Maintain Blood Pressure Control Research Articles

Racial differences in time to blood pressure control of aneurysmal subarachnoid hemorrhage patients: A single-institution study.

Aneurysmal subarachnoid hemorrhage occurs in approximately 30,000 patients annually in the United States. Uncontrolled blood pressure is a major risk factor for aneurysmal subarachnoid hemorrhage. Clinical guidelines recommend maintaining blood pressure control until definitive aneurysm securement occurs. It is unknown whether racial differences exist regarding blood pressure control and outcomes (HLOS, discharge disposition) in aneurysmal subarachnoid hemorrhage. Here, we aim to assess whether racial differences exist in 1) presentation, 2) clinical course, and 3) outcomes, including time to blood pressure stabilization, for aSAH patients at a large tertiary care medical center. We conducted a retrospective review of adult aneurysmal subarachnoid hemorrhage cases from 2013 to 2019 at a single large tertiary medical center. Data extracted from the medical record included sex, age, race, insurance status, aneurysm location, aneurysm treatment, initial systolic and diastolic blood pressure, Hunt Hess grade, modified Fisher score, time to blood pressure control (defined as time in minutes from first blood pressure measurement to the first of three consecutive systolic blood pressure measurements under 140mmHg), hospital length of stay, and final discharge disposition. 194 patients met inclusion criteria; 140 (72%) White and 54 (28%) Black. While White patients were more likely than Black patients to be privately insured (62.1% versus 33.3%, p < 0.001), Black patients were more likely than White patients to have Medicaid (55.6% versus 15.0%, p < 0.001). Compared to White patients, Black patients presented with a higher median systolic (165 mmHg versus 148 mmHg, p = 0.004) and diastolic (93 mmHg versus 84 mmHg, p = 0.02) blood pressure. Black patients had a longer median time to blood pressure control than White patients (200 minutes versus 90 minutes, p = 0.001). Black patients had a shorter median hospital length of stay than White patients (15 days versus 18 days, p < 0.031). There was a small but statistically significant difference in modified Fisher score between black and white patients (3.48 versus 3.17, p = 0.04).There were no significant racial differences present in sex, Hunt Hess grade, discharge disposition, complications, or need for further interventions. Black race was associated with higher blood pressure at presentation, longer time to blood pressure control, but shorter hospital length of stay. No racial differences were present in aneurysmal subarachnoid hemorrhage associated complications or interventions.

Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers

BackgroundUncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient’s BP is assumed uncontrolled.MethodsTo examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP).ResultsThe percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021).ConclusionsThe transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.

Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection.

Prescribed aerobic-based exercise training is a low-risk fundamental component of cardiac rehabilitation (CR). Secondary prevention therapeutic strategies following a spontaneous coronary artery dissection (SCAD) or aortic dissection (AD) should include CR. Current exercise guidance for post-dissection patients recommends fundamental training components including target heart rate zones are not warranted. Omitting fundamental elements from exercise prescriptions risks safety and makes it challenging for both clinicians and patients to understand and implement recommendations in real-world practice. We review the principles of exercise prescription for CR, focusing on translating guidelines and evidence from well-studied high-risk CR populations to support the recommendation that exercise testing and individualized exercise prescription are important for patients following a dissection. When patients self-perceive exercise intensity there is a tendency to underestimate intensities within metabolic domains that should be strictly avoided during routine exercise training following a dissection. However, exercise testing associated with CR enrolment has gained support and has not been linked to adverse events in optimally medicated post-dissection patients. Graded heart rate and blood pressure responses recorded throughout exercise testing provide key information for developing an exercise prescription. An exercise prescription that is reflective of medical history, medications, and cardiorespiratory fitness optimizes patient safety and yields improvements in blood pressure control and cardiorespiratory fitness, among other benefits. This clinical practice and education article demonstrates how to develop and manage a CR exercise prescription for post-acute dissection patients that can be safe and effective for maintaining blood pressure control and improving cardiorespiratory fitness pre-post CR.

