Abstract 356: Hypertension Management at the University of Michigan Student Run Free Clinic: Does it Meet National Guidelines?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Lindsey Gakenheimer ◽  
Hari S Conjeevaram
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Lifestyle Changes ◽  
Uncontrolled Hypertension ◽  
Diabetic Patients ◽  
University Of Michigan ◽  
Initial Visit ◽  
Free Clinic ◽  
The University

Purpose: The University of Michigan Student Run Free Clinic (UMSRFC) provides primary care to uninsured adults in Southeast Michigan. Optimal management of chronic conditions, such as hypertension, is one of the clinic’s primary goals. Our aim was to evaluate UMSRFC’s success in meeting the Centers of Medicare and Medicaid Service’s (CMS’s) goal of blood pressure (BP) within the recommended values for ≥63% of clinic patients diagnosed with hypertension. Methods: A retrospective chart review identified hypertensive patients with at least two UMSRFC visits between April 2012 and July 2013. Age, sex, ethnicity, body mass index, medications, blood pressure (BP), and comorbidities were extracted and stored in an online database. Patients were separated into two groups: those with controlled hypertension (≤140/90 mmHg for systolic/diastolic BP) at their most recent clinic date and those with uncontrolled hypertension (>140/90 mmHg for systolic/diastolic BP) at the most recent clinic visit. Results: Of 43 patients presenting with hypertension, 26 (60.5%) met inclusion criteria. The average age was 52.3 +/- 2.0 years, and 12 (46.2%) were male. The majority (17, 65.4%) of patients self-identified as Caucasian, and 24 (92.4%) were from Southeast Michigan. Follow-up BP was controlled for 17 (65.4%) patients. All 6 (23.1%) patients controlled at initial visit remained controlled at follow-up, and 15 (75%) of those uncontrolled at initial visit were controlled at follow-up. BP control among diabetic patients improved the most: from 1 (16.7%) to 5 (83.3%) (p=0.833) achieving control; statistical insignificance is likely due to sample size. Most patients reduced their BP with the addition of medications, but 2 (7.8%) achieved control with lifestyle changes (eg. reduced salt intake, increased exercise or improved home BP recording adherence) alone. Conclusions: UMSRFC has marginally exceeded CMS’s benchmark with 17 (65.4%) of patients with hypertension having a controlled blood pressure at follow-up. While this result demonstrates that a free clinic working with an uninsured population can provide quality care, UMSRFC will continue to work diligently toward the goal of controlled BP for 100% of patients with hypertension.

Abstract P494: Long-term Outcomes of a Cluster-randomized Trial Testing the Effects Blood Pressure Telemonitoring and Pharmacist Management

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Karen L Margolis ◽  
Stephen E Asche ◽  
Anna R Bergdall ◽  
Steven P Dehmer ◽  
Beverly B Green ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Trial ◽  
Clinical Care ◽  
Cluster Randomized Trial ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Routine Clinical Care ◽  
Differential Reduction ◽  
Cluster Randomized

Background/Aims: Hypertension is a common condition and leading cause of cardiovascular disease. We previously reported results of a cluster-randomized trial evaluating a home blood pressure (BP) telemonitoring and pharmacist management intervention, with significant reductions in BP favoring the intervention arm over 18 months. This analysis examined the durability of the intervention effect on BP through 54 months of follow-up and compared BP measurements performed in the research clinic and in routine clinical care. Methods: The Hyperlink trial randomized 16 primary care clinics having 450 study-enrolled patients with uncontrolled hypertension to either Telemonitoring Intervention (TI) or usual care (UC) study arms. BP was measured as the mean of 3 measurements obtained at each research clinic visit. General linear mixed models utilizing a direct likelihood-based ignorable approach for missing data were used to examine change from baseline to 54 months in systolic and diastolic BP (SBP and DBP). Results: Research clinic BP measurements were obtained from 326 (72%) study patients at the 54 month follow-up visit. Routine clinical care BP measurements were obtained from 444 (99%) of study patients from 7025 visits during the follow-up period. For TI patients, based on research clinic measurements baseline SBP was 148.2 mm Hg and 54 month follow-up was 131.2 mm Hg (-17.0 mm Hg, p<.001). For UC patients, baseline SBP was 147.7 mm Hg and 54 month follow-up was 131.7 mm Hg ( -16.0 mm Hg, p<.001). The differential reduction by study arm in SBP from baseline to 54 months was -1.0 mm Hg (95% CI: -5.4 to 3.4, p=0.63). For TI patients, baseline DBP was 84.4 mm Hg and 54 month follow-up was 77.8 (-6.6 mm Hg, p<.001). For UC patients, baseline DBP was 85.1 mm Hg and 54 month follow-up was 79.1 mm Hg (-6.0 mm Hg, p<.001). The differential reduction by study arm in DBP from baseline to 54 months was -0.6 mm Hg (95% CI: -3.5 to 2.4, p=0.67). SBP and DBP results from routine clinical measurements closely approximated the pattern of results from research clinic measurements. Conclusion: Significant BP reductions in the TI arm relative to UC were no longer seen at 54 month follow-up. To maintain intervention benefits over a longer period of time additional intervention is needed.

