Social networks help control hypertension

Social network intervention to improve blood pressure control after stroke: The TEAMS-BP randomized clinical trial

Social connections play an important role in predicting health outcomes after a stroke. In the context of clinical medicine, a social network theory proposes that each patient is embedded in a personal social network of interpersonal connections that provide social support, information, and behavioral cues. However, the effectiveness of activating and harnessing supportive personal social networks remains uncertain, particularly within healthcare situations where individualism prevails. As an initial step towards developing interventions for healthier social networks in clinical practice, we conducted a randomized controlled trial in stroke survivors. This trial compared a network intervention versus individual counseling for 3 months with the aim of lowering blood pressure after stroke. Over 2 years, we recruited 45 stroke survivors, with 24 assigned to the network intervention and 21 to the individual counseling group. Results indicated no significant difference in the primary outcome of absolute systolic blood pressure difference over 3 months between the two groups. However, subgroup analyses revealed that patients within small and close-knit networks, known as high constraint networks, who received the network intervention had a significantly larger reduction in blood pressure than patients within large and open, low constraint, networks. The study's findings are preliminary due to dropout rates in both arms, and variable engagement of network members in the intervention arm. Nevertheless, our results suggest the potential of leveraging social networks to enhance health outcomes in specific subgroups of stroke survivors, highlighting avenues for further research and intervention development. Clinical Trial Unique Identifier: NCT05258890.

The Effect of Online Group Education on Promoting Knowledge, Motivation, Self-Efficacy, Self-Care Behaviors and Preventing Uncontrolled Blood Pressure in Hypertensive Patients: A Quasi-Experiment Study

Introduction

Hypertensive patients may lack time to visit clinics and attend educational sessions, resulting in poor blood pressure control. Uncontrolled blood pressure in people with hypertension can increase the risk of heart disease and stroke.

Objective

The specific purpose of this study was to determine the effect of online group education on knowledge, motivation, self-efficacy, self-care behavior, and blood pressure control of hypertensive patients.

Method

The research method used a quasi-experiment method. The subjects were hypertensive patients in Indonesia. The sampling technique used was cluster random sampling. Total sampling consisted of 96 participants, consisting of 48 intervention groups and 48 control groups. The inclusion criteria in the study were patients with primary hypertension who were willing to become research respondents. The exclusion criteria in this study were respondents who were sick and unable to follow therapy, had hearing problems, and had complications of other diseases (kidney disease, heart disease, diabetes mellitus, and stroke). Data collection methods include observation. The instruments used were the HKLS, HBP-SCP questionnaire, and Sphygmomanometer digital.

Result

Data analysis using repeated ANOVA and Friedman tests. There was a significant decrease in systolic (p < .001) and diastolic (p = .001) blood pressure and an increase in knowledge (p < .001), motivation (p < .001), self-efficacy (p < .001), and self-care behavior (p < .001) in the intervention group.

Conclusion

Online group education effectively reduces blood pressure and increases self-care behaviors in hypertensive patients.

Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension (n = 220) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension (adjusted OR = 1.52, 95%CI = 1.22 - 1.89). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension (adjusted OR = 0.98, 95%CI = 0.96 - 1.00). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score (coef. = -0.08; 95%CI = -0.12 - 0.03). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score (coef. = 0.10; 95%CI = 0.04 - 0.17 and coef. = 0.19; 95%CI = 0.06 - 0.32, respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

The relationship between social support, stressful events, and menopause symptoms

Many women going through the menopausal transition experience vasomotor symptoms (VMS), and research has shown that there is a large amount of variation in their frequency and severity. Many lifestyle factors have been found to co-vary with VMS, including the level of social support received by the woman, and how stressed she is. Stress is well documented to worsen menopause symptoms, and there is some evidence that support eases them; however, there is little research into whether support is an effective buffer against the negative effects of stress on VMS. Using nine years of data from the Study of Women’s Health Across the Nation (n = 2718), we use multilevel Poisson regression with random effects to test: 1) if more social support is associated with decreased VMS frequency, 2) if increased life stress worsens VMS, and 3) if support acts as a buffer against stress. After adjusting for age, marital status, smoking, self-perceived overall health, ethnicity, and menopausal status, we find that stress increases the frequency of VMS. Contrary to our hypothesis, we did not find strong evidence that emotional support led to lower VMS frequency, or that support buffers against the effects of stress. Experience of a stressful event, but not amount of social support, was included in the best fitting model; with the degree to which the woman was upset by the life stressor having the largest effect on menopause symptoms. Here, women who said they were currently upset by a stressful event experienced 21% more VMS than women who had experienced no life stressor. This research highlights that social factors may impact the menopausal transition.

