scholarly journals “Blood pressure monitoring should be a habit”: adaptation of the Check. Change. Control. program for Asian American older adults, from group-based in-person to one-on-one telephone delivery

2021 ◽  
Author(s):  
Sou Hyun Jang ◽  
Emily V R Brown ◽  
Eun Jeong Lee ◽  
Linda K Ko
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Asian American ◽  
Limited English Proficiency ◽  
Blood Pressure Monitoring ◽  
Control Program ◽  
Hypertension Control ◽  
Group Setting ◽  
Face To Face ◽  
The Usa

Abstract Asian Americans have the lowest rate of awareness about hypertension, including controlled hypertension, among all racial/ethnic groups in the USA. A high proportion of Asian American older adults have limited English proficiency (LEP) and hypertension. This study adapted the Check. Change. Control. (CCC) program, a community-based intervention for hypertension control delivered in a face-to-face group setting, to phone-based delivery and evaluated the acceptability of the program among Asian American older adults with LEP. Thirteen participants received phone-based educational sessions on hypertension control over 4 months. After 4 months of interventions, we interviewed the 13 Asian American older adults and 4 counselors to examine the acceptability of the adapted CCC program. Both Asian American older adults and counselors found the phone-based delivery of the CCC program to be acceptable, and some participants recommended holding an in-person meeting before telephone delivery to review the program content and clarify information. Future study needs to explore the effectiveness of the phone-based delivery of the program on blood pressure management among larger groups of Asian American older adults.

Abstract P198: Clinic versus Out-of-Clinic Daytime Blood Pressure Among Older Adults: Data From the Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Rikki M Tanner ◽  
Daichi Shimbo ◽  
Samantha Seals ◽  
Gbenga Ogedegbe ◽  
Paul Muntner
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Blood Pressure Monitoring ◽  
White Coat ◽  
Older Individuals ◽  
Jackson Heart Study ◽  
Large White ◽  
Younger Adults ◽  
White Coat Effect ◽  
Heart Study

In the US, antihypertensive medication treatment decisions are primarily based on blood pressure (BP) measurements obtained in the clinic setting. The optimal systolic BP (SBP) goal for adults ≥60 years is controversial and a large difference between clinic and out-of-clinic daytime BP, a white-coat effect, may be present in older individuals. We estimated the white-coat effect and calculated the percentage of untreated and treated adults <60 and ≥60 years with elevated clinic BP (defined as SBP/diastolic BP [DBP] ≥140/90 mmHg), but non-elevated out-of-clinic daytime BP (“daytime BP”, defined as SBP/DBP <135/85 mmHg) among 257 African-American participants in the Jackson Heart Study with at least 10 daytime ambulatory BP measurements. For the overall population, the white-coat effect for SBP was 12.2 mmHg (95% confidence interval [CI]: 9.2-15.1) in older adults and 8.4 mmHg (95% CI: 5.7-11.1) in younger adults (p=0.06). After multivariable (MV) adjustment, this difference was 1.3 mmHg. Among those without diabetes or chronic kidney disease (CKD), the white coat effect for SBP was 15.2 mmHg (95% CI: 10.1-20.2) and 8.6 mmHg (95% CI: 5.0-12.3) for older and younger adults, respectively (p=0.04). After MV adjustment, this difference was 5.9 mmHg. Also, SBP ≥150 mmHg versus <150 mm Hg was associated with a larger white-coat effect in the overall population after MV adjustment. Among those without CKD or diabetes, older age and SBP ≥150 mmHg were associated with a larger white-coat effect after MV adjustment. Among younger and older participants with elevated clinic BP, the prevalence of non-elevated daytime BP was 34% (95% CI: 26%-44%) and 32% (95% CI: 24%-40%), respectively (p=0.64), in the overall population and 35% (95% CI: 24%-48%) and 43% (95% CI: 31%-56%), respectively, for those without CKD or diabetes (p=0.37). In conclusion, a large white-coat effect was present among older adults. These data suggest a role for ambulatory blood pressure monitoring in preventing potential over-treatment for hypertension among older adults.

