Blood Pressure Readings Research Articles

Pediatric Primary Care Physicians’ Perceptions of, and Processes for, Pediatric Blood Pressure Screening, Follow-Up, and Hypertension Management

Background/Objectives: Pediatric hypertension is an important and impactful condition. The 2017 American Academy of Pediatrics clinical practice guidelines provide recommendations for identifying and managing this condition within primary care. However, the perspectives and self-described practices of physicians are largely absent in the current evidence base. We aim to fill this gap through our qualitative investigation of physicians’ perceptions and practices related to the screening, follow-up, and management of primary pediatric hypertension. Methods: We conducted semi-structured interviews with pediatric and family medicine physicians from the largest healthcare system in central Massachusetts. The interviews explored physicians’ perceptions, and practices related specifically to pediatric blood pressure screening, follow-up for high blood pressures, and management of primary hypertension. We used rapid qualitative analysis to synthesize data into the resulting themes. Results: Eleven interviews were conducted. Resulting themes included: (1) physicians are generally concerned about pediatric hypertension and familiar with guidelines, but other concerns often take precedence, (2) blood pressure screening occurs mainly during yearly well visits, (3) physicians do not trust high blood pressure readings, (4) follow-up after high blood pressure readings varies, and (5) primary care physicians typically refer to specialists for hypertension management. Conclusions: This study expands current literature by providing salient context to the state of pediatric blood pressure screening, follow-up, and primary hypertension management after the 2017 guidelines among primary care physicians affiliated with an academic medical center. Our findings related to physicians’ trust in electronic health record flags and the utility of follow-up by school nurses warrant further investigation.

Accuracy of a Novel High-Throughput "Car Blood Pressure" Measurement Protocol.

More than one in three adults with hypertension in the United States are unaware of their condition, highlighting the importance of large-scale screening campaigns. Currently, the identification of hypertension is largely limited to medical settings. To help overcome this barrier, we developed a novel high-throughput screening protocol that measures blood pressure (BP) while patients remain seated in an automobile ("car-BP"). The aim of this study was to provide an initial assessment of the accuracy of car-BP. Three BP readings were determined in a clinic exam room before and after three BP readings were taken while patients were seated in a parked car outside (n=100 participants). The same validated device model (Omron HEM-907XL) and BP measurement methods adhering to guidelines were used in both scenarios. The average of all 6 clinic readings was compared to the average of the 3 car-BP readings in each individual. Mean clinic and car-BP readings were 120.9 ± 16.2/78.0 ± 9.9 and 118.9 ± 15.2/76.0 ± 10.0mm Hg, respectively. The paired mean and absolute mean differences in systolic BP levels between methods were -1.92mm Hg (95% confidence interval (CI) -3.2 to -0.7mm Hg) and 4.8mm Hg (95%CI 3.8 to 5.6mm Hg), respectively. A total of 85% of participants had both systolic and diastolic BP levels ≤10mm Hg different between measurement scenarios (meeting the a priori determined study primary outcome). Car-BP represents an innovative and accessible approach for potential large-scale hypertension screening campaigns.

Long-Term Blood Pressure Trends After a Remote Hypertension Intervention: A Secondary Analysis of the Digital Care Transformation: Remotely Delivered Hypertension Management Program.

Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program's long-term effects by examining participants' office BP up to 42 months post-enrollment. Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled-early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group. Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values (P<0.001) over 42 months. In the maintenance group, 89.7% of participants maintained systolic BP at goal, compared with 63.5% in the early exit group, 69.4% in the education-only group, and 90.7% in the white coat hypertension group. Age >50 years was associated with above-goal systolic BP in the maintenance group. Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.

Effects of Noise and Public Setting on Blood Pressure Readings : A Randomized Crossover Trial.

