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.

scholarly journals Controlling resistant hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Renal Hypertension ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Aldosterone Antagonists ◽  
Improve Blood Pressure Control ◽  
Blood Pressures

Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.

scholarly journals Extreme Elevations in Blood Pressure and All-Cause Mortality in a Referred CKD Population: Results from the CRISIS Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
James Ritchie ◽  
Francesco Rainone ◽  
Darren Green ◽  
Helen Alderson ◽  
Diana Chiu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Mortality Risk ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Blood Pressure Target ◽  
Renal Nerve ◽  
Renal Nerve Ablation ◽  
Pressure Lowering ◽  
Blood Pressures

Hypertension frequently complicates chronic kidney disease (CKD), with studies showing clinical benefit from blood pressure lowering. Subgroups of patients with severe hypertension exist. We aimed to identify patients with the greatest mortality risk from uncontrolled hypertension to define the prevalence and phenotype of patients who might benefit from adjunctive therapies. 1691 all-cause CKD patients from the CRISIS study were grouped by baseline blood pressure—target (<140/80 mmHg); elevated (140–190/80–100 mmHg); extreme (>190 and/or 100 mmHg). Groups were well matched for age, eGFR, and comorbidities. 77 patients had extreme hypertension at recruitment but no increased mortality risk (HR 0.9,P=0.9) over a median follow-up period of 4.5 years. The 1.2% of patients with extreme hypertension at recruitment and at 12-months had a significantly increased mortality risk (HR 4.3,P=0.01). This association was not seen in patients with baseline extreme hypertension and improved 12-month blood pressures (HR 0.86,P=0.5). Most CKD patients with extreme hypertension respond to pharmacological blood pressure control, reducing their risk for death. Patients with extreme hypertension in whom blood pressure control cannot be achieved have an approximate prevalence of 1%. These patients have an increased mortality risk and may be an appropriate group to consider for further therapies, including renal nerve ablation.

scholarly journals Uncontrolled Hypertension and its Contributing Factors in a Tertiary Care Hospital of Lahore, Pakistan.

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Omer Sabir ◽  
Anam Rashid ◽  
Muhammad Mohsin Riaz
Keyword(s):  
Blood Pressure ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Morbidity And Mortality ◽  
Uncontrolled Hypertension ◽  
Care Hospital ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Blood Pressures ◽  
Study Population

Abstract: Hypertension is a major cause of morbidity and mortality worldwide. In spite of the availability of adequate medical therapy, more than half of the patients have blood pressures persistently above the treatment threshold (140/90 mmHg). Objective: To investigate the factors responsible for uncontrolled hypertension. Materials and Methods: It was a descriptive cross-sectional study. The study population comprised of 152 consecutive hypertensive patients more than 18 years of age presenting to the Nephrology Clinic at Fatima Memorial Hospital during the period of one month (July 2020) were included in this study. The criteria for control was defined as an office BP of less than 140/90 mmHg. Results: 96 patients (63.2%) had controlled blood pressure and 56 patients (36.8%) had uncontrolled blood pressure. Males exhibited uncontrolled BP (59%) more than females. Out of all the factors studied, volume status had a significant effect on control of HTN (p=0.003). Conclusion Control of hypertension in our population is still far being perfect. There is a need to fortify our efforts to control hypertension so as to reduce associated morbidity and mortality. At the same time there is a need to conduct large studies to fully elucidate the factors contributing to uncontrolled hypertension in our population.

Abstract P256: Genetic Determinants Of Blood Pressure Associate With Apparent Treatment Resistant Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Joseph H Breeyear ◽  
Megan M Shuey ◽  
Todd L Edwards ◽  
Jacklyn Hellwege
Keyword(s):  
Blood Pressure ◽  
Risk Scores ◽  
Uncontrolled Hypertension ◽  
Polygenic Risk Score ◽  
Genetic Determinants ◽  
Treatment Resistant ◽  
Polygenic Risk ◽  
Blood Pressures ◽  
The Uk ◽  
Hispanic White