Abstract P035: Seasonal Variations In Blood Pressure Control Among U.S. Adults With Hypertension, 2011-2018

Introduction: Blood pressure (BP) varies seasonally, typically manifesting as increased BP during the winter and reduced BP during the summer, that may contribute to difficulty in maintaining BP control among individuals with hypertension. We investigated seasonal differences in population-level BP control among U.S. adults with hypertension and whether such associations were modified by demographic and socioeconomic characteristics. Methods: We used cross-sectional 2011-2018 National Health and Nutrition Examination Survey (NHANES) data to identify participants aged ≥20 years with hypertension (defined as self-report, systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or antihypertensive medication use). Participants were categorized into two seasonal periods - winter-spring (November to April) and summer-fall (May to October) - based on their NHANES examination month. Survey-weighted logistic regression modeling was performed to analyze the association of BP control (&lt;140/90 mmHg) with six-month seasonal period, adjusted for age, sex, race and ethnicity, income level, education level, and insurance status. Subgroup analyses were also performed, stratifying by demographic and socioeconomic characteristics. Results: Across all panel years, 4,350 participants had examinations in the winter-spring and 4,521 in the summer-fall season. Mean (SEM) systolic BP was significantly higher in the winter-spring season compared to the summer-fall season (136.2 [0.48] mmHg vs 134.7 [0.61] mmHg; p=0.02). A significantly lower proportion of participants had controlled BP during the winter-spring season compared to participants during the summer-fall season (50.7% vs 55.2%; unadjusted odds ratio [OR]: 0.84 [95% CI: 0.72—0.98]), though the association was modestly attenuated after adjusting for covariates (adjusted OR [aOR]: 0.88 [95% CI: 0.75—1.05]). Similar observations were seen among those taking antihypertensive medication (62.5% vs 67.7%; aOR: 0.83 [95% CI: 0.69—0.99]). Subgroup analyses in the overall hypertensive population did not reveal evidence of heterogeneity of effect across age, sex, race and ethnicity, income level, education level, or insurance status. Conclusions: Seasonal variations in population-level BP control were observed among U.S. adults with hypertension, with a lower prevalence of BP control seen among those on antihypertensive treatment during the winter-spring season than the summer-fall season. No demographic or socioeconomic characteristics appeared to be more susceptible to these seasonal variations.

A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre‐eclampsia

A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre‐eclampsia

Abstract 068: Hypertension And Longitudinal Changes In Cardiac Structure And Function In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Introduction: Hypertension, one of the most modifiable risk factors of heart disease, induces cardiac remodeling and worsens myocardial function prior to the development of clinical symptoms. Using a comprehensive cohort of Hispanic/Latino adults, we assessed cardiac structure and function, in relation to hypertension, and the longitudinal impact of blood pressure control. Hypothesis: If baseline hypertensive adults are stratified by longitudinal blood pressure (BP) control, there will be differences in the progression of cardiac structure and function parameters. Methods: The Echo-SOL Ancillary Study provided serial comprehensive echocardiographic assessments of Hispanic adults aged 45-74 years. They were arranged into two groups based on the presence of baseline hypertension (&gt;140/90mmHg). Linear regression models were used to estimate the association between baseline BP properties and the longitudinal change in echocardiogram parameters. We then subdivided each group based on whether the they maintained BP control (&lt;140/90mmHg) on follow up and used linear regression models to test for significance among the mean longitudinal change of echocardiogram parameters. All analyses accounted for the complex sampling design of HCHS/SOL and Echo-SOL. Results: There was a total of 1818 adults at baseline, with 1643 obtaining serial echocardiograms an average of 4.3 years later, mean age of approximately 56 years. Among all adults, baseline pulse pressure was significantly associated with a longitudinal increase in left ventricular (LV) end diastolic volume (β=0.13, p=0.02), whereas the change in LV mass index longitudinally decreased with baseline diastolic BP (β=-0.14, p&lt;0.01). When isolating the subgroup defined as hypertensive at baseline, the adults who had uncontrolled BP on follow up had a greater absolute increase in the average E/E’ ratio and greater decrease in average E’ velocity, 0.95±0.08 and -0.96±0.06 respectively, compared to the adults with controlled BP 0.04±0.07 and -0.74± 0.04 respectively (p&lt;0.01). In addition, the controlled BP group had a greater absolute reduction in LV end-diastolic volume of 6.94mL than those with uncontrolled BP, 4.60mL (p&lt;0.01). Conclusions: Our study is the first to study the association of longitudinal impact of blood pressure control with cardiac structure and function in Hispanic/Latino adults. We found that higher baseline brachial BP properties were associated with reduced in LV mass index and increased LV end diastolic volumes. Among the baseline hypertensive adults, there was a significantly higher progression in diastolic dysfunction among the participants who had poor BP control, but those with controlled BP on follow up had greater LV enlargement. Despite these differences, both subgroups ultimately showed a collective progression in diastolic dysfunction and a decrease in end-diastolic volume over time.