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

OBJECTIVE

Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study.

METHODS

We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support.

RESULTS

Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD.

CONCLUSIONS

After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.

Efectividad de las tecnologías de la información y comunicación en la adherencia terapéutica de pacientes con Hipertensión Arterial y Diabetes Mellitus

2222 Enferm Nefrol. 2020 Ene-Mar;23(1):22-32ResumenIntroducción: La hipertensión arterial y la diabetes me-llitus son dos de las principales causas de morbimortali-dad, siendo las precursoras de la enfermedad renal cróni-ca, catalogándose como un problema de salud pública que afecta a uno de cada diez adultos en el mundo. La falta de cumplimiento al tratamiento es la mayor causa de fra-caso en los programas de promoción y prevención, con esta revisión sistemática se busca aportar a los profesio-nales de enfermería evidencia científica a través del uso de las tecnologías de la información y la comunicación que permitan mejorar la adherencia terapéutica.Objetivo: Identificar la efectividad de las tecnologías de la información y la comunicación en la adherencia tera-péutica en personas con Hipertensión Arterial y Diabetes Mellitus. Material y Método. Se realizó una revisión sistemática de literatura en las bases de datos CUIDEN, CINAHL, COCHRANE, LILACS, PUBMED y OVID NURSING. Después de aplicar filtros de selección y listas de verifica-cion de calidad metodológica se obtuvieron 18 artículos para análisis, 12 ensayos clínicos aleatorizados, 3 estu-dios cuasi-experimentales y 3 revisiones sistemáticas. Se clasificó el nivel de evidencia de los estudios según el ins-tituto Joanna Briggs. Resultados. Se establecieron 3 categorías: Interven-ciones unicomponente, intervenciones multicomponente y rol de enfermería en el uso de TICs para favorecer la adherencia. Conclusiones. Dentro del cuidado de la salud actualmen-te hay hallazgos iniciales que apoyan la efectividad del uso de las tecnologías de la información y la comunica-ción convirtiéndola en una herramienta que favorece la adherencia al tratamiento en pacientes con hipertensión arterial y diabetes mellitus.

African American women's perceptions of the meaning of support groups for improving adherence to hypertension treatment: a conceptual model

AIM

To investigate the meaning of support groups and the features of these groups that African American (AA) women view as improving adherence to high blood pressure (HBP) treatment. The study generated a conceptual model to illuminate features of these groups that influence adherence of AA women to HBP treatment.

DESIGN

Qualitative research.

METHODS

Used focus groups and open-ended questions to obtain the views of 26 eligible AA women, recruited from South Los Angeles. Line-by-line review and coding of interview transcripts were done. The feedback was used to specify a conceptual model depicting the meaning of support groups. The Consolidated Criteria for the Reporting of Qualitative Research guidelines were used.

RESULTS

The conceptual model depicts the meaning of support groups as information giving/knowledge sharing, emotional or psychological support, instrumental support and coaching, and facilitators and barriers to joining support groups and factors for consideration in forming these groups.

Power of Peer Support to Change Health Behavior to Reduce Risks for Heart Disease and Stroke for African American Men in a Faith-Based Community

INTRODUCTION

Peer support has powerful potential to improve outcomes in a program of health behavior change; yet, how peer support is perceived by participants, its role, and how it contributes to intervention efficacy is not known, especially among African Americans. The purpose of this study was to identify the subjectively perceived experience and potential contributions of peer support to the outcomes of a peer group behavioral intervention designed to change health behavior to reduce risks for heart disease and stroke in African American men in a faith-based community.

METHODS

A peer support group intervention was implemented to increase health knowledge and to improve health behaviors in line with the American Heart Association's Life Simple 7 domains (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking). Fourteen peer group sessions and eight follow-up interviews with program participants were recorded, transcribed, and analyzed.

