Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study

Background Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. Methods and findings We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017–2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%–46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%–56.5%) had been diagnosed, 38.9% (95% CI 38.1%–39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%–32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14–1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61–0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68–1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86–1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00–1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10–1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017–2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. Conclusions Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.

Peningkatkan Pengetahuan Masyarakat tentang Manajemen Perawatan Hipertensi: Pengabdian Kepada Masyarakat

ABSTRAK Hipertensi merupakan penyakit tidak menular yang menjadi salah satu penyebab utama kematian. Hipertensi dapat menyebabkan penyakit serius lainnya seperti penyakit stroke, penyakit jantung, penyakit ginjal dan lain-lain. Penderita hipertensi kebanyakan tidak menyadari bahwa mereka memiliki tekanan darah yang tinggi. Umumnya diketahui saat melakukan pemeriksaan kesehatan atau dalam kondisi kesehatan yang buruk. Tujuan pengabdian kepada masyarakat untuk meningkatkan pengetahuan masyarakat tentang manjemen hipertensi. Metode palaksanaan pengabdian kepada masyarakat adalah penyuluhan tentang hipertensi pada penderita hipertensi di Wilayah UPT Puskemas Gang Sehat Kota Pontianak. Hasil pengabdian kepada masyarakat didapatkan adanya peningkatan pengetahuan masyarakat tentang manajemen hipertensi. Pengetahuan merupakan dasar dalam merubah perilaku seseorang menjadi lebih sehat. Kata Kunci: Edukasi, Hipertensi ABSTRACT Hypertension is a non-communicable disease that is one of the main causes of death. Hypertension can cause other serious diseases such as stroke, heart disease, kidney disease, and others. Most people with hypertension do not realize that they have high blood pressure. It is generally discovered during a medical examination or is in poor health. The purpose of community service is to increase public knowledge about hypertension management. The method of implementing community service is counseling about hypertension in hypertension sufferers in the UPT Puskemas Gang Sehat area, Pontianak City. The results of community service showed an increase in public knowledge about hypertension management. Knowledge is the basis for changing one's behavior to be healthier. Keywords: Education, Hypertension

Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis

Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was −7.83 (95% CI, −9.06 to −6.62) mm Hg for systolic BP and −4.72 (95% CI, −5.46 to −3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41–2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72–0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58–0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.

Identifying Medication-related Intents from a Bidirectional Text Messaging Platform for Hypertension Management: An Unsupervised Learning Approach

Background: Free-text communication between patients and providers is playing an increasing role in chronic disease management, through platforms varying from traditional healthcare portals to more novel mobile messaging applications. These text data are rich resources for clinical and research purposes, but their sheer volume render them difficult to manage. Even automated approaches such as natural language processing require labor-intensive manual classification for developing training datasets, which is a rate-limiting step. Automated approaches to organizing free-text data are necessary to facilitate the use of free-text communication for clinical care and research. Objective: We applied unsupervised learning approaches to 1) understand the types of topics discussed and 2) to learn medication-related intents from messages sent between patients and providers through a bi-directional text messaging system for managing participant blood pressure. Methods: This study was a secondary analysis of de-identified messages from a remote mobile text-based employee hypertension management program at an academic institution. In experiment 1, we trained a Latent Dirichlet Allocation (LDA) model for each message type (inbound-patient and outbound-provider) and identified the distribution of major topics and significant topics (probability >0.20) across message types. In experiment 2, we annotated all medication-related messages with a single medication intent. Then, we trained a second LDA model (medLDA) to assess how well the unsupervised method could identify more fine-grained medication intents. We encoded each medication message with n-grams (n-1-3 words) using spaCy, clinical named entities using STANZA, and medication categories using MedEx, and then applied Chi-square feature selection to learn the most informative features associated with each medication intent. Results: A total of 253 participants and 5 providers engaged in the program generating 12,131 total messages: 47% patient messages and 53% provider messages. Most patient messages correspond to blood pressure (BP) reporting, BP encouragement, and appointment scheduling. In contrast, most provider messages correspond to BP reporting, medication adherence, and confirmatory statements. In experiment 1, for both patient and provider messages, most messages contained 1 topic and few with more than 3 topics identified using LDA. However, manual review of some messages within topics revealed significant heterogeneity even within single-topic messages as identified by LDA. In experiment 2, among the 534 medication messages annotated with a single medication intent, most of the 282 patient medication messages referred to medication request (48%; n=134) and medication taking (28%; n=79); most of the 252 provider medication messages referred to medication question (69%; n=173). Although medLDA could identify a majority intent within each topic, the model could not distinguish medication intents with low prevalence within either patient or provider messages. Richer feature engineering identified informative lexical-semantic patterns associated with each medication intent class. Conclusion: LDA can be an effective method for generating subgroups of messages with similar term usage and facilitate the review of topics to inform annotations. However, few training cases and shared vocabulary between intents precludes the use of LDA for fully automated deep medication intent classification.

Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

Background: Hypertension has become the second-leading risk factor for death worldwide. However, the fragmented three-level “county–township–village” medical and healthcare system in rural China cannot provide continuous, coordinated, and comprehensive health care for patients with hypertension, as a result of which rural China has a low rate of hypertension control. This study aimed to explore the costs and benefits of an integrated care model using three intervention modes—multidisciplinary teams (MDT), multi-institutional pathway (MIP), and system global budget and performance-based payments (SGB-P4P)—for hypertension management in rural China.Methods: A Markov model with 1-year per cycle was adopted to simulate the lifetime medical costs and quality-adjusted life-years (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 (MDT + MIP + SGB–P4P), and the Usual practice (usual care). We used the incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) to make economic decisions and a 5% discount rate. One-way and probability sensitivity analyses were performed to test model robustness. Data on the blood pressure control rate, transition probability, utility, annual treatment costs, and project costs were from the community intervention trial (CMB-OC) project.Results: Compared with the Usual practice, Option 1 yielded an additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of $3,373.75/QALY, the NMB was –$120.97, and the NHB was −0.076 QALYs. Compared with the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost decreased by $2,007.31, yielding an ICER of –$3,680.72/QALY. The NMB was $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was –$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way sensitivity analysis showed that the most sensitive factors in the model were treatment cost of ESRD, human cost, and discount rate. The probability sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 0.008, 0.813, and 0.179, respectively.Conclusions: The integrated care model with performance-based prepaid payments was the most beneficial intervention, whereas the general integrated care model (MDT + MIP) was not cost-effective. The integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the community management of hypertension in rural China as a continuous, patient-centered care system to improve the efficiency of hypertension management.

The Effectiveness of a Nurse-led Team-Based Hypertension Management among People with Uncontrolled Hypertension in a Community Hospital, Thailand

Introduction: Uncontrolled blood pressure of people with hypertension remains a major public health issue. The purpose of this research was to evaluate the effectiveness of a Nurse-led Team-based Hypertension Management Program (NTHMP) among people with uncontrolled hypertension.Methods: This quasi-experimental one-group pre-posttest design research was done to evaluate the effectiveness of a NTHMP in a community hospital in Thailand. The sample was thirty people with uncontrolled hypertension who received outpatient care in a community hospital in Thailand. They participated in three months NTHMP which included 1) team-approached health education, 2) medication administration support, 3) motivation interviewing on behavioral adjustment and 4) home blood pressure monitoring for three months. Outcomes of the program; systolic blood pressure, diastolic blood pressure, hospital admissions with signs of hypertensive urgency were analyzed by using frequency, percentage, mean, standard deviation, and repeated measured ANOVA.Results: The results indicated that people with uncontrolled HT had lower systolic blood pressures and diastolic blood pressure compared with baseline levels (p<0.001), and no hospital admissions.Conclusion: This program provided evidence for nurses to manage blood pressure control in people with hypertension within a collaboration with multidisciplinary team members in the community hospital.

Developing Educational Materials to Support Older Adults With Hypertension Management

A comprehensive approach to hypertension management requires medication adherence as well as more general health behavior changes. Our primary objective is to provide evidence-based and tailored education about hypertension, medications, and health self-management strategies with consideration for different stages of behavior change, health literacy, education, disease knowledge, and experience. To facilitate health behavior change, enable information seeking, and increase engagement, the educational materials provide different layers of information, including tips and information in the MEDSReM app, as well as more detailed educational content on the web portal. We will present examples of the materials in different formats to show how they are tailored to ease comprehension, support adherence, and influence behavior change. These educational materials will have broad utility outside of the MEDSReM system, and will also serve as the education-only comparison condition for the randomized controlled trial.