Likelihood Of Blood Pressure Control Research Articles

444 Higher Dietary Sodium-to-Potassium Ratio Associated with Lower Likelihood of Blood Pressure Control Among Individuals with Chronic Kidney Disease

444 Higher Dietary Sodium-to-Potassium Ratio Associated with Lower Likelihood of Blood Pressure Control Among Individuals with Chronic Kidney Disease

#6749 PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN OLDER ADULTS WITH CHRONIC KIDNEY DISEASE: THE IRISH LONGITUDINAL STUDY ON AGEING

Abstract Background and Aims Hypertension is a well-known modifiable risk factor for chronic kidney disease (CKD) yet effective management remains a challenge. Data on hypertension awareness, treatment and control among CKD patients in Ireland is limited. Therefore, the objective of this study was to determine the prevalence, extent of awareness, treatment and control of hypertension among older adults with CKD in the Irish population. Method We utilised cross sectional data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) conducted between 2009 and 2011. Participants aged 50 years or more with complete measurements on serum creatinine and blood pressure (BP) were included (n = 5, 356). CKD was defined as eGFR <60ml/min/1.72m2. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported use of antihypertensive medication. Participants’ awareness and treatment of hypertension were defined using self-report and hypertension control was evaluated as systolic/diastolic blood pressure <140/90 mmHg. We determined the weighted prevalence of hypertension, awareness, treatment, and control using sample weights, and multivariable logistic regression explored associations of demographic, clinical and behavioural characteristics with control of hypertension. Associations were expressed using adjusted odds ratios (OR) with 95% confidence intervals (CIs). Analyses were conducted in Stata and R. Results There were 639/5,356 participants [13.3% (95%CI: 12.3-14.4)] with CKD. The weighted prevalence of hypertension was significantly higher in participants with CKD than without CKD (81.8% versus 59.8% respectively, P<0.001). Among those with CKD and hypertension, 70.8% (95% CI: 66.5-74.7) were aware of hypertension, and 83.4% (95% CI 79.9-86.5) were treated with antihypertensive medication. Despite higher levels of awareness and treatment of hypertension in those with CKD, only 50.4% (95% CI 45.4-55.5) of treated subjects had BP <140/90 mmHg. BP control was similarly poor for non-CKD participants at 49.4% (95%CI: 46.9-51.8). The most commonly used medications among treated CKD participants were β-blockers 41.8% (95% CI 36.7-47.1), angiotensin-converting enzyme inhibitors 34.0% (95% CI 29.2-39.2), and angiotensin receptor blockers 33.7% (95% CI: 28.9-38.8). Over half [54.8% (95% CI: 49.5-60.0)] of CKD participants were treated with ≥ 2 antihypertensive medications. In multivariable analysis, the likelihood of BP control (<140/90 mmHg) was lower for older CKD patients [OR: 0.94 (95% CI: 0.90-0.98) per 1 year increase in age], greater for those on combination therapy [OR: 1.87 (95%CI: 1.13-3.1)] and for those with history of cardiovascular disease [OR: 2.33 (95%CI: 1.43-3.82)]. Conclusion Despite established evidence that control of hypertension can slow the progression of CKD and reduce cardiovascular complications, our results indicate that the prevalence of hypertension in older adults with CKD is high and the control of hypertension is poor and worsens with advancing age. Approximately, one third of participants with CKD were unaware of their hypertensive status and approximately one fifth of participants were untreated.

Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control

Introduction: Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity. Hypothesis: We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities. Methods: We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP<140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes. Results: The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p<0.001) and missed more visits (β=0.37, p<0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure). Conclusion: Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.

Relationship between Knowledge and Family Support regarding Hypertension with Blood Pressure Control in Elders

Background : Hypertension is one of the degenerative diseases that have frequently been found among the group of elderly. If hypertension goes uncontrolled, then it might escalate and cause complication. The level of knowledge for both of patients and their families in terms of preventive actions toward hypertension complication is expected to be able to control blood pressure. Among the hypertension patients, the role of family support is very important in order to maintain and to control that the blood pressure will not increase and to return it to the normal state. In relation to this background, the objective in conducting this study was to analyze the relationship between knowledge and family support regarding hypertension with blood pressure control among the elderly with hypertension in the Sangkrah Center of Public Health, City of Surakarta. Sub jects and Met h od : This was an analytic observational study with cross sectional design. This study was conducted in Sangkrah Community Health Center in the City of Surakarta on November 2016. A total sample of 147 elderly were selected for this study by purposive sampling. The dependent variables in this study was blood pressure and was measured by sphygnomanometer. The independent variables were knowledge and family support and were collected by a set of questionnaire. The data analyzed by logistic regression. Results : Family knowledge (OR= 0.38; 95% CI= 0.13 to 1.08; p= 0.070) increased the likelihood of blood pressure control. Elderly who came from family with good knowledge regarding hypertension had 0.4 times better blood pressure control in comparison to those who came from family with poor knowledge regarding hypertension. Family support (OR= 0.43; 95% CI= 0.18 to 1.02; p= 0.046) increased the likelihood of blood pressure control. Elderly with good family support had 0.4 times better blood pressure than those who had poor family support. Conclusion : Family knowledge and family support increase the probability of blood pressure control among elderly with hypertension. Keywords : knowledge, family support, blood pressure control, elderly Correspondence : Iin Kusumawardana. Masters Program in Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: iinkusuma90@gmail.com Indonesian Journal of Medicine (2017), 2(1): 1-9 https://doi.org/10.26911/theijmed.2017.02.01.01

Impact of Work Conditions and Minority Patient Populations on Quality and Errors.

