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Tremblay ML, Guay MA, Lafleur A. Setting priorities for physical examination in pharmacy education: A Delphi study. Can Pharm J (Ott) 2024; 157:70-76. [PMID: 38463177 PMCID: PMC10924573 DOI: 10.1177/17151635241228259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 03/12/2024]
Abstract
Background As the scope of pharmacy practice is expanding, a growing number of pharmacists perform physical examination (PE) to gather additional information to monitor the effectiveness and safety of their patients' therapy. This professional activity calls for the development of comprehensive and valuable PE training. We sought to determine by consensus which PE tests should be given teaching priority in pharmacy education. Methods Using existing PE literature in pharmacy, we conducted an online Delphi survey from December 2021 to April 2022 with 16 pharmacists who practise in a variety of settings and/or who are considered experts in PE. Results After 2 Delphi rounds, consensus was reached to either include or exclude 27 PE tests in entry-to-practice programs. One last round allowed prioritizing the agreed-upon PE tests in terms of educational needs. Clinicians agreed that measuring blood pressure is indispensable and should be given teaching priority, followed by pulse rate, weight and blood glucose measurements. Endocrine system and head and neck examinations should be included in pharmacy programs, but their clinical usefulness was considered less important. Discussion We compared our results with PE literature in other health care disciplines. We found that only a few PE tests truly influence drug therapy management, that some examinations can be quite difficult to perform accurately and that without proper training and opportunities to retrain, skill decay can lead to dangerous misinterpretations. Pharmacy programs should consider focusing on teaching PE tests supported by evidence as having an impact on drug therapy management. Can Pharm J (Ott) 2024;157:xx-xx.
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Lapidaire W, Proaño A, Blumenberg C, Loret de Mola C, Delgado CA, del Castillo D, Wehrmeister FC, Gonçalves H, Gilman RH, Oberhelman RA, Lewandowski AJ, Wells JCK, Miranda JJ. Effect of preterm birth on growth and blood pressure in adulthood in the Pelotas 1993 cohort. Int J Epidemiol 2023; 52:1870-1877. [PMID: 37354551 PMCID: PMC10749774 DOI: 10.1093/ije/dyad084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Preterm birth has been associated with increased risk of hypertension and cardiovascular disease later in adulthood, attributed to cardiovascular and metabolic alterations in early life. However, there is paucity of evidence from low- and middle-income countries (LMICs). METHODS We investigated the differences between preterm (<37 weeks gestational age) and term-born individuals in birth length and weight as well as adult (18 and 20 years) height, weight and blood pressure in the Brazilian 1993 Pelotas birth cohort using linear regressions. Analyses were adjusted for the maternal weight at the beginning of pregnancy and maternal education and family income at childbirth. Additional models were adjusted for body mass index (BMI) and birthweight. Separate analyses were run for males and females. The complete sample was analysed with an interaction term for sex. RESULTS Of the 3585 babies included at birth, 3010 were followed up in adulthood at 22 years. Preterm participants had lower length and weight at birth. This difference remained for male participants in adulthood, but female participants were no shorter than their term counterparts by 18 years of age. At 22 years, females born preterm had lower blood pressures (systolic blood pressure -1.00 mmHg, 95%CI -2.7, 0.7 mmHg; diastolic blood pressure -1.1 mmHg, 95%CI -2.4, 0.3 mmHg) than females born at term. These differences were not found in male participants. CONCLUSIONS In this Brazilian cohort we found contrasting results regarding the association of preterm birth with blood pressure in young adulthood, which may be unique to an LMIC.
