Care Management Of Hypertension Research Articles

Factors influencing primary care access, utilisation and quality of management for patients living with hypertension in West Africa: a scoping review protocol

IntroductionHypertension, one of the most prevalent non-communicable diseases in West Africa, can be well managed with good primary care. This scoping review will explore what is documented in the literature...

Primary Care Management of Hypertension in Patients With Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disorder of unknown etiology that causes the immune system to attack the central nervous system. The resultant damage and destruction of nerves causes patients with MS to experience a wide variety of symptoms. Although comorbid conditions are increasing among patients with MS, there is a paucity of research on this issue. This publication addresses this gap in the literature by examining the pharmacological and nonpharmacological interventions for comorbid hypertension in Canadian patients with MS. These interventions can effectively reduce the adverse effects of hypertension in this population.

Assess the Knowledge on Self Care Management of Hypertension

Hypertensionissometimescalledsilentkillerbecausepeoplewhohaveitareoftensymptomsfree. Hypertension is a foremostdangerinfluence for cardio vasculardisease. Heart failure, cerebrovascular accident, and renal problem carriesthe risk for earlyillness or death which surges as systolicanddiastolicpressuresrise. Extended blood pressure raiseharmsthe plasmain targetorgans. “The theme of "high blood pressure"was selected for World Health Day on April 7th, 2013.Hypertensionis“silentkiller”hypertension is complex public health problem.The purpose of this research work is to assess the awarenessabout self care management. The area selected for the research study was in urban Area Anagaputhur Chennai .Adult between the age of 21-45 years were selected , from that 30 adult samples were taken for the study. Conclusion: This study concludes level of knowledge regarding self caremanagementofhypertensionawareness by proving the efficiency of health education on Knowledge of hypertension among rural adult hypertensive patient

Pharmacist care in hypertension management: systematic review of randomized controlled trials

Abstract Background Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care. One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. Methods In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. The outcomes are the change in BP, BP at follow-up, or BP control. Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis. We published the study protocol in BMJ Open. Results A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence. After removal of duplicates, 1744 were independently screened based on title and abstract by two authors (VG, ST), and 242 full texts were evaluated. A total of 72 studies with 32641 patients are currently included for data extraction. These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25). The data extraction and analysis are ongoing. Results will be presented at the congress. Conclusions This systematic review provides updated evidence on the effect of pharmacist intervention on BP management. Heterogeneity in the effect of interventions will be carefully evaluated which will help the implementation of effective interventions in various healthcare settings. Key messages • Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. • This systematic review provides updated evidence on the effect of pharmacist intervention on blood pressure management.

Visual Analytics Dashboard Promises to Improve Hypertension Guideline Implementation.

BACKGROUNDPrimary care management of hypertension under new guidelines incorporates assessment of cardiovascular disease risk and commonly requires review of electronic health record (EHR) data. Visual analytics can streamline the review of complex data and may lessen the burden clinicians face using the EHR. This study sought to assess the utility of a visual analytics dashboard in addition to EHR in managing hypertension in a primary care setting.METHODSPrimary care physicians within an urban, academic internal medicine clinic were tasked with performing 2 simulated patient encounters for hypertension management: the first using standard EHR, and the second using EHR paired with a visual dashboard. The dashboard included graphical blood pressure trends with guideline-directed targets, calculated atherosclerotic cardiovascular disease risk score, and relevant medications. Guideline-appropriate antihypertensive prescribing, correct target blood pressure goal, and total encounter time were assessed.RESULTSWe evaluated 70 case simulations. Use of the dashboard with the EHR compared with use of the EHR alone was associated with greater adherence to prescribing guidelines (95% vs. 62%, P < 0.001) and more correct identification of blood pressure target (95% vs. 57%, P < 0.01). Total encounter time fell an average of 121 seconds (95% confidence interval 69–157 seconds, P < 0.001) in encounters that used the dashboard combined with the EHR.CONCLUSIONSThe integration of a hypertension-specific visual analytics dashboard with EHR demonstrates the potential to reduce time and improve hypertension guideline implementation. Further widespread testing in clinical practice is warranted.

Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP &lt;90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP &lt; 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

A cross sectional study of the prevalence of hypertension and associated risk factors in coastal Andhra Pradesh

Background: Hypertension (HTN) accounts for 9.4 million deaths worldwide every year. A rise in HTN is projected by the global burden of HTN 2005 study, it portrays a grim picture. Community level data for hypertension is scarce in Andhra Pradesh. A cross sectional study was conducted to know the prevalence of hypertension in Vijayawada.Methods: 1009 apparently healthy adults visiting the hospital accompanying patients in outpatient department were screened for hypertension by blood pressure recording. All measurements were obtained by automated blood pressure measuring (AOBPM) systems.Results: Of the total population screened, hypertension accounted for 42.5% (n=429). A multivariate analysis showed that hypertension is more common in age group &gt;50 years [odds ratio (OR)=3.004, 95% confidence interval CI being=2.2707-3.9645], in diabetics (OR=2.9091, 95% CI=2.0595-4.1092), in males (odds ratio=1.3223, 95% CI=1.0214-1.7118) and in smokers (OR=1.7442, 95% CI=1.0469-2.9059). A linear positive association was found between obesity and hypertension. No significant association was found between hypertension and alcohol intake. This study also showed that awareness was present in only 44% and 37% had hypertension under control of known hypertensive subjects.Conclusions: This is the first cross sectional study done with AOBPM. Our study finds that hypertension is an important public health burden in coastal Andhra Pradesh with low awareness, treatment, and control. It implies that strategies need to be developed to improve effective primary care management of hypertension.