RESULTS

Seven key themes emerged, including (1) enhancing access to health behavior information and resources, (2) practicing and applying problem-solving skills with group feedback and support, (3) discussing health behavior challenges and barriers, (4) sharing health behavior changes, (5) sharing perceived health outcome improvements and benefits, (6) feelings of belonging and being cared for, and (7) addressing health of family and community.

CONCLUSION

Qualitative findings revealed a positive perception of peer support and greater understanding of potential reasons why it may be an effective strategy for African American men.

Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study

This corrects the article DOI: 10.1038/jhh.2016.100.

Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study

Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (⩾140/90 mm Hg) with ⩾3 classes of antihypertensive medication or treatment with ⩾4 classes of antihypertensive medication, including a diuretic. Self-reported medication adherence was defined as taking all prescribed antihypertensive medication in the 24 h before the study visit. The association of psychosocial factors (chronic stress, depressive symptoms, perceived social support and social network) with aTRH was evaluated using Poisson regression with progressive adjustment for demographic, clinical and behavioural factors. The prevalence of aTRH was 15.1% (n=210). Participants with aTRH had lower social network scores (that is, fewer sources of regular social contact) compared with participants without aTRH (P<0.01). No other psychosocial factors differed between groups. Social network was also the only psychosocial factor that was associated with aTRH prevalence in regression analyses. In age-, sex-adjusted and fully adjusted models, one additional unique source of social contact was associated with a 19% (PR=0.81; 95% confidence interval (CI): 0.68-0.94, P=0.001) and a 13% (PR=0.87; 95% CI 0.74-1.0, P=0.041) lower prevalence of aTRH, respectively. Social network was independently associated with aTRH and warrants further investigation as a potentially modifiable determinant of aTRH in African Americans.

The Inaugural Elijah B. Saunders Memorial Lecture: The Global Consequences of Hypertension and Related Disparities

This inaugural memorial lecture provides an opportunity to celebrate the life of Elijah B. Saunders, MD, FACC and pays tribute to his pioneering spirit in the quest to advance health equity in the prevention and control of hypertension and cardiovascular diseases. It also enables an assessment of the state of the global burden of hypertension and related disparities. Despite the remarkable biomedical research progress made over the last half-century, hypertension remains the leading risk factor for global disease burden and the major preventable contributor to cardiovascular and all-cause mortality. Additionally, disparities in hypertension-related morbidity and mortality remain pervasive worldwide. National hypertension control rates showing progress often mask important suboptimal treatment and control in population groups defined by sex, race, ethnicity, geography, and social and environmental determinants. Within these groups, many hypertension-related disparities remain largely unchanged while other gaps have widened. In essence, current research has been relatively ineffective in guiding large-scale, sustained elimination of hypertension-related disparities. An important explanation for these observations may be the significant advances made in observational epidemiological research, especially in improved surveillance and data collection that document the extent of disparities in marked contrast to the relative paucity of interventional disparities research. The paucity of these interventional research studies remains a continuing challenge. The time has come for renewed efforts in building strategic partnerships that leverage transdisciplinary, multi-sectoral expertise to provide global leadership in interventional implementation research for hypertension control and elimination of related disparities. Developing an appropriately skilled implementation research workforce will be crucial. The National Heart, Lung, and Blood Institute and its biomedical research funding partners remain committed to a strategic agenda of implementation research, training, and education for the prevention and control of hypertension and elimination of related disparities.

"I have to live like I'm old." Young adults' perspectives on managing hypertension: a multi-center qualitative study

BACKGROUND

In the U.S., young adults (18-39 year-olds) have the lowest hypertension control rates among hypertensive adults. Understanding young adults' unique perceptions about hypertension and perceived barriers to hypertension control is critical to develop effective interventions for this population. This multi-center study explored young adults': 1) emotions and reactions after a hypertension diagnosis, 2) attitudes about managing hypertension (lifestyle changes, follow-up visits, antihypertensive medication use), 3) opinions about their healthcare system's hypertension education materials, and 4) opinions about using social media to manage hypertension.

METHODS

Young adults (18-39 year-olds) with a diagnosis of hypertension and regular primary care access were recruited by the Wisconsin Research and Education Network (WREN). Two focus groups (one per age range: 18-29 years, 30-39 years) were conducted in three Midwestern Family Medicine Clinics (academic, rural, and urban). Conventional content analysis was performed.

