scholarly journals Effect of Antihypertensive Therapy on SCORE-Estimated Total Cardiovascular Risk: Results from an Open-Label, Multinational Investigation—The POWER Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Guy De Backer ◽  
Robert J. Petrella ◽  
Assen R. Goudev ◽  
Ghazi Ahmad Radaideh ◽  
Andrzej Rynkiewicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Blood Pressure ◽  
Cvd Risk ◽  
Open Label ◽  
Substantial Risk ◽  
Blood Pressures ◽  
Score Model ◽  
The Impact

Background.High blood pressure is a substantial risk factor for cardiovascular disease.Design & Methods.The Physicians' Observational Work on patient Education according to their vascular Risk (POWER) survey was an open-label investigation of eprosartan-based therapy (EBT) for control of high blood pressure in primary care centers in 16 countries. A prespecified element of this research was appraisal of the impact of EBT on estimated 10-year risk of a fatal cardiovascular event as determined by the Systematic Coronary Risk Evaluation (SCORE) model.Results.SCORE estimates of CVD risk were obtained at baseline from 12,718 patients in 15 countries (6504 men) and from 9577 patients at 6 months. During EBT mean (±SD) systolic/diastolic blood pressures declined from 160.2 ± 13.7/94.1 ± 9.1 mmHg to 134.5 ± 11.2/81.4 ± 7.4 mmHg. This was accompanied by a 38% reduction in mean SCORE-estimated CVD risk and an improvement in SCORE risk classification of one category or more in 3506 patients (36.6%).Conclusion.Experience in POWER affirms that (a) effective pharmacological control of blood pressure is feasible in the primary care setting and is accompanied by a reduction in total CVD risk and (b) the SCORE instrument is effective in this setting for the monitoring of total CVD risk.

Abstract 17345: Particulate Matter and Risk of Incident Cardiovascular Disease in a Nationwide Cohort of Men

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jaime E Hart ◽  
Jarvis T Chen ◽  
Robin C Puett ◽  
Jeff D Yanosky ◽  
Eric B Rimm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Particulate Matter ◽  
High Blood Pressure ◽  
Smoking Status ◽  
Sensitivity Analyses ◽  
Cvd Risk ◽  
Ambient Exposure ◽  
The Impact

Introduction: Chronic exposures to particulate matter (PM) have been associated with cardiovascular disease (CVD) morbidity and mortality. We examined the impact of long-term exposures to PM on the risk of incident coronary heart disease (CHD) and stroke among members of the nationwide all-male Health Professionals Follow-Up Study (HPFS) prospective cohort. Methods: HPFS members were followed biennially between 1986-2006 to obtain information on incident disease and to update information on CVD risk factors. Time-varying ambient PM 10 , PM 2.5-10 , and PM 2.5 for the previous 12 months were calculated from monthly predictions at the address level. Multivariate adjusted Cox proportional hazards models were used to estimate [HR (95%CI)] for the association between each fraction of PM and each outcome among 43,371 CVD-free members of the HPFS, adjusting for risk factors and other potential confounders. We also assessed effect modification by region of the country, BMI, smoking status, and comorbidities (hypercholesterolemia, high blood pressure, and diabetes). Sensitivity analyses were conducted restricting the population to men who provided residential (N=15,395), as opposed to work, addresses. Results: The mean (SD) levels of 12-month average PM 10 , PM 2.5-10 , and PM 2.5 were 20.7 (6.2), 8.4 (4.7) and 12.3 (3.4) μg/m 3 . In the full population, there was only modest evidence of increased risks of incident CHD or stroke with increasing PM exposures. Associations with stroke were modified by region, hypercholesterolemia, high blood pressure, and diabetes, with larger effects among those with comorbid conditions and in the Northeast and South. CHD, but not stroke, dose-responses were stronger among those who provided residential as opposed to work addresses; each 10 μg/m 3 increase, was associated with increases in overall CHD [1.10 (95%CI: 1.01-1.20), 1.09 (0.97-1.23), and 1.14 (0.98-1.32) for PM 10 , PM 2.5-10 , and PM 2.5 , respectively]. Conclusions: In this cohort of US men, PM exposures were only modestly associated with elevated risks of CHD and stroke. Comorbidities and region modified the associations with stroke, and residential ambient exposures were more associated with CHD than work ambient exposure.