A cross-sectional study of the prevalence, awareness, treatment and control of hypertension in Shenzhen, China

ObjectivesAn understanding of the awareness, treatment and control of hypertension is helpful to guide decision-making regarding interventions to reduce the risk for diseases with hypertension as a key risk factor....

Patients with Non-Insulin Depending Diabetes Mellitus and Metabolic Syndrome Are Suboptimal Treated in Swiss Primary Care

The prevalence of complicated hypertension is increasing in America and Europe. This survey was undertaken to assess the status quo of primary care management of hypertension in patients with the high-risk comorbid diseases metabolic syndrome (MetS) and/or type 2 diabetes mellitus (non-insulin depending diabetes mellitus (NIDDM)). Data of anti-hypertensive treatment of 4594 Swiss patients were collected over 1 week. We identified patients with exclusively NIDDM (N = 95), MetS (N = 168), and both (N = 768). Target blood pressure (TBP) attainment, frequency of prescribed substance-classes, and correlations to comorbidities/end-organ damages were assessed. In addition, we analyzed the prescription of unfavorable beta-blockers (BB) and high-dose diuretics (Ds). In NIDDM, Ds (61%), angiotensin receptor blockers (ARBs) (40%), and angiotensin converting enzyme inhibitors (ACEIs) (31%) were mostly prescribed, while in MetS, drugs prevalence was Ds (68%), ARBs (48%), and BB (41%). Polypharmacy in patients with MetS correlated with body mass index; older patients (>65 years) were more likely to receive dual-free combinations. TBP was attained in 25.2% of NIDDM and in 28.7% of MetS patients. In general, low-dose Ds use was more prevalent in NIDDM and MetS, however, overall, Ds were used excessively (NIDDM: 61%, MetS: 68%), especially in single-pill combination. Patients with MetS were more likely to receive ARBs, ACEIs, CCBs, and low-dose Ds than BBs and/or high-dose Ds. Physicians recognize DM and MetS as high-risk patients, but select inappropriate drugs. Because the majority of patients may have both, MetS and NIDDM, there is an unmet need to define TBP for this specific population considering the increased risk in comparison to patients with MetS or NIDDM alone.

Sorting the Wheat from the Chaff: Initial Blood Pressure Control in the VIPER-BP Study Cohort of Primary Care Patients with Previously Uncontrolled Hypertension

patients randomised to usual care (UC) or an algorithm to optimise BP control in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) Study. Methods: Prospective, multi-centre RCT involving 119 primary care clinics. Based on 26 week follow-up data we used (a) change in risk profile and (b) age, initial systolic and diastolic BP and change in BPs, to calculate changes in absolute five year cardiovascular risk score (ACVRS) and relative risk (RR) of a future coronary artery disease (CAD) or stroke event. Results: 1562patients (59± 12years, 62%men, 67%prior hypertension and BP 150± 17/88± 11mmHg) remaining above their individualised BP target were randomised (1:2 ratio) to UC (n= 524) or the VIPER-BP intervention (n= 1038). Consistent with significantly greater falls in BP in favour of the VIPER-BP intervention, mean falls in ACVRS (from baseline) were greatest in VIPER-BP versus UC patients (−3.7± 4.5% vs. −2.6± 4.5%, adjusted mean difference−1.13, 95%CI−1.63 to−0.64%, p< 0.001). Similarly, the adjusted risk of CAD (RR 0.75± 0.36 vs. 0.81± 0.39; p< 0.001) and stroke (RR 0.69± 0.49 vs. 0.80± 0.52; p< 0.001)was attenuatedmost in theVIPER-BP group. Conclusions: A structured care algorithm to optimise primary care management of hypertension not only results in loweredBP, but reducesACVRSandRRof future CVD.

Optimising management of hypertension in primary care: The Valsartan Intensified Primary Care Reduction of Blood Pressure (Viper-Bp) Study

Background The Valstartan Intensified Primary CarE Reduction of Blood Pressure Study (VIPER-BP) Study is an open-label, randomised controlled trial comparing usual primary care management with an intensive BP management strategy using three forms of valsartan-based therapy (mono-therapy, thiazide diuretic or calcium channel blocker combinations) to achieve individualised BP control. Methods To identify the features of General Practitioner (GP) management of hypertension in Australia, we analyse the response to a case scenario-based survey of 500 GPs. We subsequently recruited a national cohort of GP Investigators to enrol up to 2500 patients into the VIPER-BP Study. Results GP responses clearly demonstrated that, compared to the VIPER-BP intervention, a heterogeneous approach to the primary care management of hypertension persists in Australia. By November 2010, 2157 hypertensive patients from 272 actively recruiting GP Investigators were enrolled into the study. Of these, 1965 (91%) patients were entered into a standardised “run-in” phase of 28 days of valsartan 80 mg/day. Subsequently, 1285 patients were randomised to usual care (n = 435) or the VIPER-BP intervention (n = 850). There was a predominance of males (62%), whilst 55% had pre-existing diabetes or cardiovascular disease and 63% had been previously treated for hypertension. Mean systolic and diastolic BP on randomisation for men and women, respectively, was 148 ± 15/88 ± 11 and 148 ± 18/87 ± 10 mm Hg. Conclusions In contrast to typical primary care management of hypertension, VIPER-BP combines more intensive and aggressive therapies with structured management to more rapidly attain and sustain individualised BP targets in hypertensive patients.

Optimising Primary Care Management of Hypertension: The Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER-BP) Study

Optimising Primary Care Management of Hypertension: The Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER-BP) Study

Nurse-led management of hypertension

We read the paper of Voogdt-Pruis et al 1 with interest, since we have recently reviewed the literature for nurse interventions in primary care management of hypertension. We would like to offer the following observations: Firstly, although no previous study …