Use of Enhanced Data Visualization to Improve Patient Judgments about Hypertension Control

Objective. Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support—in the form of enhanced data visualization—could improve judgments about hypertension control. Methods. Participants (Internet sample of patients with hypertension) in 3 studies ( N = 209) viewed graphs depicting blood pressure data for fictitious patients. For each graph, participants rated hypertension control, need for medication change, and perceived risk of heart attack and stroke. In study 3, participants also recalled the percentage of blood pressure measurements outside of the goal range. The graphs varied by systolic blood pressure mean and standard deviation, change in blood pressure values over time, and data visualization type. Results. In all 3 studies, data visualization type significantly affected judgments of hypertension control. In studies 1 and 2, perceived hypertension control was lower while perceived need for medication change and subjective perceptions of stroke and heart attack risk were higher for raw data displays compared with enhanced visualization that employed a smoothing function generated by the locally weighted smoothing algorithm. In general, perceptions of hypertension control were more closely aligned with clinical guidelines when data visualization included a smoothing function. However, conclusions were mixed when comparing tabular presentations of data to graphical presentations of data in study 3. Hypertension was perceived to be less well controlled when data were presented in a graph rather than a table, but recall was more accurate. Conclusion. Enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control. More research is needed to determine the contexts in which graphs are superior to data tables.

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Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01194-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Richelle J. Koopman ◽

Shannon M. Canfield ◽

Jeffery L. Belden ◽

Pete Wegier ◽

Victoria A. Shaffer ◽

...

Keyword(s):

Blood Pressure ◽

Data Visualization ◽

Information Needs ◽

Home Blood Pressure ◽

Pressure Data ◽

Blood Pressure Data

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Patient Judgments About Hypertension Control: The Role of Variability, Trends, and Outliers in Visualized Blood Pressure Data

Journal of Medical Internet Research ◽

10.2196/11366 ◽

2019 ◽

Vol 21 (3) ◽

pp. e11366 ◽

Cited By ~ 2

Author(s):

Victoria Anne Shaffer ◽

Pete Wegier ◽

KD Valentine ◽

Jeffery L Belden ◽

Shannon M Canfield ◽

...

Keyword(s):

Blood Pressure ◽

Pressure Data ◽

Hypertension Control ◽

Blood Pressure Data

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Ambulatory blood pressure data is the best approximation of central aortic pressure in coarctation of aorta

International Journal of Cardiology Congenital Heart Disease ◽

10.1016/j.ijcchd.2021.100142 ◽

2021 ◽

Vol 4 ◽

pp. 100142

Author(s):

Alexander C. Egbe ◽

William R. Miranda ◽

Heidi M. Connolly ◽

Iftikhar J. Kullo

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Best Approximation ◽

Aortic Pressure ◽

Coarctation Of Aorta ◽

Pressure Data ◽

Central Aortic Pressure ◽

The Best Approximation ◽

Blood Pressure Data

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Artifact Detection in Invasive Blood Pressure Data using Forecasting Methods and Machine Learning

2020 IEEE International Conference on Bioinformatics and Biomedicine (BIBM) ◽

10.1109/bibm49941.2020.9313540 ◽

2020 ◽

Author(s):

Mengqi Wu ◽

Paula Branco ◽

Janny Xue Chen Ke ◽

David B. MacDonald

Keyword(s):

Machine Learning ◽

Blood Pressure ◽

Pressure Data ◽

Artifact Detection ◽

Invasive Blood Pressure ◽

Forecasting Methods ◽

Blood Pressure Data

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Comparison of 24-Hour Ambulatory Blood Pressure Data in Hypertensive Patients Switched from Nifedipine-GITS to Nifedipine-CC

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy ◽

10.1592/phco.19.1.94.30512 ◽

1999 ◽

Vol 19 (1) ◽

pp. 94-100 ◽

Cited By ~ 4

Author(s):

Richard L. Wurdeman ◽

Aryan N. Mooss ◽

Syed M. Mohiuddin ◽

B. Daniel Lucas ◽

Kay L. Ryschon ◽

...

