scholarly journals A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

2016 ◽  
Vol 26 (1) ◽  
pp. 27 ◽  
Author(s):  
Nancy R. Kressin ◽  
Judith A. Long ◽  
Mark E. Glickman ◽  
Barbara G. Bokhour ◽  
Michelle B. Orner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Communication Skills ◽  
Pressure Control ◽  
Control Site ◽  
Clinical Inertia ◽  
Improve Blood Pressure Control ◽  
Clinician Training ◽  
Primary Care Clinics ◽  
Tailored Interventions ◽  
Race Disparities

<p><strong>Background</strong>. Poor blood pressure (BP) control and racial disparities therein may be a function of clinical inertia and ineffective communication about BP care.</p><p><strong>Methods. </strong>We compared two different interventions (electronic medical record  reminder for BP care (Reminder only [RO]), and clinician training on BP care-related communication skills plus the reminder (Reminder + Training, [R+T]) with usual care in three primary care clinics, examining BP outcomes among 8,866 patients, and provider-patient communication and medication adherence among a subsample of 793.</p><p><strong>Results. </strong>Clinician counseling improved most at R+T.  BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. </p><p><strong>Conclusions. </strong>More substantial or racial/ethnically tailored interventions are needed. Ethn Dis. 2016;26(1):27-36; doi: 10.18865/ed.26.1.27</p>

Device Therapy of Hypertension

2021 ◽  
Vol 128 (7) ◽  
pp. 1080-1099
Author(s):  
Felix Mahfoud ◽  
Markus P. Schlaich ◽  
Melvin D. Lobo
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Blood Pressure Control ◽  
Carotid Body ◽  
Renal Denervation ◽  
Pressure Control ◽  
Hypertension Control ◽  
Baroreflex Activation Therapy ◽  
Improve Blood Pressure Control ◽  
Activation Therapy

In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.

Abstract 15595: Missed Targets: United States Trends in Hypertension Prevalence, Control, and Treatment 2005-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Aggarwal ◽  
Nicholas Chiu ◽  
Rishi Wadhera ◽  
Changyu Shen ◽  
Robert W Yeh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Temporal Trends ◽  
Cost Effective ◽  
Pressure Control ◽  
Healthy People ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Improve Blood Pressure Control ◽  
Hypertension Prevalence ◽  
And Control

Introduction: Hypertension is a major risk factor for cardiovascular disease. The US government, through the Healthy People Initiative 2020, set targets to improve hypertension prevalence and treatment rates in US adults by a relative 10% from 2005 to 2020, and increase control rates by a relative 40%. We examined US progress towards this goal from 2005-2018. Methods: We analyzed data from 38,876 non-pregnant US adults from the NHANES 2005-2018 surveys to determine nationally representative estimates of hypertension prevalence, treatment rates, and control. Temporal trends in hypertension prevalence, treatment, and control were assessed using weighted linear regression after age adjustment to the 2000 US census (per the Healthy People Initiative approach). In the base case, we defined hypertension as blood pressure >140/90 or on an antihypertensive; we used the ACC/AHA definition of blood pressure >130/80 in sensitivity analyses. Results: In 2017-2018, 34.3% (±1.7) of US adults had hypertension, of these 69.7% (±1.5) were on treatment, and 43.7% (±1.6) were controlled. After age-adjustment, no statistically significant changes in hypertension prevalence, treatment rates, or control were observed from 2005-2018 (p for trend 0.91, ,0.98, 0.66, Figure 1). In sensitivity analyses, applying the ACC/AHA definition increased the estimated prevalence of hypertension during the period, but trends in prevalence remained unchanged. Conclusions: There has been no material progress in reducing the prevalence of hypertension or improving rates of treatment and control from 2005 to 2018. As planning is underway for Healthy People Initiative 2030, setting of hypertension targets must be accompanied with investments in cost-effective, scalable programs to improve blood pressure control nationwide, with a focus on high-risk populations.

