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BP Control (bp + control)
Selected AbstractsImprovement In Blood Pressure Control With Impedance Cardiography-Guided Pharmacologic Decision MakingCONGESTIVE HEART FAILURE, Issue 1 2004Donald L. Sharman MD Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG-guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. All subjects were treated utilizing a previously published ICG-guided treatment algorithm. Twenty-one subjects met the BP and medication criteria. BP at entry was 157.2±13.9/78.7±9.9 mm Hg. Subjects were treated for 215±85 days (5.0±2.0 visits). After ICG-guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6±22.0 (p<0.001)/77.1±10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0±0.0 to 2.5±0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG-guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control. [source] Assessment and management of hypertension in patients with type 2 diabetesINTERNAL MEDICINE JOURNAL, Issue 3 2009M. C. Thomas Abstract Background:, Hypertension is a major risk factor for adverse outcomes in type 2 diabetes and an important target for intervention. Despite this, the management of blood pressure (BP) remains suboptimal, particularly in patients at increased risk for cardiovascular and chronic kidney disease. The aim of this study was to estimate the frequency of hypertension and its management in consecutive clinic-based samples of patients with type 2 diabetes in Australian primary care. Methods:, BP levels and antihypertensive management strategies were compared in patients with type 2 diabetes recruited as part of the Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes (DEMAND) study in 2003 (n = 1831) and the National Evaluation of the Frequency of Renal impairment cO-existing with Non-insulin-dependent diabetes (NEFRON) study in 2005 (n = 3893). Systolic BP levels and the use of antihypertensive therapies were examined in patients with and without chronic kidney disease. Results:, The patient characteristics in both studies were similar in that more than 80% of patients in both studies were hypertensive. Systolic BP targets of ,130 mmHg were achieved in approximately half of all treated patients in both studies. However, the use of antihypertensive therapy either alone or in combination increased from 70.4% in DEMAND to 79.5% in NEFRON 2 years later (P < 0.001). Despite this, antihypertensive therapy continued to be underutilized in high-risk groups, including in those with established chronic kidney disease. Conclusion:, The DEMAND and NEFRON studies both show that BP control is achievable in Australian general practice, with more than half of all patients seeing their general practitioners achieving a target systolic BP ,130 mmHg. However, more needs to be done to further reduce BP levels, particularly in patients at high risk of adverse outcomes. [source] Management of hypertension and stroke prevention: results of the Italian cardiologist surveyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2009G. Tocci Summary Objective: To provide an overview of current habits, priorities, perceptions and knowledge of cardiologists with regard to hypertension and stroke prevention in outpatient practice. Methods: A sample of 203 cardiologists operating in outpatient clinics and randomly selected amongst members of the largest Italian Outpatient Cardiologist Association were interviewed by e-mail, in April,May 2007. Results: The interviewed cardiologists reported that hypertensive outpatients represent a large percentage of their practice population, in which the clinical priority was blood pressure (BP) reduction. Stroke was identified as the most important event to prevent and it was also perceived as the most preventable hypertension-related cardiovascular event. A remarkably high rate of achieved BP control was reported, to a degree that it is inconsistent with current epidemiological reports and with the relatively low percentage use of combination therapies declared by cardiologists. Additional risk factors, organ damage, diabetes mellitus and atrial fibrillation were consistently reported in hypertensive patients. Among antihypertensive drug classes, a preference for angiotensin-converting enzyme inhibitors has been expressed by the majority of physicians; this choice was generally justified by evidence derived from international trials or by the antihypertensive efficacy of this drug class. Conclusions: The results confirm the presence of weaknesses in the current services for patients with hypertension, even when being managed by cardiologists. Discrepancies between perceptions and reality, or clinical practice and guideline recommendations are also highlighted. An analysis of these aspects may help to identify current areas of potential improvement for stroke prevention in the clinical management of hypertension in cardiology practice. [source] Barriers to Optimal Hypertension ControlJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2008Gbenga Ogedegbe MD There is an obvious gap in the translation of clinical trial evidence into practice with regards to optimal hypertension control. The three major categories of barriers to BP control are patient-related, physician-related, and medical environment/health care system factors. Patient-related barriers include poor medication adherence, beliefs about hypertension and its treatment, depression, health literacy, comorbidity, and patient motivation. The most pertinent is medication adherence, given its centrality to the other factors. The most salient physician-related barrier is clinical inertia,defined, as the failure of health care providers to initiate or intensify drug therapy in a patient with uncontrolled BP. The major reasons for clinical inertia are: 1) overestimation of the amount of care that physicians provide; 2) lack of training on how to attain target BP levels; and 3) clinicians' use of soft reasons to avoid treatment intensification by adopting a "wait until next visit" approach in response to patients' excuses. [source] ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUPNEPHROLOGY, Issue 3 2000Hoy We Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source] ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUPNEPHROLOGY, Issue 3 2000Hoy We Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source] Meta-analysis of blood pressure tracking from childhood to adulthood and implications for the design of intervention trialsACTA PAEDIATRICA, Issue 1 2010AM Toschke Abstract Aim:, Blood pressure (BP) is related with cardiovascular disease. BP tracking in childhood and its implication for intervention trials are unknown. Methods:, A systematic review and meta-analysis were conducted to estimate BP tracking. Results:, In 29 independent studies on 27 820 subjects, follow-up length and baseline age were associated with systolic BP tracking (both p < 0.05), while gender, BP measurement method and study place were not (p = 0.215, p = 0.185 and p = 0.391). The overall adjusted systolic BP correlation coefficient was 0.44 between 10 and 11 years and decreased to 0.37 between 10 and 20 years. Comparison of BP changes before and after intervention need a 26% increased sample size for a 10-year follow-up of 10 year olds, while trials comparing BP values at study end only require smaller sample sizes. Conclusion:, Blood pressure tracking from childhood to adulthood affects trials assessing long-term effects on BP and was low-to-moderate. Therefore, regular BP controls are also needed in children with normal BP measurements possibly identifying hypertensive children earlier. A slight short-term intervention effect on BP may not have any long-term effects because of low BP tracking and its decrease by age. [source] | ||||||||||||||||||||||