Guidelines emphasize quiet settings for blood pressure (BP) measurement. To determine the effect of noise and public environment on BP readings. Randomized crossover trial of adults in Baltimore, Maryland. (ClinicalTrials.gov: NCT05394376). Study measures were obtained in a clinical research office and a public food market near Johns Hopkins University School of Medicine in Baltimore, Maryland. 108 community-dwelling adults from the Baltimore, Maryland, area recruited through measurement-screening campaigns, mailings to previous study participants, and referrals from hypertension clinics. Participants were randomly assigned to the order in which they had triplicate BP measurements in each of 3 settings: 1) private quiet office (private quiet [reference]); 2) noisy public space (public loud); and 3) noisy public space plus earplugs (public quiet). Differences in mean BP readings obtained in public loud and public quiet versus private quiet, overall and stratified by baseline systolic BP (SBP), age, and recent health care utilization. Of the 108 randomly assigned participants, mean age was 56 years (SD, 17), 84% were self-reported Black, 41% were female, and 45% had an SBP of 130 mm Hg or more. The average noise level in public loud was 74 dB and in private quiet was 37 dB. Mean SBPs were: 128.9 mm Hg (SD, 22.3) in private quiet, 128.3 mm Hg (SD, 21.7) in public loud, and 129.0 mm Hg (SD, 22.2) in public quiet. Corresponding diastolic BPs (DBPs) were 74.2 mm Hg (SD, 11.4), 75.9 mm Hg (SD, 11.6), and 75.7 mm Hg (SD, 12.0), respectively. Public-loud and public-quiet BPs had minimal, non-clinically important differences from private quiet BPs: public loud: ΔSBP, -0.66 mm Hg (95% CI, -2.25 to 0.93 mm Hg) and ΔDBP, 1.65 mm Hg (CI, 0.77 to 2.54 mm Hg); public quiet: ΔSBP, 0.09 mm Hg (-1.53 to 1.72 mm Hg) and ΔDBP, 1.45 mm Hg (0.64 to 2.27 mm Hg). The patterns were generally consistent across subgroups. Single-center trial. Imbalance in the numbers and characteristics across the randomly assigned groups. The BP readings obtained in public spaces were minimally different from BPs obtained in a private office, suggesting that public spaces are reasonable settings to screen for hypertension. Resolve to Save Lives.

Comparison of continuous non-invasive blood pressure measurement using Vitalstream™ to invasive Intraarterial pressure in pediatric surgery.

Accurate blood pressure monitoring is essential in many clinical scenarios for adults and children and, when continuous measurement is critical, necessitates the insertion of an arterial line. A novel continuous non-invasive arterial pressure monitoring device using a pulse contour algorithm (Pulse Decomposition Analysis), Vitalstream™, is approved by the United States Food and Drug Administration for use in adults. In this study the performance and accuracy of the device compared to intraarterial blood pressure monitoring were assessed in children ages 2-17 undergoing major surgeries. We report the results using comparison to aspects of the recently published ISO 81060-3:2022 standard for continuous automated blood pressure measurement. 31 children ages 2-17years scheduled for major surgery requiring invasive arterial blood pressure monitoring were consented to participate. Systolic, diastolic, and mean arterial blood pressure readings were obtained from both systems during at least thirty minutes of simultaneous monitoring during hemodynamically stable periods of the surgical procedure and statistically compared. The correlations of systolic and, diastolic, and mean arterial pressures were, respectively, 0.77, 0.68 and 0.7. The Bland-Altman comparisons yielded bias of -3.79 (9.74) mmHg, 1.72 (8.45) mmHg and 2.41 (8.75) mmHg respectively, for systolic, diastolic, and mean arterial pressures, (p<0.001 for all comparisons). Concordances for systole, diastole and MAP were, respectively, 0.82, 0.85 and 0.83. Most values fell within +/-20mmhg of the corresponding arterial line values. While this meets the basic requirement for such devices published by professional societies, clinicians will need to be aware of the potential variances and make clinical decisions accordingly. The Vitalstream™ may offer low risk, accurate continuous pressure monitoring in children ages 2-17. gov: NCT04817137 The trial was registered at clinicaltrials.gov (NCT048I7173).

Prevalence of Hypertension in Outpatient Consultations in a Cardiology Department in West Africa in Dakar, Senegal According to &amp;quot;MY MEASURE MONTH&amp;quot;

Objectives: This study, conducted as part of the &amp;quot;My Measure Month&amp;quot; program in collaboration with the French Society of Hypertension, aimed to investigate the prevalence of hypertension, emphasize the importance of measuring blood pressure. Methodology: This was an observational and cross-sectional study conducted over one month in the outpatient department of a center specialized in hypertension management. The study included patients aged over 18 years. We examined hypertension data (duration, treatments, compliance) and cardiovascular risk factors. Blood pressure was measured. Three measurements were taken at one-minute intervals. In the bivariate analysis, a p-value ≤ 0.05 was considered statistically significant. Results: The prevalence of hypertension was 45.6%. Hypertension was more frequent in women (54.2%), and the most represented age group was 50 to 70 years, with a prevalence exceeding 70% in patients over 70 years old. In our sample, 13% of patients not previously known to be hypertensive had elevated blood pressure readings. Successive measurements showed variations in hypertension grades, with a progressive decrease in patients with grade II and III hypertension. Among hypertensive patients, 93% had no coverage for their medications. Most patients were on pharmacological treatment, but a significant proportion remained uncontrolled (36.2%), especially those on dual therapy. Bivariate analysis showed that age ≥ 65 years, smoking, dyslipidemia and heart failure were significantly associated with hypertension. Conclusion: An integrated strategy for prevention, screening, and treatment is crucial to reduce the burden of hypertension in this population, improve the quality of life for hypertensive patients.