Covid-19, Hypertension And Important Three Topics in Nursing Care: Physical Exercise, Adequate-Balanced Nutrition, Sleep

The new coronary virüs (COVID-19) appeared in the Wuhan, the People’s Republic of China in December 2019, and has spread throughout the World, becoming o global epidemic. When evaluating COVID-19 data in the World; the number of infected individuals who have lost their lives is increasing rapidly every day. İt emphasized that COVID-19 needs to be dealt with much more seriously for vulnerable members of the community, which includes immune problems, a history of comorbidity, and the elderly. Hypertension among comorbidity is notable in reports related to COVID-19. Although it is not clear that the relationship between hypertension and COVID-19 may be linked to Angiotensin-converting enzyme 2 (ACE2), it is an issue that is being considered. It is stated in humans that COVID-19 is connected to host cells through ACE2. Information pollution spread through the press and social media related to COVID-19 and ACE2 can cause compliance problems with antihypertensive drugs. The COVID-19 pandemic process is emphasized as an important element of blood pressure control to reduce the burden of disease. Nurses can help hypertensive individuals in the pandemic process by advising on adequate-balanced nutrition, physical exercise, and sleep to maintain blood pressure control and functional health. Nurses’ support of hypertensive individuals in the pandemic process can contribute to maintaining public Health for post-pandemic and future disasters. With this review, COVID-19’s relationship with ACE and recommendations on which topics can be counseled by nurses to hypertensive individuals who are in the disadvantaged group during a pandemic are trying to be discussed.

Bariatric Surgery for Resistant Hypertension: Working in Progress!

To discuss the recent evidence pointing the benefits of the bariatric surgery on blood pressure control in patients with obesity and hypertension. Particular focus is devoted to discuss the potential impact on resistant hypertension. Growing evidence suggest that bariatric surgery promotes not only a significant reduction in the anti-hypertensive medication while maintained blood pressure control but also a significant proportion of hypertension remission as compared to the usual care. In a sub-analysis of the GATEWAY trial using both office and 24-h ambulatory blood pressure monitoring, the prevalence of resistant hypertension significantly decreased after 12months in the surgical group whereas the numbers remained stable in the control group. Despite the lack of robust evidence, preliminary findings underscore the strong need to explore the potential role of bariatric surgery on resistant hypertension in patients with obesity. This statement is justified not only for the burden of obesity in this scenario but also for the unmet demands in managing resistant hypertension appropriately by multiple drug-therapy or the lack of real utility of procedures like renal denervation and carotid baroreflex activation.

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

The Management of Hypertension in 2018: What Should the Targets Be?

To provide an overview of the different guidelines for hypertension management from around the world. The guidelines discussed include those from the United States (US), Europe, Canada, and Latin America. All guidelines except the US define hypertension as >140/90mmHg, and the US defines it as >130/80mmHg. In general, all guidelines except those from the US emphasize lifestyle modification as the cornerstone of initial therapy given blood pressure levels <140/90mmHg. The US emphasizes lifestyle modification at all BP levels starting at 130/80mmHg. Additionally, all guidelines emphasize the need to assess cardiovascular risk with the Canadian guidelines indicating that a high cardiovascular risk person should have a goal of <130/80mmHg. All agree on the proper method of blood pressure measurement techniques and importance of home blood pressure. All support use combination therapy with the European guideline emphasizing initial therapy should be a combination pill. All guidelines stress the importance of patient adherence to maintain blood pressure control. All guidelines emphasize lifestyle modification, need for home blood pressure measurement, as well as use of proper techniques to measure blood pressure. The fundamental difference between US and all other guidelines is the definition of hypertension, >130/80mmHg in US and > 140/90mmHg in the rest of the world.

Blood pressure control in treated hypertensive Middle Eastern patients: a post hoc analysis based on JNC8 definitions.

