scholarly journals A Food Box Intervention to Reduce Blood Pressure in Native American Adults With Hypertension: The CHEERS Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 625-625
Author(s):  
Valarie Blue Bird Jernigan ◽  
Joy Standridge ◽  
Tyra Shackleford ◽  
Hilary Brookins ◽  
Tvli Jacob ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Native American ◽  
Healthy Eating ◽  
Community Based Participatory Research ◽  
Pressure Control ◽  
Reduce Blood Pressure ◽  
Lessons Learned ◽  
Uncontrolled Hypertension ◽  
Food Environments ◽  
Research Orientation

Abstract Diet-related chronic diseases, such as hypertension and obesity, are prevalent in Native American (NA) communities where poor food environments are prominent and healthy food access is limited. The Chickasaw Healthy Eating Environments Research Study (CHEERS) is an NIH-funded study aimed to improve Body Mass Index and blood pressure control among NA adults with uncontrolled hypertension. This multi-level randomized trial, guided by a community-based participatory research orientation, was co-created by tribal and university partners and is implemented within the Chickasaw Nation of Oklahoma. We created hypertension-specific food boxes that contained DASH diet foods, coupons for purchasing vegetables and fruits, educational materials, and heart-healthy recipes for supporting healthy eating. Food boxes were packed and shipped monthly to intervention participants with a 30-day supply of: one fruit serving/day, one vegetable serving/day, one serving of unsalted nuts or seeds/day, one serving of beans or lentils/day, and two servings of fatty fish/week. We will present our participatory approach in co-developing the CHEERS study methods, findings with a focus on older adults, and lessons learned. CHEERS is the first innovative food box intervention to be conducted in NA communities. Food box interventions show promise in improving dietary intake and reducing hypertension and obesity in rural and poor food environments.

Device therapy of resistant hypertension

2013 ◽  
Vol 154 (6) ◽  
pp. 203-208 ◽  
Author(s):  
Gábor Simonyi ◽  
J. Róbert Bedros ◽  
Mihály Medvegy
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Resistant Hypertension ◽  
Carotid Sinus ◽  
Maximum Tolerated Dose ◽  
Reduce Blood Pressure ◽  
Nerve Fibers ◽  
Uncontrolled Hypertension ◽  
Sympathetic Nerve Fibers ◽  
Treatment Of Hypertension

It is well known that hypertension is an independent cardiovascular risk factor. Treatment of hypertension frequently includes administration of three or more drugs. Resistant hypertension is defined when blood pressure remains above target value despite full doses (the patient’s maximum tolerated dose) of antihypertensive medication consisting of at least three different classes of drugs including a diuretic. Pharmacological treatment of hypertension is often unsuccessful despite the increasing number of drug combinations. Uncontrolled hypertension, however, increases the cardiovascular risk. Device treatment of resistant hypertension is currently testing two major fields. One of them the stimulation of baroreceptors in the carotid sinus and the other is radiofrequency ablation of sympathetic nerve fibers around renal arteries to reduce blood pressure in drug resistant hypertension. Orv. Hetil., 2013, 154, 203–208.

scholarly journals Risk factors of uncontrolled hypertension in urban slums of Central India : A Community health worker based two-year follow up

2021 ◽  
Author(s):  
Abhijit P Pakhare ◽  
Anuja Lahiri ◽  
Neelesh Shrivastava ◽  
N Subba Krishna ◽  
Ankur Joshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Uncontrolled Hypertension ◽  
Optimal Blood Pressure

