National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (3)
- Adverse Events (2)
- (-) Blood Pressure (30)
- Cardiovascular Conditions (8)
- Care Management (3)
- Case Study (2)
- Children/Adolescents (3)
- Chronic Conditions (2)
- Diabetes (6)
- Diagnostic Safety and Quality (6)
- Disparities (1)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Electronic Health Records (EHRs) (3)
- Emergency Department (2)
- Evidence-Based Practice (2)
- Guidelines (2)
- Health Information Technology (HIT) (5)
- Health Insurance (1)
- Heart Disease and Health (3)
- Home Healthcare (1)
- Lifestyle Changes (1)
- Maternal Care (1)
- Medical Errors (1)
- Medicare (1)
- Medication (6)
- Medication: Safety (1)
- Nutrition (1)
- Obesity (4)
- Obesity: Weight Management (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient Self-Management (1)
- Pregnancy (1)
- Prevention (1)
- Primary Care (4)
- Quality Improvement (1)
- Quality of Care (2)
- Quality of Life (1)
- Racial and Ethnic Minorities (3)
- Respiratory Conditions (1)
- Risk (4)
- Screening (1)
- Sexual Health (2)
- Social Determinants of Health (1)
- Stroke (1)
- Telehealth (2)
- U.S. Preventive Services Task Force (USPSTF) (3)
- Urban Health (1)
- Vulnerable Populations (1)
- Women (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 30 Research Studies DisplayedFink JT, Magnan EM, Johnson HM
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
In this observational population-based cohort study, the investigators sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. The investigators suggest that although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, they found that patients with obesity are even further behind in achieving blood pressure control.
AHRQ-funded; HS021899.
Citation: Fink JT, Magnan EM, Johnson HM .
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
High Blood Press Cardiovasc Prev 2018 Dec;25(4):391-99. doi: 10.1007/s40292-018-0284-x..
Keywords: Blood Pressure, Diabetes, Quality of Care, Obesity
Goldberg EM, Marks SJ, Merchant RC
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
This study researched treatment trends for emergency department (ED) visits for hypertension from 2005 to 2015. The study found that there is still room for improvement, and disparities still exist for Blacks and uninsured patients.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Marks SJ, Merchant RC .
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
J Am Soc Hypertens 2018 Dec;12(12):858-66. doi: 10.1016/j.jash.2018.09.010..
Keywords: Blood Pressure, Emergency Department
Anstey DE, Muntner P, Bello NA
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
The aim of this study was to determine the overlap between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) for the detection of masked hypertension (MHT). The investigators asserted that their data suggested that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
AHRQ-funded; HS024262.
Citation: Anstey DE, Muntner P, Bello NA .
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
Hypertension 2018 Nov;72(5):1200-07. doi: 10.1161/hypertensionaha.118.11319..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Sterling MR, Silva AF, Robbins L
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
This qualitative study examined the role of numeracy (basic number skills) in the management of patients with heart failure (HF). Thirty men and women aged 47-89 years with a history of HF were recruited from an urban academic primary care practice. Participants all had a history of HF within the past year, were seen at the practice within the last year, and had been hospitalized for HF within the last 6 months. They were interviewed about their numeracy to help manage monitoring weight, maintaining a low-salt diet, and monitoring blood pressure. A wide range of knowledge and understanding was found and fear served as a barrier and facilitator to carrying out HF self-care tasks involving numbers. If the patient has a caregiver who also lacks those skills or does not have HF care training, patients may not be managing their HF as well as they should.
AHRQ-funded; HS000066.
Citation: Sterling MR, Silva AF, Robbins L .
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
BMJ Open 2018 Sep 19;8(9):e023073. doi: 10.1136/bmjopen-2018-023073..
Keywords: Patient Self-Management, Education: Patient and Caregiver, Care Management, Heart Disease and Health, Nutrition, Lifestyle Changes, Obesity: Weight Management, Obesity, Blood Pressure, Cardiovascular Conditions
Rao G, Naureckas S, Datta A
Pediatric hypertension: diagnostic patterns derived from electronic health records.
