National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Blood Clots (1)
- (-) Blood Pressure (15)
- Cardiovascular Conditions (4)
- Care Management (1)
- Case Study (2)
- Children/Adolescents (2)
- Chronic Conditions (4)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (1)
- Communication (1)
- Decision Making (1)
- Dementia (1)
- Diabetes (2)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (5)
- Guidelines (4)
- Health Information Technology (HIT) (4)
- Kidney Disease and Health (3)
- Medication (2)
- Medication: Safety (1)
- Nursing (1)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Patient Self-Management (1)
- Prevention (3)
- Primary Care (3)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Risk (1)
- Screening (3)
- Sleep Problems (1)
- Social Determinants of Health (1)
- Telehealth (1)
- Tobacco Use (1)
- U.S. Preventive Services Task Force (USPSTF) (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 15 of 15 Research Studies DisplayedKilgallon JL, Gannon M, Burns Z
Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.
This study’s objective is to develop an intervention for the primary care management of uncontrolled hypertension (HTN) in chronic kidney disease (CKD) utilizing user-centered design principles and behavioral economic principles, test the effectiveness of that intervention, and collect implementation data that will facilitate the application of the intervention in other practice settings. One hundred and eighty-four eligible clinical physicians from 15 practices of The Brigham and Women's Practice -Based Research Network are enrolled in the study. The researchers will use the Reach Effectiveness Adoption Implementation Maintenance framework to assess the intervention’s effectiveness in impacting a change in mean systolic blood pressure between baseline and 6 months.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Kilgallon JL, Gannon M, Burns Z .
Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.
BMJ Open 2021 Dec 22;11(12):e054065. doi: 10.1136/bmjopen-2021-054065..
Keywords: Blood Pressure, Kidney Disease and Health, Chronic Conditions, Clinical Decision Support (CDS), Health Information Technology (HIT)
Boyd R, Carter E, Moise N
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
The purpose of this qualitative study was to explore primary care provider (PCP) awareness, knowledge, and attitudes toward masked hypertension (MHT.) The researchers conducted 3 focus groups which included 30 PCPs from 3 medical centers in New York. The analysis and thematic content analysis found that there was low knowledge about the prevalence and impact of MHT, awareness of MHT among the participants varied, and only 2 providers had diagnosed MHT. While some PCPs were receptive to MHT screening after learning about its significance, others perceived the current evidence as insufficient to change practice. There was broad consensus for lifestyle changes for MHT but concerns about a lack of randomized trial evidence for antihypertensive medication, and the possibility of harmful side effects. The researchers concluded that limited PCP knowledge about MHT, insufficient evidence, already overburdened PCPs, and concerns about the accuracy and accessibility of screening tests were key barriers to screening and treatment for MHT.
AHRQ-funded; HS024262.
Citation: Boyd R, Carter E, Moise N .
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
Am J Hypertens 2021 Dec;34(12):1322-27. doi: 10.1093/ajh/hpab115..
Keywords: Blood Pressure, Screening, Primary Care
Razon N, Hessler D, Bibbins-Domingo K
How hypertension guidelines address social determinants of health: a systematic scoping review.
Patient-level and community-level social and economic conditions impact hypertension risk and control. In this study, the investigators examined adult hypertension management guidelines to explore whether and how existing guidelines refer to social care activities. The investigators concluded that information about social determinants of health is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery.
AHRQ-funded; HS022241.
Citation: Razon N, Hessler D, Bibbins-Domingo K .
How hypertension guidelines address social determinants of health: a systematic scoping review.
Med Care 2021 Dec;59(12):1122-29. doi: 10.1097/mlr.0000000000001649..
Keywords: Social Determinants of Health, Guidelines, Evidence-Based Practice, Blood Pressure
Wegier P, Belden JL, Canfield SM
Home blood pressure data visualization for the management of hypertension: using human factors and design principles.
Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, there is an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. In this study, the investigators designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension.
AHRQ-funded; HS023328.
Citation: Wegier P, Belden JL, Canfield SM .
Home blood pressure data visualization for the management of hypertension: using human factors and design principles.
BMC Med Inform Decis Mak 2021 Aug 5;21(1):235. doi: 10.1186/s12911-021-01598-4..
