Telemonitoring and mobile follow-up strategy supported by self-assessment of blood pressure with wrist sphygmomanometer in primary health care establishments to control patients with cardiovascular diseases in COVID 19 pandemic context (Preprint)

2020 ◽  
Author(s):  
Robert Etienne Partarrieu Stegmeier ◽  
Daniela Catalina Ahumada Millar ◽  
Soledad Armijo Rivera ◽  
Víctor Hugo Navia González
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Family Health ◽  
Statistical Error ◽  
Pressure Control ◽  
Self Assessment ◽  
Self Monitoring ◽  
Improve Blood Pressure Control ◽  
Average Blood Pressure

UNSTRUCTURED A randomized control study was designed with the objective to improve blood pressure control in people with cardiovascular disease. The intervention will be carried out in three modalities: one through self-monitoring of the patient after the delivery of a wrist blood pressure recording machine; another, fully automated modality, in which patients receive educational information and reminders through their smartphone, mediated by the Red Cap / Twilio platform; and finally, an instance of doubts resolution and follow-up to be carried out through telephone calls between nursing staff and patients through the Twilio platform. It is an open study, in which patients with cardiovascular disease who are treated at the El Roble family health center, Santiago de Chile, will be recruited via web-based. Outcomes will be evaluated through the calculation of weekly average blood pressure, in addition to self-assessed surveys that seek to determine an improvement in treatment adherence, knowledge of stroke and cardiovascular disease including recognition of stroke and myocardial infarction alarm symptoms and the level of self-efficacy of the patient. A total of 126 patients were recruited, divided in a 1 to 1 ratio between the control and intervention groups. Our main objective is through this sample size to discriminate a decrease of 3 mmHg in systolic blood pressure between both groups with a confidence interval of 95% (95% CI) between the 2 groups, 80% power and 5% statistical error.

Abstract P105: A Pharmacist Guided Patient Driven Interdisciplinary Program to Improve Blood Pressure Control in Patients with Hypertension

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Charles Hopley ◽  
Emily Andrews ◽  
Patrick Klem ◽  
Liza Wilson ◽  
Michelle Jonjak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Individual Risk ◽  
Dietary Counseling ◽  
Self Monitoring ◽  
Improve Blood Pressure Control ◽  
Early Results ◽  
Cv Disease

Introduction: Approximately 65% of patients treated for hypertension do not meet blood pressure goals. New strategies are needed to improve this number given the high impact of hypertension on CV disease. Dietary approaches and patient-driven self-titration of BP medications have been shown to be effective and safe in clinical studies but are under utilized in clinical practice. We present our experience with this ongoing project. Aims: Implement a pharmacist-guided, patient-driven self-monitoring and medication titration program. Implement standardized evidence-based dietary counseling to hypertensive patients. Intervention: Patients with uncontrolled hypertension on 3 or fewer anti-hypertensive agents were contacted to participate. BP goals were established based on individual risk factors. Patients were referred to the clinical pharmacist who devised a personalized plan for BP medication titration. Provide Education on dietary modification was provided to patients. The project was first introduced at the University of Colorado Hospital CKD clinic and then transitioned to the primary care setting at A.F. Williams Family Medicine Center. Outcomes: Appeal--both to providers and patients via pre/post survey Adherence/effectiveness--tracked via patient EMR blood pressure entries Adverse Events (via survey) experienced by patients will be analyzed. Results: At time of submission 19 patients have been enrolled and 3 patients have completed 6 month follow-up visits Of all ongoing and completed patients adherence to protocol is 72.2% 2 of the 3 patients completing 6 month follow-up had significant improvement in blood pressure (avg 16.26 mmHG) Comparison of descriptive statistics gathered from pre and 6 mo program provider surveys suggest favorable acceptance of program from renal providers All patients enrolled received dietary counseling with 3 patients receiving formal dietary consults. Conclusion: Our model for self-titration and dietary counseling appears to be feasible, safe and well received from providers. At the time of submission this project is ongoing, however early results from patients completing the protocol appear to be promising.

scholarly journals The role first-day readings play in a three-day schedule of self-monitoring home blood pressure based on prognostic data. VAMPAHICA Study

2019 ◽  
Author(s):  
Joan Bayó ◽  
Antoni Dalfó ◽  
Maria A Barceló ◽  
Marc Saez ◽  
Carme Roca ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Optimal Schedule ◽  
Home Blood Pressure ◽  
Newly Diagnosed ◽  
Self Monitoring ◽  
History Of ◽  
Normotensive Subjects ◽  
Prognostic Data

Abstract BACKGROUND The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a three-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. METHODS A total of 767 newly diagnosed, non-treated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a three-day SMHBP schedule, taking two readings in the morning and two in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the three-day schedule was evaluated with and without the first-day readings (12 and 8 readings). RESULTS A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT) and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) non-fatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%) and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the two groups of hypertensives, irrespective of the schedule of readings used (SHT with vs without first-day readings: 8.81 (4.28-18.15) vs 8.61 (4.15-17.85) and WCH with vs without first-day readings: 2.71(1.13-6.47) vs 3.40 (1.49-7.78)). CONCLUSIONS Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

scholarly journals Adherence of hypertension patients in the Brazil’s Family Health Strategy

2018 ◽  
Vol 71 (3) ◽  
pp. 1030-1037 ◽  
Author(s):  
Anderson da Silva Rêgo ◽  
Cremilde Aparecida Trindade Radovanovic
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Family Health ◽  
Pressure Control ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Health Strategy ◽  
Family Health Strategy ◽  
Northwest Region