This study examined the rates of diagnostic for pediatric hypertension using electronic health records (EHRs). The rates of diagnosis were very low (6.1%) among 1478 children identified as hypertensive. Rates of diagnosis improved in children aged 12 and above but was very low for children aged 6 and under. Underdiagnosis can lead to organ failure and increased risk for adult hypertension.
AHRQ-funded; HS024100.
Citation: Rao G, Naureckas S, Datta A .
Pediatric hypertension: diagnostic patterns derived from electronic health records.
Diagnosis 2018 Sep;5(3):157-60. doi: 10.1515/dx-2018-0010..
Keywords: Children/Adolescents, Blood Pressure, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Carter EJ, Moise N, Alcantara C
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. This study explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM.
AHRQ-funded; HS024262.
Citation: Carter EJ, Moise N, Alcantara C .
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Am J Hypertens 2018 Jul 16;31(8):919-27. doi: 10.1093/ajh/hpy062..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Lakshminarayan K, Westberg S, Northuis C
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Hypertension (HTN) is significantly under-treated in stroke survivors. The study authors examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control. They concluded that a mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.
AHRQ-funded; HS021794.
Citation: Lakshminarayan K, Westberg S, Northuis C .
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Contemp Clin Trials 2018 Jul;70:24-34. doi: 10.1016/j.cct.2018.05.005..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Stroke, Cardiovascular Conditions
Egan BM, Li J, Davis RA
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. This article discusses differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
AHRQ-funded; P30 HS021667.
Citation: Egan BM, Li J, Davis RA .
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
J Clin Hypertens 2018 Jun;20(6):991-1000. doi: 10.1111/jch.13314..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Guidelines, Blood Pressure, Medication, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Myerson RM, Colantonio LD, Safford MM
Does identification of previously undiagnosed conditions change care-seeking behavior?
The purpose of the study was to determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. The study concluded that in-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
AHRQ-funded; HS000084.
Citation: Myerson RM, Colantonio LD, Safford MM .
Does identification of previously undiagnosed conditions change care-seeking behavior?
Health Serv Res 2018 Jun;53(3):1517-38. doi: 10.1111/1475-6773.12644..
Keywords: Blood Pressure, Diabetes, Home Healthcare, Cardiovascular Conditions
Chaddha A, Smith MA, Palta M
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
The objective of the study was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The study findings demonstrated the importance of implementing guideline-directed multidisciplinary care in this population.
AHRQ-funded; HS018368; HS017646.
Citation: Chaddha A, Smith MA, Palta M .
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
J Clin Hypertens 2018 May;20(5):891-901. doi: 10.1111/jch.13282..
Keywords: Cardiovascular Conditions, Diabetes, Blood Pressure
Muldoon MF, Kronish IM, Shimbo D
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
This paper reviews the manifestations and consequences of BP mismeasurement and misinterpretation in clinical practice and draw on recent research to propose a set of solutions that leverage available technologies to optimize hypertension care.
AHRQ-funded; HS024262.
Citation: Muldoon MF, Kronish IM, Shimbo D .
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
Circ Cardiovasc Qual Outcomes 2018 May;11(5):e004543. doi: 10.1161/circoutcomes.117.004543..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Henderson KH, DeWalt DA, Halladay J
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
The purpose of this study was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. Its findings showed that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project.
AHRQ-funded; HS023912.
Citation: Henderson KH, DeWalt DA, Halladay J .
Organizational leadership and adaptive reserve in blood pressure control: the Heart Health NOW study.
Ann Fam Med 2018 Apr;16(Suppl 1):S29-s34. doi: 10.1370/afm.2210.
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Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Primary Care, Quality Improvement
Tung EL, Wroblewski KE, Boyd K
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. It concluded that in a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
AHRQ-funded; HS023007.
Citation: Tung EL, Wroblewski KE, Boyd K .
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
J Am Heart Assoc 2018 Mar 24;7(7). doi: 10.1161/jaha.117.008030.
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Keywords: Blood Pressure, Disparities, Risk, Social Determinants of Health, Urban Health
Mabry-Hernandez I, Romano MJ
AHRQ Author: Mabry-Hernandez I
Screening for preeclampsia.