Impact of Systolic Blood Pressure Trajectories and Variability on Unexplained Early Neurological Deterioration Post-Endovascular Treatment in Acute Ischemic Stroke Patients.

Early neurological deterioration (END) following endovascular treatment (EVT) in acute ischemic stroke (AIS) patients is associated with poor long-term outcomes. Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24h post-EVT. Unexplained END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score 24h after EVT without any identifiable cause. Two distinct SBP trajectories-high and low-were identified within 24h post-EVT. The high-trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR]=3.28, p<0.01). SBPV alone was an independent risk factor for unexplained END (OR=1.11, p<0.05). Moreover, patients with both higher mean SBP and increased SBPV had a markedly greater risk of unexplained END (OR=13.79, p<0.05). Notably, the harmful threshold for SBPV was lower during nighttime compared to daytime. These findings suggest that increased SBPV, particularly when combined with elevated mean SBP, significantly heightens the risk of unexplained END post-EVT. Therefore, comprehensive post-EVT blood pressure management should address both absolute BP levels and BPV, with particular emphasis on nighttime monitoring, to optimize early neurological recovery.

Morbidity Profile of Workers in a Sponge Iron Industry in Goa: A Retrospective Record-based Study

Introduction The Sponge iron industries are categorized as red industries (i.e. highly polluted industries) with the major pollutants including particulate matter and gaseous pollutants, the toxic effects of which are often rapid. Prolonged exposure to such pollutants leads to obstructive lung diseases such as asthma or chronic obstructive respiratory disease. The current study aims to assess the morbidities prevalent among the workers in the Sponge iron industry in Goa and help them minimize those with suitable measures. Objective To study the morbidity profile of workers in a Sponge iron industry in Goa. Materials and Methods A retrospective record-based study was conducted on 217 workers. Selected health parameters were studied: socio-demographic details, anthropometry, blood pressure, serum Creatinine, Total cholesterol, vision tests, ECG, Spirometry, urine microscopy, and audiometry readings. Results Among the 217 workers that were studied, 8% had Hypertension, 40% workers had a refractive error, 31% had Dyslipidemia, 14.7% had mild restriction, 0.9% had moderate restriction, and 1.3% had a severe restriction in Spirometry testing, 10.1% had elevated Creatinine, 2.7% had mild to moderate hearing loss, 0.9% had changes in ECG and was referred to do echo. Conclusion The study revealed that the conditions of employment had caused numerous comorbidities among the sponge iron industry workers, several of which had spirometry restrictions suggesting pulmonary changes, which may lead to eventual respiratory deterioration and the advent of diseases such as COPD. The study revealed issues about overall health parameters, including but not limited to other intricate issues. Consequently, further tests will have to be conducted along with the use of protective equipment to reduce and limit the effects of such occupational outcomes.

Association between prophylactic aspirin use and hypertension using data from NHANES 2011–2018

Aspirin may be necessary for some patients with cardiovascular disease, but previous studies on the use and dosage of aspirin and the association with hypertension have been inadequate. The results of existing studies have been somewhat inconsistent. Our study was designed to assess the association between prophylactic aspirin use and hypertension in U.S. adults. This cross-sectional study analyzed a nationally representative sample of U.S. adults aged 40 and older from the National Health and Nutrition Examination Survey (2011–2018). Aspirin was categorized as no use, low dose (≤ 100 mg), and high dose (> 100 mg). Hypertension was defined as the average of three consecutive blood pressure readings (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg). There were 5297 participants, comprising 52.5% male and 47.4% female. The median age was 64 years (range: 56 to 72) and 3635 individuals were diagnosed with high blood pressure. Among the groups, the incidence of hypertension was 70.2% in the non-aspirin group, 68.3% in the low-dose group, and 68.0% in the high-dose group, with no statistically significant difference observed (p = 0.71). Using a fully adjusted weighted multivariate logistic regression model 4, prophylactic aspirin use was not associated with hypertension [(odds ratio [OR] 1.11; 95% CI (0.89–1.38), (odds ratio [OR] 1.15; 95% CI 0.82–1.61), P = 0.31]. Subgroup analyses, along with sensitivity analyses that excluded patients with diabetes and reclassified aspirin use status, confirmed the findings of the main study. In this nationally representative cohort of U.S. adults, no significant association was found between aspirin use or dosage and the prevalence of hypertension.

