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Abstract
Recent guidelines on diagnosis and management of high blood pressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with high BP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals, and a different approach to resistant hypertension. Finally, differences among guidelines, the persistent controversies that have led to them, and their implications for clinical practice are discussed.
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Affiliation(s)
| | - Robert D Brook
- University of Michigan, Ann Arbor, Michigan (J.B.B., R.D.B.)
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Kazemi Shishavan M, Asghari Jafarabadi M, Aminisani N, Shahbazi M, Alizadeh M. The association between self-care and quality of life in hypertensive patients: findings from the Azar cohort study in the North West of Iran. Health Promot Perspect 2018; 8:139-146. [PMID: 29744310 PMCID: PMC5935818 DOI: 10.15171/hpp.2018.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/28/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Hypertension affects the quality of life of patients and their caregivers. The aim of this study was to assess the knowledge and self-care behaviors and health-related quality of life (HRQOL) among hypertensive people. Methods: All people aged 35 years and older with hypertension were invited to participate in this study. Information on self-care behavior for hypertension (H-scale), and health-related quality of life (WHOHRQOL-BRFF) were completed by trained interviewer. Data analysis was done using SPSS 16. Results: The median age of hypertensive patients was 62.5(25th to 75th percentile: 55 to 72 years), the correlation between quality of life and overall self-care scores was not significant(r =-0.048, P =0.520). Physical activity was the only significant predictor for quality of life,showing that the quality of life of hypertensive people increased by 3.371 units per day of being physically active in the cohort study (β =0.223, P<0.01). The only significant predictor of quality of life among the elderly was medication use (β =-0.572, P<0.001). Quality of life of participants decreased 3.456 units per day as a result of medication adherence. Conclusion: No association was observed between self-care and HRQOL total score in hypertensive patients in the study. Among the self-care domains, only medication adherence and physical activity had significant association with social health. There was a reverse association between smoking and HRQOL.
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Affiliation(s)
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nayyereh Aminisani
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Shahbazi
- School of Public Health, Professor Jackson State University, Jackson, Mississippi, USA
| | - Mahasti Alizadeh
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Stress management and dietary counseling in hypertensive patients: a pilot study of additional effect. Prim Health Care Res Dev 2013; 15:38-45. [PMID: 23425517 DOI: 10.1017/s1463423612000679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In Western societies, cardiovascular (CV) disease is the primary cause of mortality, and high blood pressure (BP) is the main reversible factor leading to CV disease. Dietary habits and psychosocial stress contribute to the establishment of hypertension, while its role in the control of high BP is currently examined. In this study, we examined the effect and feasibility of a combined intervention of dietary education and stress management on the control of hypertension. METHODOLOGY A randomized, controlled pilot study was designed to evaluate the effect of combined education on stress management techniques and dietary habits (Mediterranean diet principle) on office BP after eight weeks. RESULTS Of the 45 randomized subjects, 36 were included in the final analysis (control group = 20 (age: 67 ± 12 years, 31.8%, males) and intervention group = 16 (age: 62 ± 12 years, 47%, males)). CV disease risk factors (except smoking), BP, dietary habits, perceived stress and physical activity (all assessed with validated questionnaires) were similar between the two groups at baseline. After eight weeks, office BP (systolic and diastolic) and perceived stress were significantly reduced, whereas the adherence in Mediterranean diet principle was significantly increased, but only in the intervention group. CONCLUSIONS A combined intervention of stress management techniques and Mediterranean diet education seems to be beneficial for BP reduction. Such interventions could possibly serve as a complementary treatment along with drug therapy or in the early treatment of high normal BP. A call to action for designing epidemiological studies and evaluating the efficacy of such non-pharmacological treatment strategies is therefore warranted.
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Davis SK, Quarells R, Gibbons GH. A comprehensive cardiovascular disease lifestyle treatment controlled trial among high-risk African Americans. ACTA ACUST UNITED AC 2013; 3:526-533. [PMID: 24955290 PMCID: PMC4062311 DOI: 10.4236/ojpm.2013.39071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The purpose of this study was to assess the effects of a comprehensive lifestyle intervention on modifiable cardiovascular risk factors among high-risk African Americans. Methods The study included a randomized treatment/controlled intervention trial among 136 African Americans residing in Atlanta, GA who were overweight and had elevated blood pressure. The treatment group was exposed to 3-months of a multi-component intervention and the control to an abbreviated 6-week intervention after the completion of the treatment group’s intervention. The main outcomes included mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean waist circumference, mean body mass index (BMI), mean number of times exercise per week, mean number of servings of fruits and vegetables per day, and mean level of daily stress. Data were collected at baseline and at 6-month follow-up. Separate linear regressions were used with an established significance level of p < 0.05. Results Results revealed significant net improvement in treatment group when compared to controls in waist circumference, BMI, times weekly exercise, servings of fruit and vegetables per day (p < 0.001, 0.04, 0.02, 0.002, respectively). Diastolic blood pressure also significantly improved within the treatment group for overall hypertensives from baseline to 6-month follow-up (90.9 mmHg to 83.1 mmHg, p = 0.002). Conclusion These results show that a comprehensive lifestyle intervention can improve cardiovascular risk factor profile among high risk African Americans. Caregivers should encourage patients to participate in such programs and public health policymakers should allocate resources to community based health oriented organizations to implement comprehensive lifestyle program.