A 28-year-old white woman comes to your clinic for prenatal care reporting a new-onset severe headache. She is currently pregnant with twins at an estimated gestational age of 22 weeks. Her obstetric history is significant for one previous term singleton vaginal delivery at 24 years of age without complications. This case study poses three multiple choice questions together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Mabry-Hernandez I, Romano MJ .
Screening for preeclampsia.
Am Fam Physician 2018 Jan 15;97(2):117-18.
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Keywords: Blood Pressure, Case Study, Maternal Care, Pregnancy, U.S. Preventive Services Task Force (USPSTF)
Westover AN, Nakonezny PA, Adinoff B
Impact of stimulant medication use on heart rate and systolic blood pressure during submaximal exercise treadmill testing in adolescents.
In this study of the impact of stimulant medication use on heart rate and systolic blood pressure during submaximal exercise treadmill testing in adolescents, the investigators found that adolescent stimulant medication users, compared to matched nonusers, demonstrated a trend toward decreased heart rate during submaximal exercise (which is potential evidence of chronic adaptation with stimulant exposure). There was no evidence for delayed heart rate recovery in this study, and thus, no evidence for decreased parasympathetic activity during initial exercise recovery.
AHRQ-funded; HS022418.
Citation: Westover AN, Nakonezny PA, Adinoff B .
Impact of stimulant medication use on heart rate and systolic blood pressure during submaximal exercise treadmill testing in adolescents.
J Child Adolesc Psychopharmacol 2016 Dec;26(10):889-99. doi: 10.1089/cap.2016.0064..
Keywords: Adverse Drug Events (ADE), Children/Adolescents, Blood Pressure, Medication, Medication: Safety
Brody AM, Sharma VK, Singh A
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
This study surveyed a national sample of emergency physicians on their perceived barriers in establishing an ED diagnosis of asymptomatic hypertension (HTN) and ED treatment of such patients. It found that the most common barriers to diagnosis of HTN were uncertainty regarding the validity of ED blood pressure measurements (92 percent)and reluctance to diagnose a condition which cannot be comprehensively managed in the ED setting (29 percent).
AHRQ-funded; HS000011.
Citation: Brody AM, Sharma VK, Singh A .
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
Am J Emerg Med 2016 Nov;34(11):2241-42. doi: 10.1016/j.ajem.2016.08.050.
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Keywords: Blood Pressure, Emergency Department, Diagnostic Safety and Quality, Chronic Conditions
Foy CG, Newman JC, Berlowitz DR
Blood pressure, sexual activity, and dysfunction in women with hypertension: baseline findings from the Systolic Blood Pressure Intervention Trial (SPRINT).
The authors assessed the association between systolic blood pressure and other variables, and sexual activity and sexual dysfunction in women with hypertension. They found that younger age, higher education, living with others, and higher weekly alcohol consumption were significantly associated with higher odds of being sexually active in the sample group. They concluded that systolic blood pressure was not significantly associated with sexual activity or sexual dysfunction.
AHRQ-funded; HS022989.
Citation: Foy CG, Newman JC, Berlowitz DR .
Blood pressure, sexual activity, and dysfunction in women with hypertension: baseline findings from the Systolic Blood Pressure Intervention Trial (SPRINT).
J Sex Med 2016 Sep;13(9):1333-46. doi: 10.1016/j.jsxm.2016.06.014.
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Keywords: Blood Pressure, Sexual Health, Women, Quality of Life
Tajeu GS, Kent ST, Kronish IM
Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012.
The authors analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. They found that low adherence decreased and was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in, and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90-day prescription fill, with dementia, a history of stroke, and those who reached the Medicare Part D coverage gap in the previous year. They concluded that although low adherence has decreased, rates of discontinuation and low adherence remain high.
AHRQ-funded; HS024262.
Citation: Tajeu GS, Kent ST, Kronish IM .
Trends in antihypertensive medication discontinuation and low adherence among Medicare beneficiaries initiating treatment from 2007 to 2012.
Hypertension 2016 Sep;68(3):565-75. doi: 10.1161/hypertensionaha.116.07720.
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Keywords: Blood Pressure, Medication, Medicare, Patient Adherence/Compliance
Rivera-Hernandez M, Rahman M, Mor V
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
The researchers examined the impact of Seguro Popular (Mexican social health insurance for the poor) on diabetes and hypertension care, They concluded that social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Rahman M, Mor V .