BackgroundLong-term blood pressure (BP) control is challenging due to the asymptomatic nature of hypertension and poor treatment adherence among patients. We conducted a post hoc analysis to assess “target BP” attainment and maintenance and to identify their associated factors in a sample of hypertensive Middle Eastern patients.MethodsWe previously conducted an observational study between May 2011 and September 2012 to assess antihypertensive treatment adherence and its determinants in a sample of 1,470 hypertensive patients in Lebanon and Jordan. The study consisted of 3 visits: at baseline, 3 months, and 6 months, where BP control, health-related quality of life, and treatment adherence were assessed. This post hoc analysis of data from the ADHERENCE study examined BP control in terms of target attainment at 3 months and 6 months, and target maintenance at 6 months in treatment-eligible patients as well as the determinants of BP control including the impact of the new JNC8 (Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) guideline on treatment eligibility and target BP attainment in these patients.ResultsBased on JNC8 definitions, our results revealed that 81.2% of patients achieved BP control at 6 months. At 3 months, 62.2% achieved BP control; of those, only 57.5% maintained BP control till 6 months. Factors associated with higher BP target attainment at 3 months were higher educational level, new hypertension diagnosis, older age, and lower waist circumference, systolic BP, and diastolic BP at baseline. Factors associated with higher BP target attainment at 6 months were Lebanese nationality, new hypertension diagnosis, absence of chronic kidney disease, lower systolic BP at baseline, reaching BP target at 3 months, and having a BP target of <150/90 mmHg.ConclusionOlder age, higher education levels, recent hypertension diagnosis, early achievement of target BP, and having milder disease at baseline were associated with better BP control. Moreover, JNC8 guideline reduced the number of treatment-eligible patients and increased BP target attainment.

Association of Structured Virtual Visits for Hypertension Follow-Up in Primary Care with Blood Pressure Control and Use of Clinical Services.

Optimal management of hypertension requires frequent monitoring and follow-up. Novel, pragmatic interventions have the potential to engage patients, maintain blood pressure control, and enhance access to busy primary care practices. "Virtual visits" are structured asynchronous online interactions between a patient and a clinician to extend medical care beyond the initial office visit. To compare blood pressure control and healthcare utilization between patients who received virtual visits compared to usual hypertension care. Propensity score-matched, retrospective cohort study with adjustment by difference-in-differences. Primary care patients with hypertension. Patient participation in at least one virtual visit for hypertension. Usual care patients did not use a virtual visit but were seen in-person for hypertension. Adjusted difference in mean systolic blood pressure, primary care office visits, specialist office visits, emergency department visits, and inpatient admissions in the 180days before and 180days after the in-person visit. Of the 1051 virtual visit patients and 24,848 usual care patients, we propensity score-matched 893 patients from each group. Both groups were approximately 61years old, 44% female, 85% White, had about five chronic conditions, and about 20% had a mean pre-visit systolic blood pressure of 140-160mmHg. Compared to usual care, virtual visit patients had an adjusted 0.8 (95% CI, 0.3 to 1.2) fewer primary care office visits. There was no significant adjusted difference in systolic blood pressure control (0.6mmHg [95% CI, - 2.0 to 3.1]), specialist visits (0.0 more visits [95% CI, - 0.3 to 0.3]), emergency department visits (0.0 more visits [95% CI, 0.0 to 0.01]), or inpatient admissions (0.0 more admissions [95% CI, 0.0 to 0.1]). Among patients with reasonably well-controlled hypertension, virtual visit participation was associated with equivalent blood pressure control and reduced in-office primary care utilization.

Effects of eplerenone on resistance to antihypertensive medication in patients with primary or secondary hyperaldosteronism

