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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 56 Research Studies Displayed
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:
Hypertension, Blood Pressure, Cardiovascular Conditions, 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:
Hypertension, Blood Pressure, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Guidelines
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:
Tobacco Use, Blood Pressure, Hypertension, Primary Care, Cardiovascular Conditions, Prevention, Evidence-Based Practice, Patient-Centered Outcomes Research, 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:
Hypertension, Cardiovascular Conditions, Evidence-Based Practice, Guidelines, Chronic Conditions, Blood Pressure
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 Apnea, Sleep, Blood Pressure, Hypertension
Mabry-Hernandez I, Baker SM
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, Hypertension, Screening, 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
Davoudi A, Lee NS, Chivers C
Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study.
Researchers explored the unique phenotypes of patient interactions with an automated text messaging platform for blood pressure (BP) monitoring and to estimate associations between interaction phenotypes and BP control. Through a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension, they identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring; only the minimalist communication style was associated with achieving target BP. They recommended identifying and understanding interaction phenotypes to tailor future automated texting interactions and design future interventions to achieve better BP control.
AHRQ-funded; HS026372.
Citation:
Davoudi A, Lee NS, Chivers C .
Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study.
J Med Internet Res 2020 Dec 3;22(12):e22493. doi: 10.2196/22493..
Keywords:
Telehealth, Health Information Technology (HIT), Hypertension, Blood Pressure
Gartlehner G, Vander Schaaf EB, Orr C
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
This paper is an evidence update that accompanies the final recommendation from the U.S. Preventive Services Task Force (USPSTF) on screening and treatment of hypertension in childhood and adolescence. The update confirmed the previous update that the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Forty-two studies from 43 publications were included in the final review.
AHRQ-funded; 290201500011I.
Citation:
Gartlehner G, Vander Schaaf EB, Orr C .
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 10;324(18):1884-95. doi: 10.1001/jama.2020.11119..
Keywords:
Children/Adolescents, U.S. Preventive Services Task Force (USPSTF), Hypertension, Blood Pressure, Screening, Evidence-Based Practice, Prevention, Cardiovascular Conditions, Diagnosis
Kaelber DC, Localio AR, Ross M
Persistent hypertension in children and adolescents: a 6-year cohort study.
The purpose of this study was to determine the natural history of pediatric hypertension. The study was conducted over a 72-month period among 165 primary care sites; blood pressure measurements from two consecutive 36-month periods were compared. Findings indicated that, in a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.
AHRQ-funded; HS021645.
Citation:
Kaelber DC, Localio AR, Ross M .
Persistent hypertension in children and adolescents: a 6-year cohort study.
Pediatrics 2020 Oct;146(4):Oct. doi: 10.1542/peds.2019-3778..
Keywords:
Children/Adolescents, Hypertension, Cardiovascular Conditions, Blood Pressure
Koopman RJ, Canfield SM, Belden JL
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
This study examined whether using home blood pressure visualization tools helps management of hypertension for both patients and physicians. A multidisciplinary team used iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. The study included an attitude and behavior survey and 10 focus groups with 16 patients and 24 physicians. Most patients measured their blood pressure at home, but only half shared data with their physician. Data visualization helped patients and physicians have a fuller understanding of the blood pressure “story” and helped with patient-physician interactions to better control hypertension.
AHRQ-funded; HS023328.
Citation:
Koopman RJ, Canfield SM, Belden JL .
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
BMC Med Inform Decis Mak 2020 Aug 18;20(1):195. doi: 10.1186/s12911-020-01194-y..
Keywords:
Hypertension, Blood Pressure, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Communications, Patient Self-Management, Care Management
Moise N, Phillips E, Carter E
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. In this study, the investigators used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis.
AHRQ-funded; HS025198; HS024262.
Citation:
Moise N, Phillips E, Carter E .
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
Implement Sci 2020 Aug 8;15(1):63. doi: 10.1186/s13012-020-01017-8..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Hypertension, Implementation, Blood Pressure, Screening
Shaffer VA, Wegier P, Valentine KD
Use of enhanced data visualization to improve patient judgments about hypertension control.
Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support-in the form of enhanced data visualization-could improve judgments about hypertension control. The investigators concluded that enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control.
AHRQ-funded; HS023328.
Citation:
Shaffer VA, Wegier P, Valentine KD .
Use of enhanced data visualization to improve patient judgments about hypertension control.
Med Decis Making 2020 Aug;40(6):785-96. doi: 10.1177/0272989x20940999..
Keywords:
Hypertension, Blood Pressure, Decision Making, Chronic Conditions, Cardiovascular Conditions
Cuffee YL, Rosal M, Hargraves JL
Does home remedy use contribute to medication nonadherence among Blacks with hypertension?
The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Data was obtained from the TRUST study conducted 2006-2008. Findings showed that the use of HR and the number of HRs used may be associated with medication nonadherence and with higher systolic and diastolic blood pressure among Blacks with hypertension. Recommendations included that health care providers need to be aware of health behaviors that may serve as barriers to medication adherence, such as the use of home remedies.
AHRQ-funded; HS020755.
Citation:
Cuffee YL, Rosal M, Hargraves JL .
Does home remedy use contribute to medication nonadherence among Blacks with hypertension?
Ethn Dis 2020 Summer;30(3):451-58. doi: 10.18865/ed.30.3.451..
Keywords:
Patient Adherence/Compliance, Medication, Hypertension, Racial / Ethnic Minorities, Blood Pressure
Ramirez M, Chen K, Follett RW
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
The aim of the study was to evaluate whether the implementation of the Best Practice Advisory (BPA) was associated with changes in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) prescribing during primary care encounters for patients with diabetes. The investigators concluded that a BPA with a "chart closure" hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.
AHRQ-funded; HS00046.
Citation:
Ramirez M, Chen K, Follett RW .
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
JMIR Med Inform 2020 Apr 17;8(4):e16421. doi: 10.2196/16421..
Keywords:
Blood Pressure, Hypertension, Medication, Diabetes, Primary Care, Clinical Decision Support (CDS), Decision Making, Chronic Conditions
Tung EL, Chua RFM, Besser SA
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP). They analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime in Chicago (2014-2016).The investigators concluded that rising violent crime was associated with increased BP during a temporal crime surge.
AHRQ-funded; HS023007.
Citation:
Tung EL, Chua RFM, Besser SA .
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
Am J Hypertens 2019 Nov 15;32(12):1192-98. doi: 10.1093/ajh/hpz134..
Keywords:
Blood Pressure, Cardiovascular Conditions, Hypertension, Risk, Social Determinants of Health
Fan T, Tan M
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:
Hypertension, Blood Pressure, Cardiovascular Conditions, Screening, Prevention, Case Study
Tajeu GS, Kent ST, Huang L
Antihypertensive medication nonpersistence and low adherence for adults <65 years initiating treatment in 2007-2014.
Previous evidence suggests modest improvements in antihypertensive medication adherence occurred from 2007 to 2012 among US adults >/=65 years of age. Whether adherence improved over time among adults <65 years of age is unknown. In this study, the investigators assessed trends in antihypertensive medication nonpersistence and low adherence among 379 658 commercially insured adults <65 years of age initiating treatment in 2007-2014 using MarketScan claims.
AHRQ-funded; HS024262; HS013852.
Citation:
Tajeu GS, Kent ST, Huang L .
Antihypertensive medication nonpersistence and low adherence for adults <65 years initiating treatment in 2007-2014.
Hypertension 2019 Jul;74(1):35-46. doi: 10.1161/hypertensionaha.118.12495..
Keywords:
Hypertension, Patient Adherence/Compliance, Medication, Cardiovascular Conditions, Blood Pressure
Lor M, Koleck TA, Bakken S
Association between health literacy and medication adherence among hispanics with hypertension.
This study examined the association between health literacy and medication adherence among Hispanic adults with hypertension. A cross-sectional survey of 1355 Hispanic adults, mostly Dominicans who self-report hypertension was conducted. After controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance inadequate health literacy was associated with a lower adherence score.
