scholarly journals Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

Hypertension ◽  
2021 ◽  
Author(s):  
Jamie A. Kitt ◽  
Rachael L. Fox ◽  
Alexandra E. Cairns ◽  
Jill Mollison ◽  
Holger H. Burchert ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Dietary Factors ◽  
Self Management ◽  
Chronic Hypertension ◽  
Randomized Controlled ◽  
Short Period ◽  
The Impact

Women with hypertensive pregnancies are 4× more likely to develop chronic hypertension. Previously, we showed a short period of blood pressure (BP) self-management following hypertensive pregnancy resulted in persistently lower BP after 6 months. We now report the impact on long-term BP control. Women who participated in the postpartum randomized controlled trial, SNAP-HT (Self-Management of Postnatal Hypertension; NCT02333240), were invited for 24-hour ambulatory and clinic BP measures. Height and weight were measured by calibrated scales and standardized tape measures, activity by 7-day wrist-worn accelerometer, and dietary factors assessed by questionnaire. Sixty-one of 70 eligible women were followed up 3.6±0.4 years after their original pregnancy. Twenty-four–hour diastolic BP was 7.0 mm Hg lower in those originally randomized to postpartum BP self-management instead of usual care. This difference remained significant after adjustment for either BP at the time of delivery (−7.4 mm Hg [95% CI, −10.7 to −4.2]; P <0.001) or pregnancy booking BP (−6.9 mm Hg [95% CI, −10.3 to −3.6]; P <0.001). Adjustment for current salt intake, age, body mass index, waist-to-hip ratio, arm circumference, parity, alcohol intake, and physical activity had no effect on this difference. Reductions in diastolic BP at 6 months, following self-management of BP postpartum, are maintained 3.6 years later as measured by lower 24-hour diastolic BP. Interventions to optimize BP control during the puerperium in women with hypertensive pregnancies improve BP in the longer term, in a cohort at increased risk of developing chronic hypertension and major adverse cardiovascular events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02333240.

scholarly journals DISSOCIATION BETWEEN LONG-TERM WEIGHT LOSS INTERVENTION AND BLOOD PRESSURE. AN 18-MONTH RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Vol 39 (Supplement 1) ◽  
pp. e339
Author(s):  
Yftach Gepner ◽  
Nir Goldstein ◽  
Ilan Shelef ◽  
Dan Schwarzfuchs ◽  
Hila Zelicha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Weight Loss Intervention ◽  
Randomized Controlled

scholarly journals The Effects of Tai Chi on Grade 1 Hypertension: A Study Protocol for a Randomized Controlled Trial

2019 ◽  
Author(s):  
Sang Hyun Lee ◽  
Byung-Jun Kim ◽  
In-Hwa Park ◽  
Eui-Hyoung Hwang ◽  
Eun Ju Park ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Tai Chi ◽  
Salt Intake ◽  
Controlled Trial ◽  
Treatment Options ◽  
Treatment Method ◽  
Care Group ◽  
Randomized Controlled

Abstract Background Medication is generally recommended to reduce the morbidity and mortality caused by cardiovascular disease in hypertensive patients. However, considering the difficulties and economic factors associated with long-term medication, interest in tai chi as an exercise treatment method has been recently increasing in Korean medical practice. Numerous studies have suggested that tai chi can be used to treat various diseases and affect psychosomatic factors such as anxiety. This study aims to evaluate the effect of tai chi in reducing blood pressure among grade 1 hypertensive patients.Methods In this randomized, active-controlled, assessor-blinded, two parallel-armed trial, 80 grade 1 hypertension patients will be recruited and randomly assigned to the usual care group or to the tai chi group (n = 40 in each group). Subjects who voluntarily signed a study agreement will be educated to manage their own blood pressure by restricting salt intake, losing weight, moderating alcohol consumption, performing exercise, and regulating dietary intake at their first visit. In addition to self-management, the tai chi group will perform two 60-minute tai chi sessions per week for a total of 8 weeks. Blood pressure will be measured as the primary outcome. In addition, body composition, heart rate, and the perceived strength and difficulty of the exercise will be measured as secondary outcomes.Discussion This study intends to conduct a randomized controlled trial of tai chi, which is not widely practiced in Korea. This study will provide valuable data on the effects of tai chi on hypertension, to inform non-pharmaceutical treatment options for this disorder.

Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes

2021 ◽  
Author(s):  
Gregory A Talavera ◽  
Sheila F Castañeda ◽  
Paulina M Mendoza ◽  
Maria Lopez-Gurrola ◽  
Scott Roesch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Management ◽  
Culturally Appropriate ◽  
Significant Group ◽  
Randomized Controlled ◽  
Federally Qualified Health Center

Abstract We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p &lt; .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p = &lt;.01) versus Usual Care (ΔHbA1c = −0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p &lt; .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.

scholarly journals Implementation and effectiveness from a randomized controlled trial of automated virtual type 2 diabetes self-management education: Diabetes Engagement and Activation Platform (Preprint)

2020 ◽  
Author(s):  
Roy Sabo ◽  
Jo Robins ◽  
Stacy Lutz ◽  
Paulette Kashiri ◽  
Teresa Day ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Management Education ◽  
Controlled Trial ◽  
Significant Proportion ◽  
Self Management ◽  
Patient Portals ◽  
Randomized Controlled

UNSTRUCTURED Aims: To help patients with type 2 diabetes receive recommended self-management education and support (DSMES), we designed the Diabetes Engagement and Activation Platform (DEAP) – an automated patient education tool integrated into primary care workflow – and examined its implementation and effectiveness. Methods: We invited patients age 18-85 years with hemoglobin A1C (HbA1c) ≥ 8 to participate in a randomized controlled trial comparing DEAP to usual care. DEAP modules addressing DSMES domains were programmed into patient portals, each with self-guided educational readings, videos and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA1c, body mass index (BMI), and blood pressure were measured. Results: Implementation: Out of the 680 patients invited to participate 337 (49%) agreed and were randomized. Of 189 intervention patients, all accessed the first module and 140 (74%) accessed all nine modules. Post-module knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. Effectiveness: BMI was lower for intervention patients than controls at 3 months (31.7 versus 32.1 km/m2, p=.04) and 6 months (32.5 versus 33.0 km/m2, p=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3 or 6 month HbA1c or blood pressure in the intention to treat analysis. However, intervention patients completing at least one module compared to controls had a better HbA1c (7.6% versus 8.2%, p=.03) and DBP (72.3 versus 75.9 mmHg, p-value = .01) at 3 months. Conclusions: A significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and system show promise in helping patients manage their diabetes, weight, and blood pressure.

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