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Pressure Data ◽

Hypertensive Patients ◽

Blood Pressure Data

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Abstract TMP89: Collaterals and Reperfusion Mediate Blood Pressure Changes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp89 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

David S Liebeskind ◽

Graham W Woolf ◽

Nerses Sanossian ◽

Jason D Hinman ◽

Radoslav Raychev ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Arterial Occlusion ◽

Patient Specific ◽

Pressure Data ◽

Blood Pressure Data ◽

Pressure Changes ◽

Continuous Blood Pressure

Background: The pathophysiology and optimal management of blood pressure changes in acute ischemic stroke remain unknown. Blood pressure guidelines do not consider patient-specific or serial data on dynamic blood pressure readings. We investigated continuous blood pressure data during endovascular therapy for acute stroke to discern changes associated with collaterals, recanalization and reperfusion. Methods: Continuous monitoring blood pressure data was collected in consecutive cases of endovascular therapy for acute ischemic stroke due to ICA or proximal MCA occlusion. Angiography details were independently analyzed to document site of arterial occlusion, baseline collateral grade, time of device deployments, time of recanalization, time of final reperfusion, final AOL recanalization and final TICI reperfusion. Statistical analyses correlated instantaneous and serial blood pressure changes with these angiographic parameters. Results: 80 patients (median age 73 years; 33 women) were studied. Arterial lesions included 37 ICA and 41 proximal M1 MCA occlusions. Collateral grade prior to intervention included 2 ASITN grade 4, 26 grade 3, 23 grade 2, 6 grade 1 and 0 grade 0. oTICI2C reperfusion scores after thrombectomy included 2 TICI 3 (100%), 22 TICI 2C (90-99%), 25 TICI o2B (67-89%), 9 TICI m2B (50-66%), 19 TICI 2A (<50%) and 3 TICI 0/1. More robust collateral grade was associated with greater reperfusion scores (r=0.32, p=0.028). The change in blood pressure (ΔBP) from earliest BP to time of recanalization was mean 59% of ΔBP during the entire procedure. Better collaterals were associated with lower BP prior to recanalization (r=-0.377, p=0.012). Lower BP prior to recanalization was linked with greater TICI reperfusion (r=-0.242, p=0.050). Higher TICI reperfusion scores were also associated with a greater drop or ΔBP at the time of recanalization (r=0.269, p=0.031). AOL recanalization was not related to ΔBP. Conclusions: Collaterals and reperfusion, but not recanalization, mediate blood pressure changes in acute ischemic stroke. Prospective, precision medicine stroke studies should leverage patient-specific, real-time data on continuous blood pressure with imaging correlates to define BP goals of future in-hospital management.

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Abstract P178: Sentinel Platform Reduces Blood Pressure And Crisis Hypertension (2020 Update)

Hypertension ◽

10.1161/hyp.76.suppl_1.p178 ◽

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.

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A hypertension control quality improvement pilot program: Experiences and blood pressure outcomes from physician practices

International Journal of Healthcare ◽

10.5430/ijh.v4n1p42 ◽

2018 ◽

Vol 4 (1) ◽

pp. 42 ◽

Cited By ~ 2

Author(s):

Tamkeen Khan ◽

Jianing Yang ◽

Laken Barkowski ◽

Beth Tapper ◽

Lisa Lubomski ◽

...

Keyword(s):

Blood Pressure ◽

Quality Improvement ◽

Learning Opportunities ◽

Intervention Strategies ◽

Uncontrolled Hypertension ◽

Evidence Based ◽

Pilot Program ◽

Pressure Management ◽

Hypertension Control ◽

Physician Practices

Improving Health Outcomes: Blood Pressure (IHO: BP) was a Quality Improvement (QI) pilot program developed by the American Medical Association (AMA) and Johns Hopkins Medicine aimed at helping physicians and their care teams better manage patients with uncontrolled hypertension. The pilot study was conducted at 10 ambulatory practice sites between October 2013 and November 2014 in which the initiative was to devise a framework and intervention strategies for improving hypertension control. The program included evidence-based tools and materials to support the Measure Accurately, Act Rapidly, and Partner with Patients (M.A.P.) framework, interactive components with coaching support and peer-to-peer learning opportunities, and a measurement system supported by health technology, all intended to aid blood pressure management. This paper captures the learnings from the engagement, experiences, and satisfaction of care teams from the IHO: BP pilot that were used to adjust, reassess, and refine components of the QI program. Overall, participation in the IHO: BP pilot was associated with an increase in BP control rates from a mean of 69% to 75% (p < .05) for 3 of the 10 practices. Mean systolic and diastolic blood pressure was reduced in 8 of 10 practices by a mean of 12.5 mmHg/6.5 mmHg (p < .05). Furthermore, evaluation of participant experiences indicated that 75% of the respondents were satisfied or very satisfied with the initiative. The results from this study include components of the pilot that participants indicated were most helpful and were used to generate useful information for hypertension QI efforts that were later scaled and spread to subsequent initiatives.

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