AbstractBackgroundHypertension is a leading cause of cardiovascular diseases its control is poor. There exists heterogeneity in levels of blood-pressure control among various population sub-groups. Present study conducted in framework of National Program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) in India, aims to estimate proportion of optimal blood pressure control and identify potential risk factors pertaining uncontrolled hypertension consequent to initial screening.MethodsWe conceived a cohort of individuals with hypertension confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen Accredited Social Health Activists (ASHAs) were trained from within these urban slum communities. Individuals with hypertension were linked to primary care providers and followed-up for next two years. Obtaining optimal blood-pressure control (defined as SBP< 140 and DBP<90 mm of Hg) was a key outcome. Role of baseline anthropometric, and CVD risk factors was evaluated as predictors of blood-pressure control on univariate and multivariate analysis.ResultsOf a total of 6174 individuals, 1571 (25.4%) had hypertension, of which 813 were previously known and 758 were newly detected during baseline survey. Two year follow up was completed for 1177 (74.9%). Blood-pressure was optimally controlled in 301 (26%) at baseline, and in 442 (38%) individuals at two years (absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical-inactivity, higher BMI and newly diagnosed hypertension were significantly associated with uncontrolled blood-pressure.ConclusionsIn the current study we found about six of every ten individuals with hypertension were on-treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Abstract 091: Improved Blood Pressure Control and High Adherence to a Novel Management Model of Hypertension Care in a West African Population

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Isaac Owusu ◽  
Fred Adomako-Boateng ◽  
Fred Kueffer ◽  
Molly Guy ◽  
Chemuttaai Lang’at ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pressure Control ◽  
Management Plan ◽  
West African ◽  
Sub Saharan Africa ◽  
Management Model ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Software Application

Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their condition, and write electronic prescriptions which could be accessed by participating pharmacies. Average baseline BP was 135±18/84±10 mmHg in the overall cohort and 153±13/90±11 mmHg in the subgroup with uncontrolled hypertension (n=58). After 6 months of voluntary weekly monitoring, systolic blood pressure decreased significantly (p<0.01) in the overall cohort (-4.7±18.7 mmHg) and in the uncontrolled subgroup (-15.2±17.6mmHg). Systolic blood pressure remained constant in the sub group with controlled pressure at baseline. The proportion of the population with uncontrolled hypertension decreased from 39% to 27% (p=0.01). Patient compliance with weekly BP assessments was 61% and 2,855 BP assessments were conducted. During 33 of the 2,855 BP assessments (1% of pharmacy visits), the software application directly referred patients to a health facility (33 visits in 25 patients). Improvement in overall health awareness was reported in 82% of the participants and 95% of participants indicated a desire to continue using this model in the future. Conclusions: Compliance and satisfaction with this multifaceted hypertension care model were high and led to significant and sustained decreases in blood pressure in this West African hypertensive population.

Abstract P178: Sentinel Platform Reduces Blood Pressure And Crisis Hypertension (2020 Update)

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Nirav H Shah
Keyword(s):  
Blood Pressure ◽  
New York ◽  
Monitoring Program ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Cloud Platform ◽  
Pressure Data ◽  
Blood Pressures ◽  
Study Population ◽  
Mobile Health Monitoring

Introduction: We assessed the efficacy of mobile healthhypertension monitoring for patients enrolled inMedicare’s Remote Physiologic Monitoring (RPM)program. Hypothesis: Uncontrolled hypertension is an increasingepidemic associated with cardiovascular disease.Despite many available treatments, the averagetime to blood pressure control is slow. Lack ofaccess to patient information including bloodpressure data outside of the clinic setting meansthat clinicians cannot easily titrate medications. Wehypothesized that mobile health monitoring andcommunication with clinicians in a Medicare cohortwould decrease the hypertension burden andmitigate crisis blood pressure in patients. Methods: 1,544 patients who had contributed ≥ 20 bloodpressure readings in a remote monitoring programwere included in the study population, spanningclinics in Florida, Tennessee, Arizona, Ohio, Texas,New York, and California. Eligible patients carried adiagnosis of hypertension and had been seen bytheir doctor within the year they were referred. Themobile health platform was utilized to aggregateblood pressure data, which was analyzed by aremote care team and provided to clinicians on amonthly basis. Patients’ doctors and their teamsreviewed and managed the patients based on thedata provided by the mobile-cloud platform. Theremote monitoring program provided alerts to clinicstaff for patients who had blood pressures greaterthan 180mm Hg systolic (crisis hypertension) forexpedited decision making. Results: 1,544 patients who provided >20 BP readingsfrom January 2018 to January 2020 wereincluded in the study. A total of 297,731 bloodpressure readings were included in thisanalysis. Patient readings were stratified byepoch chronologically. The first epoch (E1),represented the first 25% of readings in theremote monitoring system, and the fourth epoch(E4) represented the final 25% of readings.From E1 to E4, patients saw an averagedecrease of 3.8 mmHg in systolic bloodpressure (132.9 vs. 129.1; p<0.001). Theproportion of readings in crisis hypertensionrange decreased from 2.3% to 1.1%; p=0.03). Conclusions: RPM offers a scalable solution to resistant hypertension.