Effects of missing data imputation methods on univariate blood pressure time series data analysis and forecasting with ARIMA and LSTM

BackgroundMissing observations within the univariate time series are common in real-life and cause analytical problems in the flow of the analysis. Imputation of missing values is an inevitable step in every incomplete univariate time series. Most of the existing studies focus on comparing the distributions of imputed data. There is a gap of knowledge on how different imputation methods for univariate time series affect the forecasting performance of time series models. We evaluated the prediction performance of autoregressive integrated moving average (ARIMA) and long short-term memory (LSTM) network models on imputed time series data using ten different imputation techniques.MethodsMissing values were generated under missing completely at random (MCAR) mechanism at 10%, 15%, 25%, and 35% rates of missingness using complete data of 24-h ambulatory diastolic blood pressure readings. The performance of the mean, Kalman filtering, linear, spline, and Stineman interpolations, exponentially weighted moving average (EWMA), simple moving average (SMA), k-nearest neighborhood (KNN), and last-observation-carried-forward (LOCF) imputation techniques on the time series structure and the prediction performance of the LSTM and ARIMA models were compared on imputed and original data.ResultsAll imputation techniques either increased or decreased the data autocorrelation and with this affected the forecasting performance of the ARIMA and LSTM algorithms. The best imputation technique did not guarantee better predictions obtained on the imputed data. The mean imputation, LOCF, KNN, Stineman, and cubic spline interpolations methods performed better for a small rate of missingness. Interpolation with EWMA and Kalman filtering yielded consistent performances across all scenarios of missingness. Disregarding the imputation methods, the LSTM resulted with a slightly better predictive accuracy among the best performing ARIMA and LSTM models; otherwise, the results varied. In our small sample, ARIMA tended to perform better on data with higher autocorrelation.ConclusionsWe recommend to the researchers that they consider Kalman smoothing techniques, interpolation techniques (linear, spline, and Stineman), moving average techniques (SMA and EWMA) for imputing univariate time series data as they perform well on both data distribution and forecasting with ARIMA and LSTM models. The LSTM slightly outperforms ARIMA models, however, for small samples, ARIMA is simpler and faster to execute.

Dapagliflozin reduces the white coat effect on systolic blood pressure of patients with type 2 diabetes: a post-hoc analysis from the ADDENDA-BHS 2 trial

Background White coat effect (WCE) is a phenomenon linked to increased cardiovascular risk, where office blood pressure readings exceed home or ambulatory measurements. Excess weight and elevated blood pressure or glucose are associated with WCE in type 2 diabetes (T2D). This study compared dapagliflozin and glibenclamide on WCE in T2D patients under equivalent blood pressure and glucose control. Methods This post-hoc analysis of the ADDENDA-BHS2 trial enrolled T2D patients with high cardiovascular risk, defined by stable coronary artery disease or subclinical carotid atherosclerosis. This single-center, open-label, randomized trial included 98 participants, randomized to 12 weeks of dapagliflozin or glibenclamide, in addition to metformin. Baseline blood pressure and glucose control were adjusted to maintain equivalence. This analysis focused on 85 participants with pre- and post-treatment 24-h ambulatory blood pressure data. Results Despite blood pressure and glucose control, WCE was present in 28% of participants at baseline. Baseline-adjusted change in WCE on systolic BP showed median changes of −8.6 and 1.7 mmHg for dapagliflozin and glibenclamide groups, respectively (p = 0.048). This effect was not observed on diastolic blood pressure. Conclusion Dapagliflozin reduces WCE on systolic blood pressure compared to glibenclamide, even under equivalent blood pressure and glucose control. Clinical trial registration The trial was registered at the Clinicaltrials.gov (NCT: 02919345).