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Affiliation(s)
- Winok Lapidaire
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cauane Blumenberg
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
- Grupo de Pesquisa e Inovação em Saúde, Programa de Pós-Graduação em Saúde Pública, FURG, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil
| | - Christian Loret de Mola
- Grupo de Pesquisa e Inovação em Saúde, Programa de Pós-Graduação em Saúde Pública, FURG, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil
- Universidad Científica del Sur, Lima, Peru
| | - Carlos A Delgado
- Faculty of Medicine, Department of Pediatrics, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Neonatal Intensive Care Unit, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Darwin del Castillo
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Helen Gonçalves
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Richard A Oberhelman
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Park S, Woo HG, Kim S, Kim S, Lim H, Yon DK, Rhee SY. Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study. JMIR Form Res 2023; 7:e48332. [PMID: 37603401 PMCID: PMC10477930 DOI: 10.2196/48332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. OBJECTIVE We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. METHODS Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. RESULTS A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (-5.4 mm Hg, 95% CI -7.0 to -3.9) and DBP (-2.4 mm Hg, 95% CI -3.4 to -1.4) in participants without hypertension and FBG level in all participants (those without diabetes, -4.4 mg/dL, 95% CI -7.9 to -1.0 and those with diabetes, -3.2 mg/dL, 95% CI -5.4 to -1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (-10.9 mg/dL, 95% CI -31.1 to -5.3) compared to those using only a digital health app (P=.006). CONCLUSIONS Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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Lu Y, Linderman GC, Mahajan S, Liu Y, Huang C, Khera R, Mortazavi BJ, Spatz ES, Krumholz HM. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circ Cardiovasc Qual Outcomes 2023; 16:e009258. [PMID: 36883456 DOI: 10.1161/circoutcomes.122.009258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/09/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Visit-to-visit variability (VVV) in blood pressure values has been reported in clinical studies. However, little is known about VVV in clinical practice and whether it is associated with patient characteristics in real-world setting. METHODS We conducted a retrospective cohort study to quantify VVV in systolic blood pressure (SBP) values in a real-world setting. We included adults (age ≥18 years) with at least 2 outpatient visits between January 1, 2014 and October 31, 2018 from Yale New Haven Health System. Patient-level measures of VVV included SD and coefficient of variation of a given patient's SBP across visits. We calculated patient-level VVV overall and by patient subgroups. We further developed a multilevel regression model to assess the extent to which VVV in SBP was explained by patient characteristics. RESULTS The study population included 537 218 adults, with a total of 7 721 864 SBP measurements. The mean age was 53.4 (SD 19.0) years, 60.4% were women, 69.4% were non-Hispanic White, and 18.1% were on antihypertensive medications. Patients had a mean body mass index of 28.4 (5.9) kg/m2 and 22.6%, 8.0%, 9.7%, and 5.6% had a history of hypertension, diabetes, hyperlipidemia, and coronary artery disease, respectively. The mean number of visits per patient was 13.3, over an average period of 2.4 years. The mean (SD) intraindividual SD and coefficient of variation of SBP across visits were 10.6 (5.1) mm Hg and 0.08 (0.04). These measures of blood pressure variation were consistent across patient subgroups defined by demographic characteristics and medical history. In the multivariable linear regression model, only 4% of the variance in absolute standardized difference was attributable to patient characteristics. CONCLUSIONS The VVV in real-world practice poses challenges for management of patients with hypertension based on blood pressure readings in outpatient settings and suggest the need to go beyond episodic clinic evaluation.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, CT (Y.L., S.M., R.K., E.S.S., H.M.K.)
| | - George C Linderman
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Department of Applied Mathematics, Yale University, New Haven, CT (G.C.L.)
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, CT (Y.L., S.M., R.K., E.S.S., H.M.K.)
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, CT (Y.L., S.M., R.K., E.S.S., H.M.K.)
| | - Bobak J Mortazavi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX (B.M.)
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX (B.M.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, CT (Y.L., S.M., R.K., E.S.S., H.M.K.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., G.C.L., S.M., Y.L., C.H., R.K., B.M., E.S.S., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, CT (Y.L., S.M., R.K., E.S.S., H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Silva RP. Normality thresholds for ambulatory blood pressure monitoring (ABPM) in the European, American and Brazilian guidelines: is there a need for revision? INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200148. [PMID: 36110157 PMCID: PMC9468494 DOI: 10.1016/j.ijcrp.2022.200148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ricardo Pereira Silva
- Corresponding author. Federal University of Ceará, School of Medicine, Rua Costa Mendes, 1608, 4° andar, CEP: 60430-140, Fortaleza, Ceará, Brazil.
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Feasibility of Precision Medicine in Hypertension Management-Scope and Technological Aspects. J Pers Med 2022; 12:jpm12111861. [PMID: 36573720 PMCID: PMC9698650 DOI: 10.3390/jpm12111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient's profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy-either functional or technological-limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.
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Groenland EH, Vendeville JPAC, Bemelmans RHH, Monajemi H, Bots ML, Visseren FLJ, Spiering W. Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study. Hypertension 2022; 79:2373-2382. [PMID: 35959685 PMCID: PMC9444260 DOI: 10.1161/hypertensionaha.122.19685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM).
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Jean-Paul A C Vendeville
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Remy H H Bemelmans
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (R.H.H.B.)
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands (H.M.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (M.L.B.)