Resistant hypertension is an important problem; nearly half of diagnosed hypertensives are not controlled to target blood pressure levels, and approximately 90% of strokes occur among patients with resistant hypertension. Primary aldosteronism accounts for approximately 20% of resistant hypertension, but the role of secondary hyperaldosteronism in resistant hypertension is seldom considered. We assessed the effects of eplerenone in patients with hypertension and either primary or secondary hyperaldosteronism. Patients with a history of resistant hypertension and a supine plasma aldosterone level ≥ 360 pmol/L were randomized to eplerenone versus placebo in a fully blinded study for one year. A medication intensity score was developed to assess the resistance of hypertension to medication (blood pressure × medication intensity). We assessed the effects of eplerenone on blood pressure and on resistance to concomitant medication. Final results were available in 37 patients (19 on eplerenone and 18 on placebo). Resistance to medication, as assessed by the intensity of concomitant medication required to maintain blood pressure control, was markedly reduced by eplerenone: medication intensity scores declined by -0.50 ± 1.04 (SD) on placebo versus -2.11 ± 1.45 with eplerenone (P = 0.0001), the Systolic Resistance Score declined by -80.00 ± 122.93 on placebo versus -334.05 ± 21.73 on eplerenone (P = 0.0001), and the Diastolic Resistance Score increased by 1.28 ± 31.65 on placebo and declined by -40.74 ± 57.08 on eplerenone (P = 0.009). Eplerenone significantly reduced resistance to concomitant antihypertensive medication in both primary and secondary hyperaldosteronism.

Abstract P258: Antihypertensive Medication Nonadherence Among Hispanic Adults by Healthcare Access and Acculturation Characteristics - Estilos Survey, 2015

Medication adherence for hypertensive adults (HTNs) is an important factor in achieving and maintaining blood pressure control, as it has been associated with better health outcomes and lower costs of medical care. We assessed the differences in the prevalence of self-reported antihypertensive medication use and adherence among Hispanic HTNs by selected characteristics. Methods: ESTILOS is an online panel for health survey data of Hispanic adults in the USA. In 2015, 1,000 adults completed the survey with a response rate of 29%. The resulting data were weighted using 8 factors: gender, age, household income, household size, education, census region, country of origin, and acculturation (based on years living in the USA, language spoken at home, cultural self-identification, and use of Spanish language). The differences among characteristics for prevalence ± standard error of medication use and adherence were compared by using χ 2 statistics. Results: The prevalence of hypertension was 27.5±2.7%. The prevalence of antihypertensive medication use in HTNs was 67.9±4.6%) overall and was higher among those ≥55 years of age (95.2±2.1%; P =&lt;0.0001), retirees (92.3±4.0%; P =0.0002), who had healthcare coverage (72.5±4.8%; P =0.02) and had a primary care physician (PCP) (71.9±4.9%; P =0.03), did not have any reported cost barriers to seeing their PCP within past 12 months (71.9±5.3%; P =0.001), and took 3-4 lifestyle actions (79.7±5.4%; P =0.015) than &lt;3 lifestyle actions). Among HTNs taking antihypertensives, 24.0±7.0% reported missing or skipping medication doses. HTNs aged &lt;55 years or who could not see a PCP within the past year due to cost barriers, were more likely to miss or skip doses of antihypertensive medication (&lt;55=54.1±13.4%) vs &gt;55=11.5±5.3%; P =0.03 and could not see PCP=45.2±12.1% vs 12.0±5.2%; 0.01, respectively). Conclusion: Poor antihypertensive medication adherence among Hispanics with hypertension was associated with younger age groups and those who reported barriers to engaging with a PCP. Public health practitioners and clinicians can utilize this information to support their programs and can tailor strategies for improved outcomes.

Abstract WP402: Performance Measurement of Blood Pressure Management in the Acute Phase of Intracerebral Hemorrhage

Background: Patients with intracerebral hemorrhage (ICH) frequently present with elevated blood pressure (BP) requiring treatment. We conducted an exploratory analysis to examine BP management during the acute phase of ICH. We hypothesized that BP management and time to achieve goal BP would be variable. Our aim was to identify areas for improvement in BP management. Methods: We performed a retrospective chart review on consecutive patients with spontaneous ICH admitted to our neurosurgical intensive care unit (NSICU) from February-March 2015. Exclusions included secondary causes of ICH or comfort care orders placed within 72 hours of arrival. Demographic and clinical characteristics were collected as well as times for BP treatment order placement, IV treatment initiation and discontinuation. We recorded hourly BPs for the first 72 hours of hospitalization. Primary outcome measure was the time to achieve institutional guideline recommended BP control defined as SBP &lt;150 mmHg, maintained for &gt;6 hours. Secondary outcome included the proportion of patients who achieved SBP target &gt;85% of the time. Results: We screened 37 patients and 29 met criteria. Baseline information is summarized in Table 1. Documented BP goals for 25 of 29 patients targeted a SBP goal &lt;150 mmHg. Documentation of BP goals, orders for treatment and initiation of IV medication for BP treatment all happened concurrently about 1 hour after admission (Figure 1). SBP control was achieved at a median of 9.3 hours after admission. Only 46.4% of patients achieved target SBP &gt;85% of the time. Conclusions: In our population, there is variability in the time it takes to achieve and maintain goal SBP with less than half of patients maintaining BP control. We identified targeted areas for improvement. Our data is limited by its retrospective nature and small size. Since aggressive BP management limits hematoma growth and may improve outcomes, we propose development of benchmarks to guide BP management in ICH patients.