The Prevalence and Predictors of MetS Among Commercial Long Distance Bus Drivers (CLDBDs) in Cape Coast, Ghana

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Metabolic syndrome (MetS) is a foremost risk consideration for the development of cardiovascular disease which is a major cause of mortality around the globe. &amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: This study determined the prevalence and predictors of MetS amongst Commercial Long Distance Bus Drivers (CLDBDs) in Cape Coast, Ghana. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: A cross sectional study design that conveniently enrolled 170 registered male CLDBDs from five bus Unions. We included in the study long distance bus drivers registered at the unions, with a valid drivers’ license C. Obesity was determined using the WHO cut-offs. We determined blood pressure among the drivers through diastolic and systolic readings of arterial blood pressures and categorized based on the WHO cut offs. Fasting blood glucose level was reached through laboratory analysis. The MetS was determined based on ATP III NCEP criteria. Percentages were presented for socio-demographic and lifestyle variables. Chi-square statistics was performed on socio-demographic, occupational and lifestyle factors associated with MetS. Multinomial logistic regression was used to determine the factors that predicted the likelihood of developing metabolic syndrome at 95% confidence interval (95%CI). &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The average age and duration of commercial long-distance driving were 41± 8 years and 18± 8 hours respectively. About 14.2% were obese. A total of 22.4% had diastolic blood pressure 90 mmHg or higher and 21.2% had systolic blood pressure 140 mmHg or higher. About 2.2% of respondents had high levels of LDL-c and 8.8% had high HDL-c levels. Whilst 2.2% had high levels of triglyceride, 4.4% had high levels of total cholesterol (TC). About 82.6% had fasting blood glucose level &amp;gt; 6.1 mmol/L. The prevalence of MetS was 44% alcohol intake was statistically associated with metabolic syndrome (p&amp;lt; 0.01). Alcohol intake predicted MetS [OR=5.17; 95% CI: 1.75-15.2; P=0.03]. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The prevalence of metabolic syndrome was high among this group. Out of the five symptoms used for MetS classification, fasting blood glucose proportion was highest and alcohol intake placed drivers at about five times at risk of development of MetS compared with drivers who do not.

Minimum number of readings necessary for determining long-term visit-to-visit blood pressure variability to predict cardiovascular outcomes in people with diabetes.

People with diabetes often have increased blood pressure (BP) variability because of autonomic dysfunction and arterial stiffness, making it a critical factor in predicting clinical outcomes. We investigated the reproducibility of long-term visit-to-visit BP variability (VVV) and the minimum number of BP readings to reliably determine VVV in people with diabetes. This multicenter retrospective study used data from electronic health records of the Korea University Medical Center database. Altogether, 10 475 people with diabetes who had more than nine BP readings during a maximum period of 2 years were identified. This study focused on the coefficient of variation of these readings and their correlation with major adverse cardiovascular events (MACE) over a 3-year follow-up period. The mean age of the participants was 65.2 years. Of these, 53.2% were men, and 87.4% had hypertension. The mean coefficient of variation of multiple SBP readings that best predicted the 3-year MACE were 8.4, 9.5, 9.0, 9.0, and 9.7 for three, five, seven, nine, and all readings, respectively. Patients with high VVV (coefficient of variation of five SBP readings >9) exhibited a higher incidence of 3-year MACE (10.1%) than those with low VVV (5.4%, P < 0.001). In the multivariable analysis, high VVV of both SBP and DBP were independently associated with 3-year MACE. Long-term VVV in the BP is a reproducible and reliable predictor of cardiovascular outcomes in people with diabetes. A minimum of five BP measurements are recommended for effective intraindividual VVV estimation and cardiovascular risk assessment.

Blood pressure in young Aboriginal and Torres Strait Islander people: analysis of baseline data from a prospective cohort study.