Hypertension is estimated to affect more than 49.6% of US adults 20 years and older. Of those individuals with hypertension, more than ten million are classified as apparent treatment resistant hypertensive (aTRH). The attributable risk of uncontrolled hypertension was estimated to be 49% for cardiovascular disease and 62% for stroke. We developed a polygenic risk score (PRS) for systolic (SBP) and diastolic (DBP) blood pressure to examine the association between the genetic determinants of blood pressure and aTRH with the goal of identifying high risk individuals. The meta-analyzed transethnic results of Giri et al., Biobank Japan, and Liang et al. were used to generate a PRS with PRS-CS followed by p -value thresholding, and validation in the UK Biobank (n max =341,930). Associations were modeled with logistic regression adjusted for age, age-squared, BMI, sex, and ten principal components of ancestry in BioVU’s transethnic population (n max =37,978), as well as non-Hispanic Black (n max =5,026) and non-Hispanic White (n max =28,545) subsets. The SBP PRS was significantly associated with an increased aTRH risk in the non-Hispanic White subset (1.08 (1.04 - 1.12), p = 0.00037) and transethnic (1.08 (1.04 - 1.13), p = 0.00020) populations, but not the non-Hispanic Black subset. The DBP PRS was not associated with aTRH in any population. Our findings present evidence that individuals with a higher genetic predisposition towards hypertension are at higher risk of aTRH. By integrating polygenic risk scores and clinical covariates in prediction of aTRH, individuals’ therapeutic regimens may be tailored to help maintain stable blood pressures, therefore reducing their risk of comorbidities.

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.

scholarly journals The FAITH Trial: Baseline Characteristics of a Church-based Trial to Improve Blood Pressure Control in Blacks

2015 ◽  
Vol 25 (3) ◽  
pp. 337 ◽  
Author(s):  
Antoinette Schoenthaler, EdD ◽  
Kristie Lancaster, PhD ◽  
Sara Midberry, MPH ◽  
Matthew Nulty, MPH ◽  
Elizabeth Ige, BS ◽  
...  
Keyword(s):  
Blood Pressure ◽  
New York ◽  
Lifestyle Intervention ◽  
Fruits And Vegetables ◽  
Pressure Control ◽  
Activity Level ◽  
Lifestyle Behaviors ◽  
Black Adults ◽  
Improve Blood Pressure Control ◽  
Faith Based

<strong>Objective: </strong>To describe the baseline char­acteristics of participants in the Faith-based Approaches in the Treatment of Hyperten­sion (FAITH) Trial.<p><strong>Design: </strong>FAITH evaluates the effectiveness of a faith-based lifestyle intervention vs health education control on blood pressure (BP) reduction among hypertensive Black adults.</p><p><strong>Setting, Participants, and Main Measures: </strong>Participants included 373 members of 32 Black churches in New York City. Baseline data collected included participant demo­graphic characteristics, clinical measures (eg, blood pressure), behaviors (eg, diet, physical activity), and psychosocial factors (eg, self-efficacy, depressive symptoms).</p><p><strong>Results: </strong>Participants had a mean age of 63.4 ± 11.9 years and 76% were female. About half completed at least some college (53%), 66% had an income ≥$20,000, and 42.2% were retired or on disability. Partici­pants had a mean systolic and diastolic BP of 152.1 ± 16.8 mm Hg and 86.2 ± 12.2 mm Hg, respectively, and a mean BMI of 32 kg/m2. Hypertension (HTN) medications were taken by 95% of participants, but most (79.1%) reported non-adherence to their regimen. Participants reported consuming 3.4 ± 2.6 servings of fruits and vegetables and received 30.9% of their energy from fat. About one-third (35.9%) reported a low activity level.</p><p><strong>Conclusion: </strong>Participants in the FAITH trial exhibited several adverse clinical and behavioral characteristics at baseline. Future analyses will evaluate the effective­ness of the faith-based lifestyle intervention on changes in BP and lifestyle behaviors among hypertensive Black adults. <em>Ethn Dis</em>. 2015;25[3]:337-344.</p>

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.

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