Hypertension guidelines: Evidence-based treatments for maintaining blood pressure control.

Approximately one in three adults in the United States has hypertension. This article provides an update on the latest JNC-8 guideline for treating hypertension in adults. Emphasis is placed on new and updated information and implications for primary care clinicians to help patients achieve and maintain better blood pressure control.

Patients with undiagnosed hypertension: hiding in plain sight.

Patients with undiagnosed hypertension: hiding in plain sight.

The Kaiser Permanente Northern California Hypertension Project 2001-2012: How an integrated care delivery system increased and maintained blood pressure control rates from 44% to 86% in 11 years

Small studies have been published on the effect of hypertension programs on blood pressure (BP) control, but few studies have reported the efficacy of a large-scale hypertension programs. Kaiser Foundation Health Plan of Northern California is a not-for-profit integrated health care delivery system with a membership of over 2.3 million adult members. In 2001, the Kaiser Permanente Northern California Hypertension Project was developed as an evidence-based program to increase BP control for members with hypertension. We previously reported our experience from 2001 to 2009, and in this report we describe the results from 2009 to 2012. In 2001, the Kaiser Permanente Northern California Hypertension Project was established. A registry of patients with hypertension was created to identify at-risk patients. Physician level and Medical Center level metrics were established to measure performance over time. An evidence based clinical practice guideline was developed, disseminated, reviewed and updated every 2 years. Clinicians were systematically educated on the guidelines and updated on their individual and group hypertension control performance measurements. Infrastructure was established including the creation of medical assistant BP checks and promotion of single pill combination medical therapy with angiotensin-converting enzyme inhibitor (ACEI) and hydrochlorothiazide (HCTZ). Medical centers that

Consider specific co-morbidities and disease aetiology when treating hypertension in patients with chronic kidney disease

Maintaining blood pressure control and reducing proteinuria in hypertensive patients with chronic kidney disease is crucial to prevent the progression of kidney disease and the development or worsening of cardiovascular disease. Pharmacological treatment recommendations vary depending on the specific aetiology of disease, as well as patient characteristics. The majority of patients will require multi-drug therapy in order to achieve blood pressure goals.

Variables associated with change in blood pressure control status after 1-year follow up in primary care: a retrospective analysis: the TAPAS study

This 1-year, retrospective, observational study assessed factors associated with changes in hypertension control status and differences in blood pressure (BP) management among general practitioners in Spain. In 2009, 307 investigators from 260 primary care centres in Spain recruited the first four consecutive patients with hypertension that fit into one of four predefined cohorts: (1) uncontrolled BP at baseline and at a 1-year follow-up visit; (2) uncontrolled BP at baseline and good BP control at the 1-year follow-up visit; (3) good BP control at baseline and loss of BP control at the 1-year follow-up visit; and (4) good BP control at baseline and at the 1-year follow-up visit. A total of 1385 patients were included. Patients with poor BP and patients that lost BP control exhibited more cardiovascular risk factors. Although antihypertensive treatment was increased more markedly in these patients, this was not sufficient to attain/remain BP goals. Predictors for attaining BP control were no smoking, absence of diabetes, reduction in cholesterol, low baseline cholesterol, and no weight gain. Predictors for failing to maintain BP goals were weight gain, high baseline LDL cholesterol, and no reduction in fasting glucose. NSAID prescriptions increased markedly in patients that lost BP control compared to those that maintained BP control. Antihypertensive therapy should be intensified and healthy lifestyle changes should be emphasized, particularly weight control to improve BP control. Drugs that may increase BP levels, such as NSAIDs, should also be avoided.