Objectives:To determine whether workplace conditions affect care quality and errors, especially in primary care clinics serving minority patients.Methods:We conducted a 3-year assessment of work conditions and patient outcomes in 73 primary care clinics in the upper Midwest and New York City. Study participants included 287 physicians and 1204 patients with hypertension and/or diabetes. Chart audit data were contrasted between clinics with ≥30% minority patients (minority-serving clinics, or MSCs) and those with <30% (nonminority-serving clinics, or NMSCs). Physicians reported on time pressure, work control, clinical resources, and specialty referral access; managers described room availability; and chart audits determined care errors and quality. Two-level hierarchical models tested work conditions as mediators between MSC status and clinical outcomes.Results:Error rates were higher in MSCs than NMSCs (29.6% vs 24.8%, P < .05). Lack of clinical resources explained 41% of the effect of MSC status on errors (P < .05). Diabetes control was poorer in MSCs than in NMSCs (53.8% controlled vs 76.1%, P < .05); lack of clinical resources explained 24% of this difference (P < .05). Room availability increased quality in both MSCs and NMSCs by 5.95% for each additional room per clinician per session. Lack of access to rooms and specialists decreased the likelihood of blood pressure control in MSCs.Conclusion:Work conditions such as clinical resources, examination room availability, and access to referrals are significantly associated with errors and quality, especially in MSCs.

The effect of regular primary care utilization on long-term glycemic and blood pressure control in adults with diabetes.

Complications of diabetes mellitus (DM) can be reduced with regular preventive care and guidance on self-management. We investigated whether regular primary care utilization could improve glycemic control and blood pressure control among American Indian/Alaska Native people with DM. Patient characteristics, risk factors, and health outcomes were identified from electronic health records of a cohort of 2138 adults with DM who received care between 1995 and 2010 from Southcentral Foundation, a tribal provider. Bivariate probit regression models estimated the probability of glycemic control and blood pressure control as functions of regular primary care, risk factors, and access factors, while taking into account potential bias arising from voluntarily choosing to seek primary care services. Regular primary care was associated with an 89% increased likelihood of blood pressure control (95% confidence interval [CI], 59-118%) and 177% increased likelihood of glycemic control (95% CI, 123-222%). Increasing the distance by 10 miles to primary care services reduced the likelihood of regular primary care by 3.7% (95% CI, -2.9% to -4.6%). Regular primary care utilization over 16 years was associated with higher rates of blood pressure control and glycemic control for adults with DM. People living closer to primary care services had a better chance of improved outcomes.

Current quality of cardiovascular prevention for Million Hearts: An analysis of 147,038 outpatients from The Guideline Advantage

Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The degree to which outpatient providers are controlling risk factors has not been fully described. We examined adherence to the Million Hearts clinical quality measures using The Guideline Advantage, a nationwide quality improvement program for outpatient care. Specifically, we determined the proportion of patients with (1) ischemic vascular disease who were prescribed an antiplatelet drug; (2) hypertension whose blood pressure was controlled; (3) diabetes mellitus whose most recent low-density lipoprotein cholesterol level was <100 mg/dL; and 4) a tobacco use screening and who received a smoking cessation intervention as needed. From January 1, 2010, to March 31, 2012, there were 147,038 patients enrolled from 25 US practices. At the practice level, antiplatelet prescription ranged from 50.0% to 82.3% (median 71.9%, interquartile range [IQR] 66.7-82.1), hypertension control ranged from 48.6% to 75.3% (median 66.6%, IQR 60.1-70.9), hyperlipidemia control among patients with diabetes mellitus ranged from 53.3% to 100.0% (median 75.8%, IQR 65.8-83.0), and tobacco use screening and intervention ranged from 31.0% to 98.8% (median 79.8%, IQR 72.0-83.2). Black and people of color races were associated with a lower likelihood of blood pressure control and cholesterol control. Female gender was associated with a lower likelihood of antiplatelet prescription and cholesterol control. Compliance with quality measures for the Million Hearts initiative varies widely and is notable for racial and gender disparities. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.

Patient and Social Environment Factors Associated With Self Blood Pressure Monitoring by Male Veterans With Hypertension

Self blood pressure monitoring (SBPM) can facilitate hypertension management, but determinants of SBPM are understudied. The authors examined the relationship of patient and social environment characteristics to monitor possession and frequency of SBPM in 578 male hypertensive veterans. Measures included possession of a monitor; SBPM frequency; concurrent blood pressure control; and patient demographic, clinical, and psychosocial factors. In logistic regression analyses, older age, diabetes, unemployment, and better mental health status were related to greater likelihood of monitor possession. Ordinal logistic regression showed that among patients with a monitor, having diabetes, being unemployed, and having a shorter duration of hypertension were independently related to greater frequency of SBPM. Monitor possession, but not frequency of SBPM, was related to a decreased likelihood of blood pressure control in adjusted analyses. Our results suggest that patient characteristics may influence SBPM and may represent points of leverage for intervening to increase self-monitoring.