scholarly journals Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

2019 ◽  
Vol 71 (4) ◽  
pp. 461-470 ◽  
Author(s):  
Christie M. Bartels ◽  
Edmond Ramly ◽  
Heather M. Johnson ◽  
Diane R. Lauver ◽  
Daniel J. Panyard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Blood Pressure ◽  
Specialty Clinic ◽  
Blood Pressures

scholarly journals Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard A. Parker ◽  
Paul Padfield ◽  
Janet Hanley ◽  
Hilary Pinnock ◽  
John Kennedy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Statistical Analysis ◽  
Propensity Score ◽  
Random Coefficient ◽  
White Coat ◽  
White Coat Effect ◽  
Regression Adjustment ◽  
The Impact

Abstract Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

Abstract P136: Healthier Personal Habits Of Primary Care Physicians Increase The Likelihood Of Their Recommending Lifestyle Modifications For Their Hypertensive Patients That Are Consistent With The National Guidelines

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Olivia Y Hung ◽  
Nora L Keenan ◽  
Jing Fang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Blood Pressure ◽  
Primary Care Physicians ◽  
Lifestyle Modification ◽  
Lifestyle Interventions ◽  
Lifestyle Modifications ◽  
Hypertensive Patients ◽  
Attitudes And Behaviors ◽  
And Behaviors

Introduction: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians’ personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. Hypothesis: Primary care physicians who have healthier habits, as defined by eating more cups of fruits and/or vegetables, exercising more frequently, and/or not smoking, would be more likely to recommend lifestyle interventions consistent with JNC VII than their counterparts who have less healthy habits. Methods: One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. Results: The respondents’ average age was 45.3 years and 68.5% (685 of 1000) were male. In regards to physician behavior, 4.0% (40 of 1000) smoked at least once a week, 38.6% (386 of 1000) ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% (274 of 1000) exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (922 of 1000), or cut down on salt (961 of 1000), or attain or maintain a healthy weight (948 of 1000), or limit the use of alcohol (754 of 1000), or be physically active (944 of 1000). Collectively, 66.5% (665 of 1000) made all 5 lifestyle modification recommendations. Physicians who were between 40 - 49 years old were 1.6 times as likely of making all 5 lifestyle recommendations compared with those who were under 40 years. Additionally, those who exercised at least once per week or did not actively smoke were approximately twice as likely to recommend these interventions. Conclusions: The probability of recommending all five lifestyle modifications increased with both the physician exercising at least once per week and not having smoked.

Cost-effectiveness of diagnosis of high blood pressure in primary care

The Lancet ◽  
2012 ◽  
Vol 379 (9817) ◽  
pp. 709-710 ◽  
Author(s):  
David S Wald ◽  
Mark C Simmonds ◽  
Joan K Morris ◽  
Peter M Rothwell ◽  
Nicholas J Wald
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cost Effectiveness ◽  
High Blood Pressure

scholarly journals Use of physical activity and cardiorespiratory fitness in identifying cardiovascular risk factors in male brazilian adolescents

2016 ◽  
Vol 18 (6) ◽  
pp. 678
Author(s):  
Lilian Messias Sampaio Brito ◽  
Luis Paulo Gomes Mascarenhas ◽  
Deise Cristiane Moser ◽  
Ana Cláudia Kapp Titski ◽  
Monica Nunes Lima Cat ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass ◽  
Cardiorespiratory Fitness ◽  
High Blood Pressure ◽  
Abdominal Obesity ◽  
Age Groups ◽  
Cross Sectional ◽  
The Impact

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n6p678 The aim of this study was to investigate the impact of physical activity (PA) and cardiorespiratory fitness (CRF) levels on the prevalence of overweight and high blood pressure levels in adolescents. In this observational, cross-sectional study, 614 boys aged 10-14 years were assessed for height, body mass, body mass index (BMI), waist circumference (WC) and blood pressure (BP). CRF was assessed using a run test (Léger Test) and subjects were then grouped according to their CRF level. PA level was assessed through a questionnaire (The Three Day Physical Activity Recall) and classified into two groups, namely > 300 minutes of PA/week and < 300 minutes of PA/week. Maturational stage was evaluated according to the development of pubic hair (self-assessment) as proposed by Tanner. We used statistical descriptive analysis, univariate and multivariate analyses in the total participants and subjects were divided by age. Fifty percent of the sample performed < 300 minutes of PA/week and 67.6% had unsatisfactory CRF levels. There was a higher prevalence of unsatisfactory CRF levels among subjects with altered BMI (overweight), WC (abdominal obesity) or BP (high blood pressure) for all age groups. PA history, however, did not show any significance. A total of 31% of participants were overweight, 24.8% had abdominal obesity and 15.4% had increased BP. Unsatisfactory CRF levels were found to be a better predictor for the diagnosis of cardiovascular diseases (CV) risk factors than PA history, regardless of age group. 

