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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.
Results1 to 25 of 63 Research Studies Displayed
Hashemi A, Vasquez K, Guishard D
Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study.
This study tested whether implementing two evidence-based interventions--DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring--lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities. Participants were clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. They received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Primary outcomes was a) change in systolic BP measured by independent health professionals, and b) change in percent with "controlled BP" (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline. The authors enrolled 94 participants, with COVID closures interrupting implementation mid-study. Mean systolic BP at Month-1 changed by -4.41 mmHg compared to Baseline. Participants with controlled BP increased at Month 1 and changes in mean BP at Month 1 was significantly correlated with BMI, age, and baseline BP. Mean systolic mean SMBP changed by -6.9 mmHg at Months 5/6.
Citation: Hashemi A, Vasquez K, Guishard D . Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study. Nutr Metab Cardiovasc Dis 2022 Aug;32(8):1998-2009. doi: 10.1016/j.numecd.2022.05.018..
Keywords: Elderly, Blood Pressure, Community-Based Practice, Patient Self-Management, Nutrition, Lifestyle Changes, Vulnerable Populations
Commodore-Mensah Y, Loustalot F, Himmelfarb CD CD
AHRQ Author: McNellis R
Proceedings from a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention workshop to control hypertension.
In order to address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities.
Citation: Commodore-Mensah Y, Loustalot F, Himmelfarb CD CD . Proceedings from a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention workshop to control hypertension. Am J Hypertens 2022 Mar 8;35(3):232-43. doi: 10.1093/ajh/hpab182..
Keywords: Hypertension, Blood Pressure, Prevention, Cardiovascular Conditions
Bryant KB, Green MB, Shimbo D
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
This analysis examined how historical use of home blood pressure monitoring (HBPM) aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis and how HBPM use varies by patient characteristics. A cohort of 7185 adults aged 20 years or older without a diagnosis of hypertension or antihypertensive medication use and a high office BP (≥130/80 mm Hg) who participated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014 cycle were included. Participants who answered as having self-initiated or physician recommended HBPM were categorized as having used or having been told to use HBPM. The authors estimate that 31.4 million US adults did not have diagnosed hypertension, were not taking antihypertensive medications, and had an office BP ≥130/80 mm Hg. Out of that population, 95.3% would have met criteria to undergo out-of-office BP monitoring by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Only 3.6% (1.1 million) were told to use HBPM, and 15.7% had used HPBM. There were no differences in use by race/ethnicity, sex, health insurance status, or source of routine healthcare. The authors suggest the use of a telemonitoring system to improve ease of HBPM.
Citation: Bryant KB, Green MB, Shimbo D . Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go. Hypertension 2022 Feb;79(2):e15-e17. doi: 10.1161/hypertensionaha.121.18463..
Keywords: Hypertension, Diagnostic Safety and Quality, Blood Pressure
Fiscella K, He H, Sanders M
Blood pressure visit intensification in treatment (BP-Visit) findings: a pragmatic stepped wedge cluster randomized trial.
This randomized controlled trial evaluated the impact of multimodal strategies on time between visits and on improvement in systolic BP (SBP) among patients with uncontrolled hypertension. A total of 4277 adult patients with diagnosed hypertension and two BPs ≥ 140/90 pre-randomization and at least one visit during the post-randomization control period participated. The core intervention included three clinician hypertension-based trainings, monthly clinician feedback reports, and monthly meetings with practice champions. The main outcomes desired were change in time between visits when BP was not controlled and change in SBP. The intervention did not improve time to the next visit compared with control periods. SBP was reduced by 1.13 mmHg but was not maintained during follow-up. Hypertension control in the practices improved by 5% during intervention and was sustained post-intervention 5.4%.
Citation: Fiscella K, He H, Sanders M . Blood pressure visit intensification in treatment (BP-Visit) findings: a pragmatic stepped wedge cluster randomized trial. J Gen Intern Med 2022 Jan;37(1):32-39. doi: 10.1007/s11606-021-07016-9..
Keywords: Blood Pressure, Medication, Hypertension
Kilgallon 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: Kidney Disease and Health, Blood Pressure, Hypertension, 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.
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
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.
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.
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.
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.
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.
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 Problems, Blood Pressure, Hypertension
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.
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.
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.
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.
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, Diagnostic Safety and Quality
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.
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.
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, Communication, 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.
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.
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.
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.
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
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.
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
Shahu A, Herrin J, Dhruva SS
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
This study used data from the randomized clinical trial ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to study the effect of socioeconomics and blood pressure control and cardiovascular outcomes. The study sites were stratified by their county-level median household income into income quintiles. The lowest income sites (quintile 1) were most likely to be women, black or Hispanic, have less education, to live in the South and to have fewer cardiovascular risk factors. Despite standardized treatment protocols, quintile 1 participants were less likely to have blood pressure control, and all greater all-cause mortality, heart failure hospitalizations/mortality and end-stage renal disease than the highest income participants (quintile 5).
Citation: Shahu A, Herrin J, Dhruva SS . Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT. J Am Heart Assoc 2019 Aug 6;8(15):e012277. doi: 10.1161/jaha.119.012277..
Keywords: Hypertension, Blood Pressure, Disparities, Heart Disease and Health, Cardiovascular Conditions, Prevention, Patient-Centered Outcomes Research, Outcomes
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