RESULTS

Thirty-eight young adults (mean: 26.7 [9.6] years old, 34% male, 45% Black, 42% with ≥1 year of college) identified barriers to managing hypertension. Emergent themes overlapped across age groups and geographic regions. Most respondents were surprised and angry about a hypertension diagnosis; they expected to develop hypertension, but at a much older age. A hypertension diagnosis negatively altered their "young" self-identity; suggested behavior changes and antihypertensive medications made them feel "older" than their peers. Young adults missed blood pressure follow-up visits due to co-payments, transportation barriers, and longer than desired wait times for brief visits. Contrary to our hypothesis, most young adults disliked social media or text messaging to support self-management; they were most concerned that their peers would see the hypertension communication. Current hypertension education materials were described as not addressing young adults' health questions and are often discarded before leaving the clinic.

CONCLUSIONS

Targeting interventions to young adults' unique needs is necessary to improve hypertension control and cardiovascular preventive healthcare delivery.

SOCIAL ENGAGEMENT AND USE OF HYPERTENSIVE MEDICATION AMONG ADULTS IN CHINA

This study’s objectives were, first, to examine the association between social engagement and the odds of taking hypertensive medications and treatment among adults in China; and second, to explore the lifestyle and psychological mechanisms underlying this association. Data were from the WHO Study on Global AGEing and Adult Health (WHO-SAGE), a national survey of 11,046 participants aged 18 to 69 conducted in China in 2010. The key outcome was a dichotomous indicator of whether the respondent was taking hypertensive medication or other treatment. A series of logistic regression models were fitted to examine the research questions. Higher levels of social engagement were found to be associated with a lower odds of taking hypertensive medication or treatment, and the association was stronger for women than for men. Lifestyle factors (i.e. smoking and BMI) and perceived overall life satisfaction were significant covariates. Life satisfaction helped explain some of the social engagement benefit for both men and women and BMI only appeared to be a mediator for men. Being married was not significantly associated with lower odds of taking hypertensive medication or treatment in either men or women. Social engagement seems to be protective against hypertension for adult men and women in China, although causation could not be determined in this cross-sectional study. Psychosocial mechanisms are probably at work, but these vary by gender.

Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy?

INTRODUCTION

Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders.

METHODS

We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness.

RESULTS

We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities.

CONCLUSIONS

Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.

Incident depression increases medical utilization in Medicaid patients with hypertension

Hypertension is an important risk factor for cardiovascular disease and occurs disproportionately among patients with depression. Few studies have rigorously examined outcomes specifically among hypertensive patients with newly diagnosed comorbid depression.

AIM

We hypothesized that incident depression would exacerbate hypertensive disease and that this would be evident through greater utilization of medical services than would otherwise occur in the absence of depression.

METHODS

Claims data for hypertensive patients enrolled in Maryland Medicaid (2005-2010) were used to estimate the change in annualized utilization following incident depression, compared to a matched cohort of hypertensive patients never diagnosed with depression. Multivariate regression was used to adjust for changes in antihypertensive medications, adherence and comorbidity that followed depression onset.

RESULTS

While medical utilization increased after incident depression, additional encounters tended to be for nonacute medical care and there was no significant increase in encounters specifically for cardiovascular or hypertension-related conditions.

DISCUSSION

The results contribute to the discussion on the relationship between depression and cardiovascular disease and will inform future studies that aim to look at longer term outcomes in patients with hypertension.

Stakeholder engagement in patient-centered outcomes research: high-touch or high-tech?

Patient and stakeholder engagement enhances the meaningfulness of patient-centered outcomes research. Continuous engagement of diverse patients helps to achieve representativeness and to avoid tokenism, but is perceived as challenging due to resource and time constraints. The widespread availability of the internet, mobile phones, and electronic devices makes 'high-tech' solutions appealing, but such approaches may trade-off larger sample sizes for shallower engagement and/or skewed perspectives if most participants reflect users of technology. More traditional 'high-touch' solutions such as in-person interviews, focus groups, and town hall meetings can provide qualitative and sociological context and potentially more in-depth insights from small numbers of patients, but such approaches are also prone to selection bias as well. We compare and contrast high-tech and high-touch approaches to engaging stakeholders and suggest hybrid processes.