scholarly journals Telehealth: improving maternity services by modern technology

2020 ◽  
Vol 9 (4) ◽  
pp. e000895
Author(s):  
Nusrat Fazal ◽  
Anne Webb ◽  
Jo Bangoura ◽  
Mohamed El Nasharty
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Innovative Technology ◽  
Potential Solution ◽  
Pressure Monitoring ◽  
Nice Guidelines ◽  
Maternity Services ◽  
Face To Face ◽  
Medical Disorders ◽  
Frequent Monitoring

Hypertension is considered one of the most common medical disorders causing complexities in pregnancy. It could be a newly developed pregnancy-induced hypertension (PIH) or a pre-existing hypertension developing into superimposed pre-eclamptic toxaemia. PIH affects approximately 10% of pregnancies and can have a serious impact on both maternal and fetal well-being; hence requires frequent monitoring and timely intervention. National Institute for Health and Care Excellence (NICE) guidelines recommends once or twice weekly monitoring of blood pressure for such patients. The required frequent monitoring comes with certain implications for patients and healthcare services. An average patient with PIH would need to see her healthcare provider once or twice a week until delivery and 6 weeks thereafter. This certainly increases pressure on limited National Health Service (NHS) resources. Home-based monitoring using Telehealth technology can represent a potential solution for achieving good-quality care for the patient without increasing the workload for healthcare providers. We used ‘Florence’, a text-based technology platform to support home monitoring. We tested its acceptability, feasibility and safety to replace face-to-face appointments for blood pressure monitoring in selected patients with PIH. We implemented our project in three progressive phases using a plan, do, study, act methodology. Florence, telehealth technology was used for blood pressure monitoring instead of face-to-face appointments, and the effect of this innovative technology on the services and the patient experience was studied and necessary modifications were made before progression into the next phase. We recruited 75 patients over 12 months through the progressive phases and replaced around 800 face-to-face appointments by remotely supervised monitoring sessions with Florence successfully, with improved care and patient satisfaction. We also achieved better compliance with the NICE guidelines for blood pressure monitoring in PIH. Our project concluded that Telehealth can be a potential solution for improving care in maternity services, with lesser burden on NHS resources.

Abstract MP03: Associations Of 24-hour Blood Pressure Patterns With Cognitive Function In Healthy Older Adults

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Kyle Conway ◽  
Nketi Forbang ◽  
Tomasz Beben ◽  
Michael Criqui ◽  
Joachim Ix ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Community Living ◽  
Pressure Measurements ◽  
Clinic Blood Pressure ◽  
Night Time ◽  
Moca Score

Background: Abnormal 24-hour ambulatory blood pressure monitoring (ABPM) patterns have been associated with diminished cognitive function in hypertensive and very elderly populations. The relationship between ABPM patterns in community-living older adults is unknown. Methods: We conducted a cross-sectional study in which ABPM, in-clinic blood pressure, and cognitive function measures were obtained in 354 community living older adults. We used multiple linear regression to examine the associations of in-clinic and ABPM with the Montreal Cognitive Assessment (MoCA [range 0-30 with lower levels indicating worse cognition]), adjusting for age, sex, race/ethnicity, education, and comorbid medical conditions. Results: The mean age was 72 years, 68% were female, and 13% were African American; 45% had a diagnosis of hypertension. In-clinic blood pressure measurements were not significantly associated with cognitive function after adjustment. In contrast, less nighttime systolic dipping percentage (Figure) and lower 24-hour average diastolic blood pressure obtained from the ABPM were both significantly associated with worse cognitive function. In the final model, each 1% less night-time dipping was associated with 0.25 points (0.1-0.9) lower MoCA score, whereas each 10 mmHg lower diastolic blood pressure was associated with 0.59 (0.14-1.05) points lower MoCA score. Conclusions: In community-living older persons, less nighttime systolic dipping and lower 24-hour diastolic blood pressure obtained by ABPM were associated with worse cognitive function whereas clinic based blood pressure measurements were not. Future studies should examine whether 24-hour diastolic blood pressure and nighttime systolic dipping may predict future risk for cognitive impairment. (Legend: Dipping quartiles: Q1 -17.8% to 6.0%; Q2 6.1% to 11.0%; Q3 11.1% to 16.3%; Q4 16.4% to 34.2%)

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