Provider communication style and treatment intensification in uncontrolled hypertension

2016 ◽  
Vol 4 (2) ◽  
pp. 377
Author(s):  
Varsha Vimalananda ◽  
Jeffrey L Solomon ◽  
Barbara G Bokhour
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Quantitative Methods ◽  
Statistical Significance ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Provider Communication ◽  
Medication Regimen ◽  
Treatment Intensification ◽  
Questioning Style

Rationale, Aims and Objectives: Provider decisions to intensify antihypertensive medications are usually based on clinical metrics (i.e., blood pressure control), but may also be based on patient provided information. When providers use a participatory questioning style, patients share more information and providers may identify barriers to blood pressure control other than an inadequate medication regimen, such as poor adherence. Providers may in turn focus on such barriers rather than intensify treatment. We examined how providers’ question style influenced their treatment intensification for uncontrolled hypertension. Methods: We used qualitative and quantitative methods to analyze data from 43 audiorecorded clinical encounters. Transcripts were coded according to a priori categories including provider question style (open- and/or closed-ended) and whether treatment was intensified, as determined by interpretation of providers’ verbalizations. We used Fisher’s exact test to evaluate the association of provider questioning style with treatment intensification.Results: Providers used a mix of open- and closed-ended questions less frequently than they used closed-ended questions alone. Treatment intensification was less common when a mix of questions was used instead of closed-ended questions alone, although this difference did not reach statistical significance (29% vs. 73% of instances, p=0.07).Conclusions: Provider communication that invites patient participation may elicit more information about patient behavior, but may not impact decisions about treatment intensification in uncontrolled hypertension. Future studies should examine this question among a larger sample and investigate the relationship of participatory communication to improvements in blood pressure control.

scholarly journals Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mary N. Kubo ◽  
Joshua K. Kayima ◽  
Anthony J. Were ◽  
Seth O. McLigeyo ◽  
Elijah N. Ogola
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Renal Transplant ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Factors Associated ◽  
Poor Blood Pressure Control ◽  
Male Sex

Objective.To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting.Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis.Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5,p=0.006), higher levels of proteinuria (p=0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7,p<0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0,p=0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0,p<0.001) were independently associated with uncontrolled hypertension.Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

scholarly journals Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Luu Quang Thuy ◽  
Nguyen Hoang Thanh ◽  
Le Hong Trung ◽  
Pham Huy Tan ◽  
Hoang Thi Phuong Nam ◽  
...  
Keyword(s):  
Social Support ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Structural Characteristics ◽  
Pressure Control ◽  
Information Support ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
Adherence Score ◽  
Practical Support

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension ( n = 220 ) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension ( adjusted   OR = 1.52 , 95 % CI = 1.22 − 1.89 ). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension ( adjusted   OR = 0.98 , 95 % CI = 0.96 − 1.00 ). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score ( coef . = − 0.08 ; 95 % CI = − 0.12 − 0.03 ). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score ( coef . = 0.10 ; 95 % CI = 0.04 − 0.17 and coef . = 0.19 ; 95 % CI = 0.06 − 0.32 , respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

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