk patients received relevant actions related to their CV risk, for example, blood pressure home measurement or prescription for statins, antihypertensives or antidiabetics. Education ≥10 years increased the odds for non-adherence (OR 0.58, 95% CI 0.0.37 to 0.92, p=0.02).Conclusions75% of the high-risk patients consulted their GP after the secondary care CV risk screening, and 38% of these received an action relevant for their CV risk. Higher education decreased adherence.

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Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation

BMC Health Services Research ◽

10.1186/s12913-021-07363-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gabbi Frith ◽

Kathryn Carver ◽

Sarah Curry ◽

Alan Darby ◽

Anna Sydes ◽

...

Keyword(s):

Blood Pressure ◽

High Risk ◽

Cardiac Rehabilitation ◽

Group Analysis ◽

Patient Activation ◽

Low Risk ◽

Smart Device ◽

Face To Face ◽

High Risk Patients ◽

Risk Patients

Abstract Background Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me. Methods Patients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me. Results Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals. Conclusion Participation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face. Trial registration As this was not a clinical trial, the study was not registered in a trial registry.

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Effects of Aging on the Variability of Arterial Pressure in Essential Hypertensive Patients

Clinical Science ◽

10.1042/cs063411s ◽

1982 ◽

Vol 63 (s8) ◽

pp. 411s-414s ◽

Cited By ~ 2

Author(s):

Jun Ogawa ◽

Shigeo Takata ◽

Gakuji Nomura ◽

Shiro Arai ◽

Takayuki Ikeda ◽

...

Keyword(s):

Blood Pressure ◽

Stroke Volume ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Pulse Pressure ◽

Baroreflex Sensitivity ◽

Peripheral Resistance ◽

Resistance Index ◽

Average Systolic Blood Pressure ◽

Effects Of Aging

1. We studied the effects of aging on the variability of blood pressure in mild to moderate essential hypertensive subjects. 2. Cardiac index was greater and total peripheral resistance index was less in patients under 40 years (by an average of 1.06 litres min−1 m−2 and 9.23 mmHg 1−1 min−1 m−2) than in those over 40 respectively (P < 0.001 for each). 3. Pulse pressure/stroke volume was less by an average of 0.345 mmHg/ml in patients under 40 years than that in those over 40 (P < 0.001). Pulse pressure/stroke volume was correlated with age (r = 0.621), average systolic blood pressure (r = 0.623) and inversely with baroreflex sensitivity (r = −0.494). 4. Baroreflex sensitivity was less by an average of 3.1 ms/mmHg in patients over 30 years than in those under 30 (P < 0.025). Baroreflex sensitivity was inversely correlated with age (r = −0.617) and average systolic blood pressure (r = −0.589). 5. Beat by beat variability of systolic blood pressure was correlated with age (r = 0.460), particularly when the data of those in their twenties were excluded (r = 0.618), and significantly with pulse pressure/stroke volume (r = 0.650), average systolic blood pressure (r = 0.618) and inversely with baroreflex sensitivity (r = −0.477). These relationships were not observed for diastolic blood pressure. 6. Maximum difference in systolic blood pressure in a day was correlated with pulse pressure/stroke volume (r = 0.482) and average systolic blood pressure (r = 0.648) but not with baroreflex sensitivity. These relationships were not observed for diastolic blood pressure. 7. Variability of systolic blood pressure in patients over 30 years gradually increased with age. In contrast, those of systolic and diastolic blood pressures in subjects in their twenties were relatively large. This might be related to factors other than aging, presumably those which underlie the hyperdynamic circulatory state.

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