scholarly journals Classification of Hypertensive and Normotensive Subjects Using Bilateral Differential Biopotential Signals

2021 ◽  
Author(s):  
Arindam Sarkar ◽  
Bhaswati Goswami ◽  
Ratna Ghosh
Keyword(s):  
Blood Pressure ◽  
Random Forest ◽  
High Blood Pressure ◽  
Pivotal Role ◽  
Modern World ◽  
Hypertensive Subject ◽  
Normotensive Subjects ◽  
Electrocardiogram Ecg ◽  
Day By Day

Abstract Hypertension or high blood pressure is a severe health issue in the modern world, especially in this pandemic scenario, that can cause many heart related diseases or even death, and it is increasing day by day. For this reason, a reliable, automatic and easy to use system for hypertensive subject detection is an important focus for the researchers. Biopotential signals can play a pivotal role in this regard. Though, few strategies were proposed based on electrocardiogram (ECG) or electrodermal (EDA) signals, but those require special circuitry, as well as trained persons. In this article, a method is proposed to classify hypertensive and normotensive subjects using differential biopotential signals. Neither special circuitry, nor much expertise is required for handling this system. It was assumed that progression of rest is dependent upon blood pressure. To serve the purpose, signals were acquired from both hypertensive and normotensive subjects bilaterally for 10 continuous minutes. Result of the random forest (RF) classification establishes that from the analysis of the progression of the bilaterally acquired differential biopotential signals, hypertensive subjects can be distinguished from normotensive subjects.

scholarly journals SAT-558 A Dedicated Endocrine Hypertension Service Increases the Timely Diagnosis of Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jun Yang ◽  
Yin Y Lim ◽  
Renata Libianto ◽  
Jimmy Shen ◽  
Morag Jennifer Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Aldosteronism ◽  
Pressure Control ◽  
Organ Damage ◽  
Antihypertensive Medications ◽  
Endocrine Hypertension ◽  
Treatment Naïve ◽  
Hypertension Diagnosis ◽  
The Impact

Abstract Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk that could be averted with targeted treatment. An Endocrine Hypertension Service (EHS), encompassing an education program, streamlined diagnostic tests and dedicated PA clinic, was developed to address this issue. Aims: To analyse the impact of Victoria’s first dedicated EHS on the pattern of PA diagnoses. Methods: Socio-demographic and clinical data from all patients who attended the EHS since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results: The proportion of referrals from primary care increased (20% in Y1 to 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1 to 19% in Y3). Patients with a hypertension diagnosis of 5 years or less at the time of referral to EHS increased from 34% in Y1 to 45% in Y3 whilst the percentage of patients with a hypertension diagnosis of more than 10 years decreased from 50% in Y1 to 35% in Y3. Consistent with an earlier presentation, the proportion of patients with end-organ damage at the time of referral decreased from 44% in Y1 to 29% in Y3. Almost a third of the PA patients had unilateral disease; all of those who underwent adrenalectomy had biochemical cure. Patients with bilateral PA were treated with spironolactone. Their systolic/diastolic blood pressure decreased by 15/12 mmHg in Y1, 17/13 mmHg in Y2 and 23/11 mmHg in Y3; while the mean number of antihypertensive medications decreased from 2.9 to 1.8 in Y1, 2.7 to 2.0 in Y2 and 2.2 to 1.6 in Y3 Conclusion: The EHS has facilitated an increase in referrals for PA screening from primary care, resulting in the earlier diagnosis of PA, when less complications are present, and optimised patient outcomes. A broader uptake of such a clinical service, integrated with education outreach, will bridge the gap between the reported high prevalence of PA and the actual low diagnostic rates.

scholarly journals Effect of the physical activity program on the treatment of resistant hypertension in primary care