AHRQ-funded; HS019853; HS022961.
Citation:
Lor M, Koleck TA, Bakken S .
Association between health literacy and medication adherence among hispanics with hypertension.
J Racial Ethn Health Disparities 2019 Jun;6(3):517-24. doi: 10.1007/s40615-018-00550-z..
Keywords:
Blood Pressure, Health Literacy, Hypertension, Medication, Patient Adherence/Compliance, Racial / Ethnic Minorities
Anstey DE, Moise N, Kronish I
Masked hypertension: whom and how to screen?
The purpose of this study was to review issues regarding the practical implementation of screening strategies for masked hypertension. In this review, challenges to screening strategies for masked hypertension, and factors that should be considered when deciding to screen using ambulatory or home blood pressure monitoring were highlighted.
AHRQ-funded; HS024262.
Citation:
Anstey DE, Moise N, Kronish I .
Masked hypertension: whom and how to screen?
Curr Hypertens Rep 2019 Apr 4;21(4):26. doi: 10.1007/s11906-019-0931-1..
Keywords:
Blood Pressure, Hypertension, Screening
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, the investigators conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data.
AHRQ-funded; HS023328.
Citation:
Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
J Med Internet Res 2019 Mar 26;21(3):e11366. doi: 10.2196/11366..
Keywords:
Hypertension, Blood Pressure, Chronic Conditions, Health Information Technology (HIT), Medication, Decision Making
Liyanage-Don N, Fung D, Phillips E
Implementing home blood pressure monitoring into clinical practice.
The purpose of this study was to review data that supports the use of home blood pressure monitoring (HBPM) and to provide practical guidance to clinicians who wish to incorporate HBPM into their practice. Home blood pressure monitoring more accurately reflects the risk of cardiovascular events than office blood pressure measurements, and evidence supports the hypothesis that HBPM combined with clinical support improves blood pressure control. In spite of this, HBPM use remains low due to barriers between patients, clinicians, and healthcare system levels; understanding these barriers is crucial for the development of strategies to implement HBPM. This article considers how recommended best practices can facilitate the successful and effective implementation of HBPM.
AHRQ-funded; HS024262.
Citation:
Liyanage-Don N, Fung D, Phillips E .
Implementing home blood pressure monitoring into clinical practice.
Curr Hypertens Rep 2019 Feb 12;21(2):14. doi: 10.1007/s11906-019-0916-0..
Keywords:
Blood Pressure, Diagnosis, Primary Care, Screening
Goldberg EM, Wilson T, Jambhekar B
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
This study researched the value of giving home blood pressure devices to patients in emergency departments (EDs) with a triage blood pressure (BP) of >= 120/80 mmHg and no history of hypertension. About 68% of the participants used the device at least 4 times. Those participants with elevated BP had follow-up with their primary care doctor 46% of the time.
AHRQ-funded; HS000011.
Citation:
Goldberg EM, Wilson T, Jambhekar B .
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
High Blood Press Cardiovasc Prev 2019 Feb;26(1):45-53. doi: 10.1007/s40292-019-00300-0..
Keywords:
Blood Pressure, Diagnosis, Emergency Department, Hypertension
Patil SJ, Koopman RJ, Belden J
The role of home BP monitoring: answers to 10 common questions.
This review examines what role home blood-pressure monitoring (HBPM) should take in the management of patients with hypertension. The answers to ten evidence-based questions, with reference to USPSTF recommendations, are used to provide insight. These questions include: Can HPBM be used to confirm a hypertension diagnosis? What are the diagnostic and treatment targets for HBPM? Does HBPM improve control of hypertension? Does HBPM help improve medication adherence? Does HBPM improve BP outcomes?
AHRQ-funded; HS023328.
Citation:
Patil SJ, Koopman RJ, Belden J .
The role of home BP monitoring: answers to 10 common questions.
J Fam Pract 2019 Jan/Feb;68(1):29-33..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Hypertension, Home Healthcare, Care Management, Evidence-Based Practice
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, Disparities, Emergency Department, Hypertension