To assess the distribution of blood pressure levels and the prevalence of hypertension and pre-hypertension in young Indigenous people (10-24 years of age). Prospective cohort survey study (Next Generation: Youth Wellbeing Study); baseline data analysis. Aboriginal and Torres Strait Islander people aged 10-24 years living in regional, remote, and urban communities in Central Australia, Western Australia, and New South Wales; recruitment: March 2018 - March 2020. Blood pressure categorised as normal, pre-hypertension, or hypertension using the 2017 American Academy of Pediatrics guidelines (10-17 years) or 2017 American College of Cardiology/American Heart Association guidelines (18-24 years); associations of demographic characteristics and health behaviours with hypertension and pre-hypertension, reported as relative risk ratios (RRRs) with 95% confidence intervals (CIs). Complete data were available for 771 of 1244 study participants (62%); their mean age was 15.4 years (standard deviation [SD], 3.9 years), 438 were girls or young women (56.8%). Mean systolic blood pressure was 111.2 mmHg (SD, 13.7 mmHg), mean diastolic blood pressure 66.3 mmHg (SD, 11.0 mmHg). Mean systolic blood pressure was higher for male than female participants (mean difference, 6.38 mmHg; 95% CI, 4.60-8.16 mmHg), and it increased by 1.06 mmHg (95% CI, 0.76-1.36 mmHg) per year of age. Mean systolic blood pressure increased by 0.42 mmHg (95% CI, 0.28-0.54 mmHg) and diastolic blood pressure by 0.46 mmHg (95% CI, 0.35-0.57 mmHg) per 1.0 kg/m2 increase in body mass index. Ninety-one participants (11.8%) had blood pressure readings indicating pre-hypertension, and 148 (19.2%) had hypertension. The risks of pre-hypertension (RRR, 4.22; 95% CI, 2.52-7.09) and hypertension (RRR, 1.93; 95% CI, 1.27-2.91) were higher for male than female participants; they were greater for people with obesity than for those with BMI values in the normal range (pre-hypertension: RRR, 2.39 [95% CI, 1.26-4.55]; hypertension: RRR, 3.20 [95% CI, 1.91-5.35]) and for participants aged 16-19 years (pre-hypertension: 3.44 [95% CI, 1.88-6.32]; hypertension: RRR, 2.15 [95% CI, 1.29-3.59]) or 20-24 years (pre-hypertension: 4.12 [95% CI, 1.92-8.85]; hypertension: RRR, 4.09 [95% CI, 2.24-7.47]) than for those aged 10-15 years. Blood pressure was within the normal range for most young Indigenous people in our study, but one in three had elevated blood pressure or hypertension. Community-level, culturally safe approaches are needed to avoid the early onset of cardiovascular risks, including elevated blood pressure.

Factors associated with discussing high blood pressure readings in clinical notes.

Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension. Data from 2016-2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features. The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01). We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.

Clinical impact of a tiered, pharmacist‐driven remote patient monitoring protocol utilizing self‐measured blood pressure readings

AbstractIntroductionPairing self‐measured blood pressure (SMBP) with protocolized, non‐physician follow‐up consistently improves hypertension (HTN) management. However, these interventions are often resource‐intensive and rely on a degree of technological proficiency that may exclude a vulnerable subset of the population.ObjectivesThe primary objective of this study was to determine the rate of attainment of blood pressure (BP) control (defined as &lt;140/&lt;90 mmHg) based on the most recent clinic‐measured BP readings 12 months or more after enrollment in the Digital Care Monitoring program. The secondary objective was to determine if there was a difference between the most recent clinic‐measured systolic and diastolic BP readings before enrollment compared with 12 months or more after the enrollment eligibility period.MethodsThis study examined the impact of a tiered, non‐physician SMBP program, engaging patients through a familiar communication medium to relay home BP readings. A pre‐post quality improvement study was conducted in the outpatient arm of an integrated delivery network. Patients meeting selection criteria were invited to voluntarily enroll bi‐monthly from October 2021 to July 2023. Patients consenting to enrollment received reminders twice weekly to respond with home BP readings, and an outreach protocol was established utilizing a medical assistant and clinical pharmacist.ResultsThe rate of attainment of BP control 12 months or more after the enrollment eligibility period was found to be 79.2% (p &lt; 0.01). BP dropped significantly over the 12‐month treatment course with a mean systolic BP difference of 19.97 mmHg (p &lt; 0.001) and a mean diastolic BP difference of 12.34 mmHg (p &lt; 0.001).ConclusionThe results indicate that a tiered, pharmacist‐driven remote patient monitoring protocol utilizing SMBP readings is an effective management strategy to reduce BP in patients with uncontrolled HTN.