Abstract P262: Spot Urine Sodium to Potassium Ratio Predicts Increasing Blood Pressure Levels in a General Population: The Nagahama Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Yasuharu Tabara ◽  
Yoshimitsu Takahashi ◽  
Takeo Nakayama ◽  
Fumihiko Matsuda
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Linear Regression Analysis ◽  
Prognostic Significance ◽  
Reverse Causality ◽  
Cross Sectional ◽  
Salt Loading ◽  
Available N ◽  
Spot Urine

Excessive salt intake is a risk factor for hypertension. The most reliable method for estimating daily salt intake is measurement of 24-h urinary sodium excretion, while it is inconvenient. Sodium-to-potassium ratio (Na/K) of a urine sample is another index of salt loading. We previously reported that a simple measure of spot urine Na/K might be a representative of salt loading in a cross-sectional setting. Here, we conducted a longitudinal study aiming to clarify a prognostic significance of spot urine Na/K for increasing blood pressure (BP) levels. Study subjects consists of 9,769 general individuals. Among them, individuals whose baseline Na/K was available (n=9,328), who were normotensive at baseline (n=6,392), and who participated in the follow-up measurement (n=5,209) were included in this analysis (51.8±12.9 years old, male: 29.2%). Mean follow-up duration was 5.0±0.5 years. Mean Na/K at baseline was 3.1±1.7, and showed step-wise increase with BP levels (optimal: 3.0±1.6, normal: 3.3±1.8, high normal: 3.4±1.8, P<0.001). Other major factors that were significantly associated with Na/K was fasting time (r=-0.220, P<0.001), and CKD (CKD (n=694): 2.7±1.6, control: 3.2±1.7, P<0.001). Mean SBP was significantly increased during follow-up period (baseline: 116±12, follow-up: 119±15 mmHg), and 805 individuals (15.5%) were newly diagnosed as hypertension (HT). These individuals were significantly older (HT: 60.3±9.9, NT: 50.3±12.8 years), were frequently male (36.4%, 27.9%), and had higher SBP (127±9, 115±11 mmHg) at baseline (P<0.001). In contrast, baseline spot urine Na/K was slightly lower in individuals who developed HT (3.0±1.6, 3.1±1.8, P=0.013), while that measured at follow-up investigation was oppositely higher in hypertensives (3.1±1.8, 2.8±1.5, P<0.001). Multiple linear regression analysis adjusted for the covariates identified baseline Na/K (β=0.108, P<0.001) and changes in Na/K during follow-up period (β=0.222, P<0.001) as independent determinants for future SBP levels. Higher spot urine Na/K, as well as increases in the Na/K levels, was significant determinant for future BP levels. The apparently lower baseline Na/K levels in individuals who developed HT might be due to reverse causality.

Abstract P622: Racial Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alison L Herman ◽  
Adam H De Havenon ◽  
Guido J Falcone ◽  
Shadi Yaghi ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Systolic Blood Pressure ◽  
White Matter Hyperintensity ◽  
Diabetic Patients ◽  
Patient Race ◽  
Black Patients ◽  
The Mean ◽  
White Patients

Introduction: White matter hyperintensities (WMH) are linked to cognitive decline and stroke. We hypothesized that Black race would be associated with greater WMH progression in the ACCORDION MIND trial. Methods: The primary outcome is WMH progression in mL, evaluated by fitting linear regression to WMH volume on the month 80 MRI and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as “other” race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. Results: We included 276 patients who completed the baseline and month 80 MRI, of which 207 were white, 48 Black, and 21 Hispanic. During follow-up, the mean number of SBP, LDL, and A1c measurements per patient was 21, 8, and 15. The mean (SD) WMH progression was 3.3 (5.4) mL for blacks, 2.5 (3.2) mL for Hispanics, and 2.4 (3.3) mL for whites. In the multivariate regression model (Table 1), Black, compared to white, patients had significantly more WMH progression (β Coefficient 1.26, 95% CI 0.45-2.06, p=0.002). Hispanic, compared to white, patients did not have significantly different WMH progression (p=0.392), nor was there a difference when comparing Hispanic to Black patients (p=0.162). The predicted WMH progression was significantly higher for Black compared to white patients across a mean SBP of 117 to 139 mm Hg (Figure 1). Conclusions: Black diabetic patients in ACCORDION MIND have a higher risk of WMH progression than white patients across a normal range of systolic blood pressure.