Keywords: Blood Pressure, Cardiovascular Conditions, Health Information Technology (HIT), Care Management
Dorr DA, D'Autremont C, Pizzimenti C
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
This study examined guideline-based high blood pressure (HBP) and hypertension recommendations and evaluated the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources-based, patient-facing clinical decision support HBP application. Findings showed that data quality from the electronic health record required to implement recommendations for HBP was highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.
AHRQ-funded; HS026849.
Citation: Dorr DA, D'Autremont C, Pizzimenti C .
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
Appl Clin Inform 2021 Aug;12(4):710-20. doi: 10.1055/s-0041-1732401..
Keywords: Blood Pressure, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Information Technology (HIT)
Akwo EA, Robinson-Cohen C, Chung CP
Association of apparent treatment-resistant hypertension with differential risk of end-stage kidney disease across racial groups in the million veteran program.
Apparent treatment-resistant hypertension (ATRH) has been linked to end-stage kidney disease (ESKD) and cardiovascular disease. In this study, the investigators tested the hypothesis that the effect of ATRH on ESKD is greater in Black patients than in White patients and investigated the effect of ATRH on ESKD independent of APOL1 genotype. The investigators concluded that ATRH was associated with an elevated risk of adverse kidney and cardiovascular outcomes. The effect of ATRH on incident ESKD was magnified among patients with reduced kidney function as well as Black patients, independently of APOL1 genotype.
AHRQ-funded; HS026395.
Citation: Akwo EA, Robinson-Cohen C, Chung CP .
Association of apparent treatment-resistant hypertension with differential risk of end-stage kidney disease across racial groups in the million veteran program.
Hypertension 2021 Aug;78(2):376-86. doi: 10.1161/hypertensionaha.120.16181..
Keywords: Blood Pressure, Kidney Disease and Health, Racial and Ethnic Minorities
Fan T, Tan M
AHRQ Author: Fan T
Screening for hypertension in adults.
This Putting Prevention into Practice case study involves a 23-year-old patient presenting for a wellness visit with no concerns. The patient’s medical record shows a history of polycystic ovary syndrome, blood pressure of 110/70 mm Hg from a visit one year ago, and a body mass index of 28.2. Three questions are presented, along with answers.
AHRQ-authored.
Citation: Fan T, Tan M .
Screening for hypertension in adults.
Am Fam Physician 2021 Aug 1;104(2):193-94..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Evidence-Based Practice, Guidelines, Prevention, Case Study
Cohen DJ, Sweeney SM, Miller WL
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
This study identified conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care using samples and interviews from a subset of 104 practices participating in EvidenceNOW, a multisite cardiovascular disease prevention initiative. The authors calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening, and if relevant, counseling and the proportion of hypertensive patients with adequately controlled BP. Primary care staff were surveyed and interviewed. In clinician-owned practices, implementing a workflow to routinely screen and counsel patients on smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome. These improvements did not occur though in health- or hospital system-owned practices or in Federally Qualified Health Centers. BP outcome improved by at least 10 points among solo practices after medical assistants learned how to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improvement took place when staff took a second BP measurement after the first measurement was elevated and when staff learned where to document this information in the electronic health record. For larger and health- and hospital system-owned practices, 50 or more hours of facilitation was needed to improve BP outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Sweeney SM, Miller WL .
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
Ann Fam Med 2021 May-Jun;19(3):240-48. doi: 10.1370/afm.2668..
Keywords: Blood Pressure, Tobacco Use, Primary Care, Quality Improvement, Cardiovascular Conditions, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention, Outcomes
Carey RM, Wright JT, Taler SJ
Guideline-driven management of hypertension: an evidence-based update.
This paper is an evidence-based update to the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. The authors conducted a literature review of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics included blood pressure (BP) measurement, patient evaluation, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and BP threshold for drug therapy, lifestyle and pharmacological management, treatment target BP goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches.
AHRQ-funded; HS027944.
Citation: Carey RM, Wright JT, Taler SJ .
Guideline-driven management of hypertension: an evidence-based update.
Circ Res 2021 Apr 2;128(7):827-46. doi: 10.1161/circresaha.121.318083..