Parent and Primary Care Clinician Perceptions About Pediatric Hypertension

Despite published guidelines and a prevalence of pediatric hypertension of approximately 3%, less than 25% of affected children are identified, with 60% not receiving any intervention despite detection. Understanding the knowledge and perceptions of parents or caregivers and health care teams is crucial to identify factors that may contribute to these unacceptably low detection rates. To examine the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection. This qualitative study, interviewed parents of children diagnosed with hypertension who did not follow up within 1 year after diagnosis and health care clinicians (medical assistants, nurses, managers, pediatricians, and nurse practitioners) across 10 clinics in Delaware and Pennsylvania between November 1, 2022, and March 31, 2023. With the use of an inductive thematic approach, codes were developed and themes identified by multidisciplinary research investigators. A total of 38 stakeholders (mean [range] age, 43 [25-64] years; 33 [86%] female), including 13 parents and 25 health care clinicians, were interviewed. The parent sample was diverse based on race (5 [46%] Black, 5 [38%] White, and 3 [23%] other race), ethnicity (5 [38%] Hispanic and 8 [62%] non-Hispanic), and Child Opportunity Index (5 [38%] very low or low, 3 [23%] moderate, and 5 [38%] high or very high). Parents and clinicians demonstrated awareness of the significance of pediatric hypertension. Parents thought blood pressure checks were important; however, clinicians often had competing priorities during annual visits. Both groups expressed skepticism about high blood pressure readings, attributing them to situational factors or white coat syndrome. Parents and clinicians shared concerns about medication use and preferred lifestyle change. Parents advocated for further testing, whereas clinicians exhibited varying perspectives on additional diagnostics, emphasizing targeted testing strategies and cautious medication approaches. In this qualitative study of parents and clinicians, both groups were skeptical of blood pressure readings and expressed concerns about medication use, with a preference for lifestyle changes over medication. Improving detection may require better measurement tools, reassurance about medications, and clear communication on the role of nonpharmacologic treatments, while future interventions should incorporate the perspectives of both parents and clinicians to develop practical strategies for managing pediatric hypertension.

Effect Of Crossed Leg On Blood Pressure Reading Among Hypertensive Patient In Selected Hospital Haridwar District, Uttarakhand

Effect Of Crossed Leg On Blood Pressure Reading Among Hypertensive Patient In Selected Hospital Haridwar District, Uttarakhand

May Measurement Month 2022: results from the global blood pressure screening campaign

IntroductionElevated blood pressure (BP) is the major contributor to mortality and disease burden worldwide. May Measurement Month (MMM) is a global BP screening campaign, which aims to raise awareness of...

Feasibility Testing of a Health Literacy Intervention With Adolescents and Young Adults in South Africa: The LifeLab Soweto Programme.

Low health literacy levels during adolescence and young adulthood (AYA) may impact acute healthcare access and longer-term health outcomes. Previous research in South African AYA suggests that health literacy levels are typically suboptimal but few interventions exist. This study aimed to test the acceptability and feasibility of a co-created, interactive health literacy intervention (LifeLab-Soweto) with AYA in Soweto, South Africa. Participants (18-24 years, n = 107) were recruited (September-October 2022) from a youth development centre database by telephone and through snowball sampling. AYA involved in the co-creation process were excluded. Pre-intervention data on participant age, gender identity and ability to correctly identify a normal blood pressure (BP) reading were captured via survey. Post-intervention, participants repeated the BP question and completed a satisfaction survey. Additionally, n = 31 AYA agreed to an in-depth interview about their LifeLab-Soweto experience. Interview transcripts were analysed using inductive thematic analysis. Participants (mean age 21 ± 2.4 years; 59% female, 39% male, 2% nonbinary) generally viewed LifeLab-Soweto as well-designed, relevant, simple to follow, fun, useful, and interesting, with most reporting an increased understanding of health and that they would use this new knowledge. Comparing pre- and post-intervention BP question accuracy, males showed the greatest improvement in scores. Interviews showed that, while LifeLab-Soweto was not what AYA were expecting, gains in health knowledge led AYA to consider changes in health behaviours including accessing health services. Life-Soweto presents an acceptable, feasible and relevant health literacy intervention for South African youth with potential to improve health literacy and health behaviours. To ensure the health literacy intervention was contextually relevant, age appropriate, and gender inclusive, a group of 40 adolescents (aged 18-24 years, male, female and non-binary) were recruited from Soweto to firstly identify the health topics that were most pressing in their daily lives. This youth advisory group identified stress as a major challenge impacting physical and mental health, health behaviour and daily functioning. Together with the youth group, researchers from South Africa and the UK worked to co-develop the health literacy intervention that delivers self-directed exploration and learning of how stress impacts health, behaviour and well-being. This manuscript describes how this cocreated intervention was received by a broader range of South African youth who were not involved in the cocreation process.