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.

scholarly journals Salt intake and blood pressure in the university of Asuncion-Paraguay youths: a preliminary study

2012 ◽  
Vol 34 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Tania Campagnoli ◽  
Lorena Gonzalez ◽  
Francisco Santa Cruz
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Preliminary Study ◽  
The University

Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lauren East ◽  
Zainab Mahmoud ◽  
Amanda Verma
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Vital Signs ◽  
Wilcoxon Test ◽  
Initial Visit ◽  
Office Visits ◽  
Paired Data ◽  
Cardiology Clinic ◽  
Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
Eva Mistry ◽  
Mohammad Anadani ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Adjusted Risk ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

Cross-talk between ANGPTL4 gene SNP rs1044250 and weight management is a risk factor of Mets

2020 ◽  
Author(s):  
Zhoujie Tong ◽  
Jie Peng ◽  
Hongtao Lan ◽  
Wenwen Sai ◽  
Yulin Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Waist Circumference ◽  
Weight Management ◽  
Independent Risk Factor ◽  
Lifestyle Changes ◽  
Elevated Blood Pressure ◽  
Base Line ◽  
Elevated Blood

Abstract Background The prevalence of metabolic syndrome (Mets) is closely related to the increased incidence of cardiovascular events. Angiopoietin-like protein 4 (ANGPTL4) is contributory to the regulation of lipid metabolism, herein, may provide a target for gene-aimed therapy of Mets. This case-control study was designed to elucidate the relationship between Angiopoietin-like protein 4 (ANGPTL4) gene single nucleotide polymorphism (SNP) rs1044250 and the onset of Mets, and to explore the effect of interaction between SNP rs1044250 and weight management on Mets. Methods We have recruited 1018 Mets cases and 1029 controls in this study. The SNP rs1044250 was detected, base-line information and Mets-related indicators were collected. A 5-year follow-up survey was carried out to track the lifestyle changes, drug treatments and changes in Mets-related indicators. Results ANGPTL4 gene SNP rs1044250 is an independent risk factor for increased waist circumference (OR 1.618, 95% CI [1.119–2.340]; p = 0.011) and elevated blood pressure (OR 1.323, 95% CI [1.002–1.747]; p = 0.048), the prevalence of Mets (OR 1.875, 95% CI [1.363–2.580]; p < 0.001) is increased. The follow-up survey shows that rs1044250 CC genotype patients with weight gain have an increased number of Mets components (M [Q1, Q3]: CC 1 (0, 1), CT + TT 0 [-1, 1]; p = 0.021); The interaction between SNP rs1044250 and weight management is a risk factor for increased SBP (β = 0.075, p < 0.001) and increased DBP (β = 0.097, p < 0.001), the synergistic effect is negative (S < 1). Conclusion ANGPTL4 gene SNP rs1044250 is an independent risk factor for increased waist circumference and elevated blood pressure, therefore, for Mets. Weight management that interacts negatively with ANGPTL4 polymorphism is an essential lifestyle intervention approach for elevated blood pressure.

scholarly journals Long-Term Use of Aldosterone-Receptor Antagonists in Uncontrolled Hypertension: A Retrospective Analysis

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Pieter M. Jansen ◽  
Koen Verdonk ◽  
Ben P. Imholz ◽  
A. H. Jan Danser ◽  
Anton H. van den Meiracker
Keyword(s):  
Blood Pressure ◽  
Multivariate Analysis ◽  
Essential Hypertension ◽  
Primary Aldosteronism ◽  
Treatment Duration ◽  
Uncontrolled Hypertension ◽  
Receptor Antagonists ◽  
Aldosterone Receptor

Background. The long-term efficacy of aldosterone-receptor antagonists (ARAs) as add-on treatment in uncontrolled hypertension has not yet been reported.Methods. Data from 123 patients (21 with primary aldosteronism, 102 with essential hypertension) with difficult-to-treat hypertension who received an ARA between May 2005 and September 2009 were analyzed retrospectively for their blood pressure (BP) and biochemical response at first followup after start with ARA and the last follow-up available.Results. Systolic BP decreased by22±20and diastolic BP by9.4±12 mmHg after a median treatment duration of 25 months. In patients that received treatment >5 years, SBP was33±20and DBP was 16 ± 13 mmHg lower than at baseline. Multivariate analysis revealed that baseline BP and follow-up duration were positively correlated with BP response.Conclusion. Add-on ARA treatment in difficult-to-treat hypertension results in a profound and sustained BP reduction.

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