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Affiliation(s)
- Sharon K Davis
- National Institutes of Health, National Human Genome Research Institute, Bethesda, USA
| | - Rakale Quarells
- Morehouse School of Medicine, Social Epidemiology Research Center, Cardiovascular Research Institute, Atlanta, USA
| | - Gary H Gibbons
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, USA
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Ewing GW. Mathematical modeling the neuroregulation of blood pressure using a cognitive top-down approach. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 2:341-52. [PMID: 22737671 PMCID: PMC3339057 DOI: 10.4297/najms.2010.2341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The body′s physiological stability is maintained by the influence of the autonomic nervous system upon the dynamic interaction of multiple systems. These physiological systems, their nature and structure, and the factors which influence their function have been poorly defined. A greater understanding of such physiological systems leads to an understanding of the synchronised function of organs in each neural network i.e. there is a fundamental relationship involving sensory input and/or sense perception, neural function and neural networks, and cellular and molecular biology. Such an approach compares with the bottom-up systems biology approach in which there may be an almost infinite degree of biochemical complexity to be taken into account. Aims: The purpose of this article is to discuss a novel cognitive, top-down, mathematical model of the physiological systems, in particular its application to the neuroregulation of blood pressure. Results: This article highlights the influence of sensori-visual input upon the function of the autonomic nervous system and the coherent function of the various organ networks i.e. the relationship which exists between visual perception and pathology. Conclusions: The application of Grakov′s model may lead to a greater understanding of the fundamental role played by light e.g. regulating acidity, levels of Magnesium, activation of enzymes, and the various factors which contribute to the regulation of blood pressure. It indicates that the body′s regulation of blood pressure does not reside in any one neural or visceral component but instead is a measure of the brain′s best efforts to maintain its physiological stability.
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Affiliation(s)
- Graham Wilfred Ewing
- Montague Healthcare, Mulberry House, 6 Vine Farm Close, Cotgrave, Nottingham NG12 3TU, United Kingdom
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de Gusmão JL, Mion D, Pierin AMG. Health-related quality of life and blood pressure control in hypertensive patients with and without complications. Clinics (Sao Paulo) 2009; 64:619-28. [PMID: 19606236 PMCID: PMC2710433 DOI: 10.1590/s1807-59322009000700003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 04/03/2009] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications. MATERIALS AND METHODS Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 +/- 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher's Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into "with complications" (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and "without complications" (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics. RESULTS In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143+/-18/84+/-11 and 144+/-21/93+/-11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128+/-17/75+/-13 and 128+/-15/83+/-11 mm Hg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the "with complications" group and from 78% to 50% in the "without complications" group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher's Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher's Questionnaire showed no differences in these scores. CONCLUSION Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.
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Affiliation(s)
- Josiane Lima de Gusmão
- Hypertension Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
- School of Nursing, Universidade de São Paulo - São Paulo/SP, Brazil., E-mail:
, Tel/Fax: 55 11 3069.7686
| | - Decio Mion
- Hypertension Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
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Newton JT, Allen CD, Coates J, Turner A, Prior J. How to reduce the stress of general dental practice: the need for research into the effectiveness of multifaceted interventions. Br Dent J 2006; 200:437-40. [PMID: 16703032 DOI: 10.1038/sj.bdj.4813463] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2005] [Indexed: 11/08/2022]
Abstract
While the practice of dentistry has been demonstrated to be significantly stressful, there have been few published studies describing interventions to reduce the stress of dental practitioners. This article describes research into the prevention and alleviation of stress amongst a variety of healthcare professionals, including dental practitioners, and describes the findings from a small scale study of an intervention aimed at general dental practitioners who reported high levels of work related stress. It is argued that to be effective, interventions should be tailored to the individual needs of the practitioner, within a structured intervention framework. Further research into the effectiveness and cost-effectiveness of stress management for dental practitioners is required.
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Affiliation(s)
- J T Newton
- Oral Health Services Research & Dental Public Health, GKT Dental Institute London, USA.
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Webb M, Beckstead J, Meininger J, Robinson S. Stress management for African American women with elevated blood pressure: a pilot study. Biol Res Nurs 2006; 7:187-96. [PMID: 16552946 DOI: 10.1177/1099800405283144] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reports the results of a pilot study testing the effects of two stress management interventions on blood pressure (BP) and stress-related variables in employed African American women. Thirty-three women with mean age 44.8 +/- 7.6 years were randomly assigned to a cognitive mediation group (n=10), a relaxation group (n=12), or a delayed treatment control group (n=11). The participants in the two stress management groups participated in a 10-week intervention; the delayed treatment control group received BP monitoring during the 10-week period. Measures included BP, the State-Trait Anger Expression Inventory, Personal Strain, and Coping Resources. Although no significant Group x Time effects were found in BP, anger, or personal strain, several of the outcome measures appear to be sensitive and showed cell means in the hypothesized direction. Further study of the effects of stress management interventions on BP and stress, with a larger sample, is warranted.
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Affiliation(s)
- Mary Webb
- College of Nursing, University of South Florida, Tampa 33612, USA.
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Wesa KM, Grimm RH. Recommendations and Guidelines Regarding the Preferred Research Protocol for Investigating the Impact of an Optimal Healing Environment on Patients with Hypertension. J Altern Complement Med 2004. [DOI: 10.1089/acm.2004.10.s-245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kathleen M. Wesa
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Richard H. Grimm
- Berman Center for Outcomes and Clinical Research, Department of Medicine and Epidemiology, University of Minnesota, Minneapolis, MN
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Sheridan S, Pignone M, Donahue K. Screening for high blood pressure: a review of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med 2003; 25:151-8. [PMID: 12880884 DOI: 10.1016/s0749-3797(03)00121-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT In 1996, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for hypertension. Since that time, the published literature on hypertension has expanded rapidly, necessitating a new examination of the evidence supporting screening. OBJECTIVE Update the 1996 evidence review on screening for hypertension. DATA SOURCES The 1996 Guide to Clinical Preventive Services, recent systematic reviews, and focused searches of MEDLINE were used to identify new evidence relevant to detecting and treating hypertension. STUDY SELECTION When a good quality, recent systematic review was available, it was used to summarize previous research; MEDLINE was searched only for more recent articles. Two authors reviewed abstracts (and full texts, if necessary) of potentially relevant articles to determine if they should be included. DATA EXTRACTION One author extracted data from included studies into evidence tables. DATA SYNTHESIS Hypertension can be effectively detected through office measurement of blood pressure. Treatment of elevated blood pressure in adults can reduce cardiovascular events. The magnitude of risk reduction depends on the degree of hypertension and the presence of other cardiovascular risk factors. Available studies have found no important adverse effects on psychological well-being and mixed effects on the absenteeism rates of adults who are screened and labeled as being hypertensive. CONCLUSIONS Substantial indirect evidence supports the effectiveness of screening adults to detect hypertension and treating them to reduce cardiovascular disease.
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Affiliation(s)
- Stacey Sheridan
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina-Chapel Hill, 5039 Old Clinic Building, CB 7110, Chapel Hill, NC 27599, USA.
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Abstract
Hypertension is a major risk factor for many cardiovascular diseases including stroke, coronary heart disease, cardiac failure, and endstage renal disease. Therefore, prevention of hypertension becomes an important goal in overall efforts to control blood pressure and reduce the incidence of hypertension-related cardiovascular and renal complications and outcomes. Many risk factors underlying hypertension have been identified including nonmodifiable factors such as age, gender, genetic factors, and race, as well as modifiable factors including overweight, high sodium intake, low potassium intake, alcohol consumption, and reduced physical activity. A number of studies have demonstrated that interventions aimed at changing these modifiable factors might decrease blood pressure and even prevent the development of hypertension. Thus, present national recommendations and guidelines include lifestyle modifications ranging from weight loss in case of obesity, engagement in regular isotonic physical activity, reduced sodium diet (<100 mmol/d), supplementation of potassium, and alcohol moderation (<1 ounce of ethanol or its equivalent per day).
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Affiliation(s)
- Michel Slama
- Hypertension Research Laboratories, Division of Research, Oschner Clinic Foundation, New Orleans, LA 70121, USA.
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Blumenthal JA, Sherwood A, Gullette ECD, Georgiades A, Tweedy D. Biobehavioral approaches to the treatment of essential hypertension. J Consult Clin Psychol 2002. [PMID: 12090370 DOI: 10.1037/0022-006x.70.3.569] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Davis MM, Jones DW. The role of lifestyle management in the overall treatment plan for prevention and management of hypertension. Semin Nephrol 2002. [DOI: 10.1053/snep.2002.28642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
AIM OF THE STUDY To explore the content and structure of communication between patient and nurse at follow-up appointments concerning hypertension. BACKGROUND Hypertension is a chronic condition and calls for co-operation between health care providers and patients over a long period of time. One important purpose of the follow-up consultations is to transfer knowledge between patients and health care providers in order to empower patients. This is an important determinant of the quality of care. DESIGN/METHODS The study was based on 20 audio-recordings of actual follow-up appointments and was approved by ethics committees. The consultations took place at four different health care units for hypertensive patients. FINDINGS The average length of consultations was 18 minutes. In the consultations, patients initiated an average of eight new topics and nurses an average of 20. All nurses talked with patients about life style. Compared with previous studies of follow-ups with physicians, consultations with nurses addressed lifestyle factors and adherence to treatment to a higher degree. It was also observed that patients were more actively involved in interaction with nurses compared with the follow-ups with physicians. CONCLUSIONS Active patient participation in care is a critical factor in improving adherence to treatment. It would be of value to develop and assess a more patient-centred organization of hypertension care and thereby more individualized hypertension treatment. Nurses may have a pivot role in such care.
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Affiliation(s)
- U B Aminoff
- Department of Caring Sciences, Mid-Sweden University, Sundsvall, Sweden
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