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
Health Serv Res 2016 Aug;51(4):1323-46. doi: 10.1111/1475-6773.12404.
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Keywords: Health Insurance, Diabetes, Blood Pressure, Elderly, Access to Care
Thomas HN, Evans GW, Berlowitz DR
Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT).
The researchers evaluated the relations among class of antihypertensive medication from women in the Systolic Blood Pressure Intervention Trial (SPRINT) and the outcomes: sexual activity and sexual function. There were no significant differences in sexual activity among women taking one or more antihypertensives and women not taking any. Women taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker had higher odds of sexual activity. The authors concluded that no single class of antihypertensive medication was associated with sexual dysfunction.
AHRQ-funded; HS022989.
Citation: Thomas HN, Evans GW, Berlowitz DR .
Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT).
J Hypertens 2016 Jun;34(6):1224-31. doi: 10.1097/hjh.0000000000000911.
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Keywords: Medication, Blood Pressure, Sexual Health, Women, Adverse Drug Events (ADE), Adverse Events
Westover AN, Nakonezny PA, Barlow CE
Heart rate recovery and systolic blood pressure recovery after maximal exercise in prevalent users of stimulant medications.
This study examined the impact of stimulant medication use on heart rate recovery (HRR) and systolic blood pressure (SBP) recovery after maximal exercise testing in a large sample with adjustment for confounders such as fitness, obesity, and smoking. It found that stimulant medication users had increased odds of both abnormal HRR and abnormal SBP recovery compared with matched nonusers.
AHRQ-funded; HS022418.
Citation: Westover AN, Nakonezny PA, Barlow CE .
Heart rate recovery and systolic blood pressure recovery after maximal exercise in prevalent users of stimulant medications.
J Clin Psychopharmacol 2016 Jun;36(3):295-7. doi: 10.1097/jcp.0000000000000485.
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Keywords: Blood Pressure, Medication, Adverse Drug Events (ADE)
Goldberg EM, Levy PD
New approaches to evaluating and monitoring blood pressure.
The authors reviewed the current literature on mobile health technologies and novel diagnostic and management protocols and made recommendations on how to incorporate these innovations into practice. They recommend collaboration between device designers and clinical researchers to develop rigorous clinical trials to test cardiovascular outcomes associated with emerging technologies.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Levy PD .
New approaches to evaluating and monitoring blood pressure.
Curr Hypertens Rep 2016 Jun;18(6):49. doi: 10.1007/s11906-016-0650-9.
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Keywords: Blood Pressure, Telehealth, Health Information Technology (HIT), Diagnostic Safety and Quality
Booth JM, Jonassaint CR
The role of disadvantaged neighborhood environments in the association of John Henryism with hypertension and obesity.
In this study, the investigators tested the The John Henryism hypothesis which proposes that high-effort, active coping in impoverished, low-resource environments is associated with an increased risk of cardiovascular disease, but a lower risk of disease in a high-resource environment. They found that in their study, which modeled objective measures of neighborhood disadvantage, John Henryism Active Coping was associated with increased risk for cardiovascular disease among individuals living in highly disadvantaged neighborhoods which lack resources and opportunities for upward social mobility.
AHRQ-funded; HS022989.
Citation: Booth JM, Jonassaint CR .
The role of disadvantaged neighborhood environments in the association of John Henryism with hypertension and obesity.
Psychosom Med 2016 Jun;78(5):552-61. doi: 10.1097/psy.0000000000000308..
Keywords: Blood Pressure, Obesity, Vulnerable Populations
Budiman-Mak E, Epstein N, Brennan M
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
This study's objective is to examine whether systolic blood pressure has any prognostic value for lower-extremity amputations. The authors concluded that this study showed a significant graded relationship between systolic blood pressure variability and risk of major amputation among non-elderly persons with diabetes.
AHRQ-funded; HS018542.
Citation: Budiman-Mak E, Epstein N, Brennan M .
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
Diabetes Res Clin Pract 2016 Apr;114:75-82. doi: 10.1016/j.diabres.2016.01.010.
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Keywords: Diabetes, Blood Pressure, Risk, Chronic Conditions