2018 ◽  
Vol 19 (6) ◽  
pp. 575-583 ◽  
Author(s):  
Piotr J. Kruk ◽  
Michał Nowicki
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Primary Care ◽  
Resistant Hypertension ◽  
Lifestyle Modification ◽  
Heart Association ◽  
Pressure Control ◽  
Physical Activity Program ◽  
Activity Program ◽  
The Impact

AbstractBackgroundRegular physical activity is widely recommended for patients with arterial hypertension as an essential component of lifestyle modification. Much less is known about the impact of physical exercise on the management of treatment of resistant hypertension (RH). The aim was to assess the effect of physical activity program intensified by mobile phone text reminders on blood pressure control in subjects with RH managed in the primary care.MethodsIn total, 53 patients with primary hypertension were qualified, including 27 who met the criteria for RH and 26 with well-controlled hypertension (WCH). Ambulatory 24-h blood pressure was monitored and body composition evaluated with bioimpedance and habitual physical activity profile was determined continuously over 72 h with accelerometer. All measurements were performed at baseline and after three and six months. The patients were asked to modify their lifestyle according to American Heart Association Guidelines that included regular aerobic physical activity tailored to individual needs.FindingsPhysical activity in RH increased significantly after six months compared with control subjects (P=0.001). Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the RH group decreased significantly after three months but after six months only office DBP remained significantly lower. After three months 24-h SBP decreased by 3.1±11 mmHg (P=0.08) and DBP by 2.0±6 mmHg (P=0.17) in RH, whereas in WCH respective changes were +1.2±10 and −0.3±6 mmHg. After six months 24-h BP changes were similar.ConclusionIndividualized structured physical activity program increases physical activity in the treatment of resistant hypertensives in primary care but the effect on 24-h blood pressure is only transient.

Abstract P206: Prenatal Cadmium Burden, Birth Weight, And Offspring Adolescent Blood Pressure

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Megan K Suter ◽  
Daniel Enquobahrie ◽  
Catherine Karr ◽  
Sheela Sathyanarayana ◽  
Joseph T Flynn ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Birth Weight ◽  
High Blood Pressure ◽  
Cadmium Concentration ◽  
Effect Modification ◽  
Childhood And Adolescence ◽  
Environmental Toxicants ◽  
Third Trimester ◽  
Stage 1 ◽  
The Impact

Background: Cadmium is a ubiquitous, toxic heavy metal associated with several adverse health outcomes, including high blood pressure, in adults. The impact of maternal cadmium burden on offspring birth weight and have not been thoroughly explored. We investigated associations of prenatal cadmium burden with birth weight and offspring blood pressure in childhood and adolescence. Methods: We analyzed data from 202 mother-child pairs who were recruited for the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) study in Mexico City (1997-2000). Prenatal cadmium burden was characterized using maternal urine collected in the third trimester of pregnancy - continuous and quartile specific-gravity adjusted cadmium (log-UCd, μg/L). Outcomes were offspring birth weight and blood pressure (measured at age 7-15 years). Blood pressure status (normal, elevated, stage 1 hypertension) was defined based on the 2017 American Academy of Pediatrics Guidelines. Those with elevated or stage 1 hypertension were categorized as having high blood pressure. Linear and logistic regression models were used to examine associations, adjusted for potential confounders. Potential effect modification by offspring sex was assessed using interaction terms and sex-stratified models. Results: Study participants included 93 males and 109 females, with a mean age of 10.0 (SD=1.5) years. Median third trimester urinary cadmium concentration was 0.17 μg/L (IQR=0.12, 0.26). The prevalence of high blood pressure was 19.3% (39/202). Prenatal cadmium was not associated with birthweight (β=-58.94 grams, 95%CI: -138.07, 20.19), offspring systolic blood pressure (β=-0.90 mmHg, 95%CI: -2.87, 1.06), diastolic blood pressure (β=-1.21 mmHg, 95%CI: -2.68, 0.26), or high blood pressure (OR=0.64, 95%CI: 0.34, 1.21). We found similar results when prenatal cadmium was modeled with quartiles. There was no evidence of effect modification by sex for any of the outcomes. Conclusions: In the current study, maternal third trimester was not associated with offspring blood pressure or birth weight, however future studies are needed to confirm these findings.

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