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
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Divisón-Garrote J, Velilla-Zancada S, Artigao-Rodenas L, García-Lerín A, Vicente-Molinero A, Piera Carbonell A, Alonso-Moreno F, Crespo-Sabarís R, Valls-Roca F, Martín-Rioboó E, Pallarés-Carratala V. Home blood pressure self-measurement: “Current situation and new perspectives”. HIPERTENSION Y RIESGO VASCULAR 2022; 40:85-97. [PMID: 36114104 DOI: 10.1016/j.hipert.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022]
Abstract
The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals. Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.
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Green BB, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Margolis KL, Thompson MJ. Automated Office Blood Pressure and the Impact of Attendance and Rest on Diagnostic Accuracy. Am J Hypertens 2022; 35:638-646. [PMID: 35240678 DOI: 10.1093/ajh/hpac032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Automated office blood pressure (AOBP) using 3-5 measurements taken with an oscillometric device with or without an attendant in the room may decrease "white coat" effect. We evaluated the impact of the presence or absence of the attendant and rest on BP and diagnosis of hypertension. METHODS We randomly assigned 133 adults aged 18-85 with high BP at baseline (≥140/90 mm Hg), no hypertensive diagnosis and no antihypertensive medications to either attended AOBP first, unattended second, or unattended AOBP first, attended second. Outcomes included within-person BP difference for attended vs. unattended measurements; 5 vs. 15 minutes of rest; and the diagnostic performance of AOBP compared with daytime automated blood pressure measurement (ABPM). RESULTS We found no significant differences between attended and unattended AOBP (mean difference attended - unattended [95% confidence interval, CI], systolic 0.14 mm Hg [-0.78, 1.06]; diastolic 0.16 mm Hg [-0.45, 0.78]) or by rest time (mean difference 15 - 5 minutes [95% CI], systolic -0.45 mm Hg [-1.36, 0.47]; diastolic 0.61 mm Hg [-1.23, 0.003]). AOBP was lower than mean daytime ABPM, regardless of attendance or rest (after 5 minutes rest systolic -3.6 and diastolic -2.55 mm Hg, P = 0.001 for both comparisons). Using daytime ABPM of ≥135/85 mm Hg as the diagnostic threshold, AOBP sensitivity and specificity after 5 minutes of rest were 71.0% and 54.1%, respectively. CONCLUSIONS The presence or absence of a clinic attendant during AOBP measurement and the amount of rest time before AOBP measurements had no effects on BP. AOBP measurements have low sensitivity and specificity for making a new diagnosis of hypertension.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Washington Permanente Medical Group, Seattle, Washington, USA
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Yoshio N Hall
- Kidney Research Institute, University of Washington, Department of Medicine, Seattle, Washington, USA
| | | | - Matthew J Thompson
- University of Washington, Department of Family Medicine, Seattle, Washington, USA
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Leung AA, Williams JVA, Tran KC, Padwal RS. Epidemiology of Resistant Hypertension in Canada. Can J Cardiol 2022; 38:681-687. [PMID: 35122938 DOI: 10.1016/j.cjca.2022.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Resistant hypertension is associated with cardiovascular morbidity and mortality. The objective of this study was to estimate the prevalence of apparent treatment-resistant hypertension in Canadian adults and examine the characteristics of those affected. METHODS A nationally-representative, cross-sectional study was conducted using Canadian Health Measures Survey (2007-2017) data. The frequency of respondents with uncontrolled blood pressure despite 3 or more antihypertensive medications of different drug classes (and at least one agent being a diuretic), or treatment with 4 or more agents, irrespective of blood pressure, was determined. RESULTS A total of 245,700 people were identified to have apparent treatment-resistant hypertension, representing 5.3% (95% confidence intervals [CI], 4.5% to 6.2%) of adults treated for hypertension in Canada. Respondents who had uncontrolled blood pressure with 3 or more antihypertensive drugs were more likely women (55.8% [95% CI, 41.1% to 70.4%]), 70 years of age or older (45.3% [95% CI, 32.8-57.9]), and overweight or obese (84.2% [95% CI, 72.3% to 96.1%]). Respondents with apparent treatment-resistant hypertension also had a high likelihood of chronic kidney disease (36.0% [95% CI, 21.4% to 50.6%]), diabetes (35.2% [95% CI, 21.7% to 48.7%]), dyslipidemia (68.0% [95% CI, 55.2% to 80.8%]), and previous history of heart attack (9.9% [95% CI, 4.8% to 15.1%]) or stroke (7.1% [95% CI, 0 to 14.4%]). CONCLUSIONS Despite being prescribed at least 3 antihypertensive drugs, a considerable proportion of Canadians, especially women, have difficulty achieving blood pressure control, predisposing them to a higher risk of cardiovascular complications and death.
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Affiliation(s)
- Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, AB, Canada;; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;.
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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