Impact of Hypertension Guideline Implementation on Blood Pressure Control and Drug Use in Primary Care Clinics

1999 ◽  
Vol 25 (2) ◽  
pp. 68-77 ◽  
Author(s):  
Patrick J. O’Connor ◽  
Elaine S. Quiter ◽  
William A. Rush ◽  
Mark Wiest ◽  
Jeffrey T. Meland ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Drug Use ◽  
Blood Pressure Control ◽  
Guideline Implementation ◽  
Pressure Control ◽  
Primary Care Clinics ◽  
Hypertension Guideline

Examining the Feasibility of a Simple Intervention to Improve Blood Pressure Control for Primary Care Patients

2016 ◽  
Vol 31 (4) ◽  
pp. 291-295
Author(s):  
Giang T. Nguyen ◽  
Heather A. Klusaritz ◽  
Alison O’Donnell ◽  
Elise M. Kaye ◽  
Heather F. de Vries McClintock ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Improve Blood Pressure Control ◽  
Primary Care Patients

2012 Consensus Document of the Italian Society of Hypertension (SIIA): Strategies to Improve Blood Pressure Control in Italy

2013 ◽  
Vol 20 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Massimo Volpe ◽  
Enrico Agabiti Rosei ◽  
Ettore Ambrosioni ◽  
Santina Cottone ◽  
Cesare Cuspidi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Italian Society ◽  
Improve Blood Pressure Control ◽  
Consensus Document

Abstract P052: The Effect of Re-designing Workflow and Introducing Automated Blood Pressure Devices in Community-based Primary Care Clinics

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Romsai T Boonyasai ◽  
Greg P Prokopowicz ◽  
Jeanne Charleston ◽  
Kathryn A Carson ◽  
Gary J Noronha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Measurement ◽  
Clinical Inertia ◽  
Intervention Period ◽  
Post Intervention ◽  
Community Based ◽  
Primary Care Clinics ◽  
Clinic Staff ◽  
Measurement Protocol

BACKGROUND: Prior studies report that poor technique and terminal digit preference (TDP) can distort blood pressure (BP) estimates in clinical settings. These limitations may bias population BP estimates, increase clinician workload, and contribute to clinical inertia. HYPOTHESIS: We hypothesized that BP measurement training with an automated blood pressure measurement (aBPM) device would reduce TDP, reduce the number of times clinicians repeat staff-obtained measurements, and reduce average BP estimates within each site. METHODS: We replaced aneroid BP measurement devices in 6 community-based primary care clinics with aBPM devices (Omron HEM-907XL) and trained clinic staff with a standardized BP measurement protocol using 1 hour presentations and follow-up visits. We report mean weekly BP measured in the 8 weeks pre- and 4 weeks post-intervention at the first intervention site. Results are analyzed using chi-squared and paired t-tests. RESULTS: Clinic staff recorded 5796 BP readings in the 8 week pre-intervention period and 2321 readings in the 4 weeks post-intervention period. TDP and clinician workload improved after the intervention. Pre-intervention, 1941 of 4833 (40.2%) of systolic BP and 2199 of 4833 (45.5%) of diastolic BP ended in zero, in contrast to 216 of 2158 (10.0%) of systolic and 219 of 2158 (10.2%) of diastolic readings post-intervention (P<.001 for both SBP and DBP). Clinicians repeated BP obtained by staff in 963 of 5796 (16.6%) of visits pre-intervention but only in 163 of 2321 (7.0%) of visits post-intervention (P<.001). TDP persisted when clinicians repeated staff-obtained BP readings post-intervention: 58 of 163 (35.6%) systolic and 65 of 163 (35.7%) diastolic BP ended in zero (P=.32 for SBP and P=.35 for DBP in comparison with pre-intervention BP readings). Overall, BP estimates changed modestly following the intervention. Post-intervention, mean systolic BP rose 1.4 mmHg (P=.004) and diastolic BP declined 3.1 mmHg (P<.001). Among clinician-repeated BP readings, systolic BP rose 2.4 mmHg (P=.12 for pre/post change) and diastolic BP declined 0.4 mmHg (P=.72 for pre/post change). CONCLUSIONS: A standardized BP measurement protocol used with an aBPM device in community-based primary care settings can reduce TDP and clinician workload but is associated with only modest change in population BP estimates.

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