Keywords: Blood Pressure, Guidelines, Evidence-Based Practice, Cardiovascular Conditions, Chronic Conditions
Makarem N, Alcántara C, Williams N
Effect of sleep disturbances on blood pressure.
This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Recommendations include efforts to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.
AHRQ-funded; HS024274.
Citation: Makarem N, Alcántara C, Williams N .
Effect of sleep disturbances on blood pressure.
Hypertension 2021 Apr;77(4):1036-46. doi: 10.1161/hypertensionaha.120.14479..
Keywords: Sleep Problems, Blood Pressure, Respiratory Conditions
Mabry-Hernandez I, Baker SM
AHRQ Author: Mabry-Hernandez I
Screening for high blood pressure in children and adolescents.
This Putting Prevention into Practice case study concerns a 10-year-old boy with obesity and a family history significant for hypertension and hyperlipidemia presenting for a well-child examination. The parents express concern about their child’s risk for hypertension and ask whether they should be monitoring his blood pressure. Three questions are presented, along with answers.
AHRQ-authored.
Citation: Mabry-Hernandez I, Baker SM .
Screening for high blood pressure in children and adolescents.
Am Fam Physician 2021 Mar 15;103(6):371-72..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Blood Pressure, Screening, Guidelines, Evidence-Based Practice, Prevention, Case Study
Gregg LP, Hedayati SS, Yang H
Association of blood pressure variability and diuretics with cardiovascular events in patients with chronic kidney disease stages 1-5.
This study looked at whether blood pressure variability (BPV) is associated with cardiovascular outcomes and end-stage kidney disease (ESKD) in patients with chronic kidney disease. The authors studied US veterans with nondialysis chronic kidney disease stages 1-5 and hypertension on nondiuretic antihypertensive monotherapy. This case-control study compared veterans on only one antihypertensive prescription with those who were prescribed a second antihypertensive prescription. Each group had 31,394 participants. BPV was associated with composite cardiovascular events. It was associated with cardiovascular events and death but not ESKD in patients with chronic kidney disease.
AHRQ-funded; HS022418.
Citation: Gregg LP, Hedayati SS, Yang H .
Association of blood pressure variability and diuretics with cardiovascular events in patients with chronic kidney disease stages 1-5.
Hypertension 2021 Mar 3;77(3):948-59. doi: 10.1161/hypertensionaha.120.16117..
Keywords: Kidney Disease and Health, Blood Pressure, Cardiovascular Conditions, Chronic Conditions
Horton DB, Xie F, Chen L
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
The purpose of this study was to quantify rates of incident treatment for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1-18 years. Participants were identified using US Medicaid claims data and included more than 930,000 children diagnosed with autoimmune diseases or a nonimmune comparator condition. Findings showed strong dose-dependent relationships between current glucocorticoid exposure and all outcomes, suggesting strong relative risks, but low absolute risks, of newly-treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.
AHRQ-funded; HS021110.
Citation: Horton DB, Xie F, Chen L .
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
Am J Epidemiol 2021 Feb 1;190(3):403-12. doi: 10.1093/aje/kwaa197..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Blood Clots, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient Safety, Blood Pressure
van Dalen JW, Marcum ZA, Gray SL
Association of angiotensin II-stimulating antihypertensive use and dementia risk: post hoc analysis of the PreDIVA trial.
The purpose of this study was to assess whether angiotensin II-stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin I receptor blockers) convey a lower risk of incident dementia compared to angiotensin II-inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, β-blockers, and nondihydropyridine calcium channel blockers), in accordance with the "angiotensin hypothesis." The investigators concluded that users of angiotensin II-stimulating antihypertensives had lower dementia rates compared to angiotensin II-inhibiting antihypertensive users, supporting the angiotensin hypothesis.
AHRQ-funded; HS022982.
Citation: van Dalen JW, Marcum ZA, Gray SL .
Association of angiotensin II-stimulating antihypertensive use and dementia risk: post hoc analysis of the PreDIVA trial.
Neurology 2021 Jan 5;96(1):e67-e80. doi: 10.1212/wnl.0000000000010996.
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Keywords: Medication, Dementia, Blood Pressure
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes