Lower utilization of home blood pressure monitoring in younger, poorly educated hypertensive males - real-life data.
- 作者列表："Chudek A","Owczarek AJ","Ficek J","Almgren-Rachtan A","Chudek J
:Background: Home blood pressure monitoring (HBPM) became a standard in the management of hypertension. However, there are few data concerning the utilisation of blood pressure (BP) monitors in daily clinical practice.Aim: The aim of this analysis was to show: (1) how frequently hypertensive patients are equipped with BP monitors, (2) how often they perform regular HBPM and running BP diaries, (3) what are the correlates of utilisation of BP monitors, in a large real-life cohort of hypertensives examined for the efficacy of antihypertensive therapy. Patients and methods: The survey was conducted by 570 physicians among 14,200 hypertensive patients, of whom 12,289 (6163 women; mean age 63 ± 12 years) declared use of antihypertensive medicines. Each patient was asked whether at home is having and using regularly or occasionally BP monitor and running BP diary. BP control was assessed based on the mean of two attended office BP measurements.Results: Among patient equipped with BP monitors (87.2%), 73.4% were conducting HBPM regularly, while 26.6% occasionally, and 66.9% were running BP diaries. Controlled BP was achieved by 34.5% (32.9% men and 36.1% women; p < .001), more frequently by equipped with BP monitors (34.9 vs 31.7%, p < .001). Female sex, education, professional activity, active lifestyle, older age, hypertensive polytherapy, longer than 5-year therapy for hypertension, and coexistence of diabetes were factors increasing, while alcohol consumption, visceral obesity and heart failure decreasing the probability of being equipped with BP monitor and running BP diary. Regular HBPM were more frequently among women, physically active, older, diabetics, viscerally obese and patients with coronary artery disease.Conclusions: (1) The majority of hypertensive Poles are already equipped with BP monitors, (2) three-fourth patients perform regular HBPM and two-third run BP diaries, (3) there is still a need to promote utilisation of BP monitors among younger, poorly educated hypertensive males.
背景: 家庭血压监测 (HBPM) 成为高血压管理的标准。然而，关于在日常临床实践中使用血压 (BP) 监测仪的数据很少。目的: 本分析的目的是显示 :( 1) 高血压患者配备血压监测仪的频率，(2) 他们定期进行 HBPM 和运行 BP 日记的频率, (3)在检测降压治疗疗效的大型真实高血压患者队列中，使用 BP 监测仪的相关因素是什么。患者与方法: 调查了 570 名高血压患者中的 14,200 名医生，其中 12,289 名 (6163 名女性; 平均年龄 63 ± 12 岁) 宣布使用抗高血压药物。询问每位患者在家是否定期或偶尔使用 BP 监测仪和运行 BP 日记。根据两次参加办公室 BP 测量的平均值评估 BP 控制。结果: 在装有 BP 监测仪的患者中 (87.2%)，73.4% 定期进行 HBPM，26.6% 偶尔进行，66.9% 进行 BP 日记。控制血压达到 34.5% (32.9% 为男性，36.1% 为女性; P <.001)，更频繁地通过配备 BP 监视器 (34.9 vs 31.7%，p <.001)。女性、文化程度、职业活动、积极生活方式、高龄、高血压综合治疗、高血压治疗 5 年以上、糖尿病并存是增加因素，而饮酒、内脏肥胖和心力衰竭降低配备 BP 监测仪和运行 BP 日记的概率。定期 HBPM 在女性、体力活动、老年、糖尿病、内脏肥胖和冠心病患者中更常见。结论 :( 1) 大多数高血压患者已经配备了 BP 监测仪，(2) 4分之3 的患者定期执行 HBPM，3分之2 的患者运行 BP 日记，(3)仍然需要促进年轻、受教育程度低的高血压男性使用 BP 监测仪。
METHODS:BACKGROUND:Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease (CVD) risk. Pregnancy morbidities, including preeclampsia, and CVD are common in systemic lupus erythematosus (SLE). Possible connections are important to explore. In a population-based cohort, we investigated whether HDP is associated with a higher risk of cardiovascular outcomes separately in SLE and non-SLE to examine the role of SLE. METHODS:We identified first singleton births in the Medical Birth Register (1987-2012) among mothers with SLE and a large general population comparison group. Discharge diagnoses for HDP, cardiovascular outcomes, and hypertension in the Patient Register were identified using ICD codes. We estimated adjusted hazard ratios and 95% confidence intervals (HR, 95% CI) of the association between HDP and outcomes, in separate models in women with and without SLE. We then evaluated additive and multiplicative effect modification using relative excess risk due to interaction and Cox models jointly accounting for SLE and HDP, respectively. Mediation analysis estimated the proportion of the association between SLE and outcome explained by HDP. RESULTS:HDP were more common in SLE pregnancies (20% vs 7%). In SLE, HDP were associated with a two-fold higher rate of cardiovascular outcomes and three-fold higher rate of incident hypertension. HDP mediated 20% of the latter association. In women without SLE, HDP was associated with higher hypertension incidence later in life. CONCLUSION:In women with and without SLE, HDP were associated with a three-fold higher rate of hypertension. In SLE, women with HDP developed cardiovascular outcomes twice as often as women without HDP.
METHODS:BACKGROUND:'Neuronal precursor cell expressed developmentally down-regulated 4-like' (NEDD4L) is considered a candidate gene for hypertension-both functionally and genetically-through the regulation of the ubiquitination of the epithelial sodium channel (ENaC). This study explores the relationship between genetic variation in NEDD4L and hypertension with chronic kidney disease (CKD) in the southeastern Han Chinese population. METHODS:We recruited 623 CKD patients and measured ambulatory blood pressure monitoring (ABPM), and the rs4149601 and rs2288774 polymorphisms in NEDD4L were genotyped using qPCR. RESULTS:For rs4149601, significant differences in genotype frequencies in an additive model (GG vs GA vs AA) were observed between normotensive patients and hypertensive patients when hypertension was classified into ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension (P = 0.038, 0.005 and 0.006, respectively). In a recessive model (GG+GA vs AA), the frequency of the AA genotype of rs4149601 in the hypertension groups were all higher than that in the normotensive groups. The genotype distribution of rs2288774 did not differ significantly between the normotensive and hypertensive patients. In both the full cohort and the propensity score matching (PSM) cohort, the AA genotype of rs4149601 (compared to the GG+GA genotype group) was independently correlated with ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension by multivariate logistic regression analysis. CONCLUSIONS:The present study indicates that the AA genotype of rs4149601 associates with hypertension in CKD. Consequently, the rs4149601 A allele might be a risk factor for hypertension with CKD.
METHODS:BACKGROUND:The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS:Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS:Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION:Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION:Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.