ABSTRACT Objective: to evaluate the adherence and associate it to blood pressure control and to follow-up observation of people with hypertension in the Brazil’s Family Health Strategy. Method: cross-sectional study, conducted with 417 people in treatment of hypertension, living in a municipality located in the Northwest region of the state of Paraná, Brazil. The data were collected in the first 2016 semester, using an instrument adapted and validated for the evaluation of satisfaction with the services offered by Primary Health Care. Analysis of variance and the logistic regression model were used for the treatment of variables. Results: it was evidenced that people with inadequate follow-up observation evaluate the relations between professional/user and the guidance to the medications used as unsatisfactory. Conclusion: weak guidelines and ineffective dialogue between health professionals and users might result in an inadequate follow-up observation of blood pressure control and of people with hypertension.

Getting to know a new protocol in hypertension care

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Mona Lundin
Keyword(s):  
Blood Pressure ◽  
Digital Technology ◽  
Interaction Analysis ◽  
Medical Discourse ◽  
Graphical Form ◽  
Graph Data ◽  
Average Blood Pressure ◽  
Infrastructure Design

This study explores the use of a new protocol in hypertension care, in which continuous patient-generated data reported through digital technology are presented in graphical form and discussed in follow-up consultations with nurses. This protocol is part of an infrastructure design project in which patients and medical professionals are co-designers. The approach used for the study was interaction analysis, which rendered possible detailed in situ examination of local variations in how nurses relate to the protocol. The findings show three distinct engagements: (1) teasing out an average blood pressure, (2) working around the protocol and graph data and (3) delivering an analysis. It was discovered that the graphical representations structured the consultations to a great extent, and that nurses mostly referred to graphs that showed blood pressure values, which is a measurement central to the medical discourse of hypertension. However, it was also found that analysis of the data alone was not sufficient to engage patients: nurses' invisible and inclusion work through eliciting patients' narratives played an important role here. A conclusion of the study is that nurses and patients both need to be more thoroughly introduced to using protocols based on graphs for more productive consultations to be established. 

scholarly journals Skin autofluorescence predicts new cardiovascular disease and mortality in people with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henderikus E. Boersma ◽  
Robert P. van Waateringe ◽  
Melanie M. van der Klauw ◽  
Reindert Graaff ◽  
Andrew D. Paterson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Fasting Blood Glucose ◽  
Multivariable Analysis ◽  
Oral Glucose ◽  
Skin Autofluorescence ◽  
Z Score

Abstract Background Skin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D. Methods We included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2–9 years), while 40% were detected during the baseline examination by elevated fasting blood glucose ≥7.0 mmol/l) and/or HbA1c ≥6.5% (48 mmol/mol). Results Mean (±SD) age was 57 ± 12 yrs., BMI 30.2 ± 5.4 kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56 ± 0.99 vs 0.34 ± 0.89 AU, p < 0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78 ± 1.25 AU. During a median follow-up of 3.7 yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10–3.20, p < 0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61–2.61, p < 0.001) and death (OR 2.98, 2.25–3.94, p < 0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD. Conclusions Measuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

scholarly journals POS0815 CLINICAL CHARACTERISTICS, IMAGING PHENOTYPE, AND LONG-TERM OUTCOMES OF TAKAYASU ARTERITIS PATIENTS WITH HYPERTENSION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 661.1-661
Author(s):  
Y. Sun ◽  
L. Ma ◽  
H. Chen ◽  
C. Rongyi ◽  
L. Jiang
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Clinical Features ◽  
Takayasu Arteritis ◽  
Pressure Control ◽  
Free Survival ◽  
The World ◽  
Cluster 2

Background:Hypertension occurred in 30-80% of TAK patients around the world. The occurrence of hypertension might severely worsen TAK prognosis. Nevertheless, data describing the specific imaging features in hypertensive TAK patients and the associations between hypertensive severity, blood pressure control status and long-term outcome were still lacking.Objectives:To investigate the characteristics and associations of hypertensive characteristics with adverse events-free survival in Takayasu arteritis (TAK) patients with hypertension.Methods:This research was based on a prospectively on-going observational cohort-East China Takayasu Arteritis (ECTA) cohort. In all, 618 TAK patients, who registered in the ECTA cohort up to December 2019, were enrolled. The main outcome was the adverse-events-free survival among hypertensive TAK patients during the follow-up ended on August 2020.Results:Totally, 204 (33.0%) patients suffered from hypertension, with 48 (23.5%), 62 (30.4%), and 94 (46.1%) mild, moderate, and severe hypertension, respectively. Cluster analysis indicated three imaging phenotypes for hypertensive TAK patients: Cluster 1: involvement of the abdominal aorta and/or renal artery (n=56, 27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, and the aortic arch and its branches (n=38, 18.6%); Cluster 3: combined involvement of Cluster 1 and Cluster 2 (n=111, 54.4%). By the end of the follow-up, the blood pressure control rate was 50.8%, while the adverse-events-free survival was 67.9% in the entire hypertensive population. Multivariate Cox regression analysis indicated that well-controlled blood pressure (HR=2.13, 95%CI 1.32–3.78, p=0.047), co-existence of severe aortic valve regurgitation (HR=0.87, 95%CI 0.64–0.95, p=0.043), Cluster 1 (HR=0.69, 95%CI 0.48–0.92, p=0.017) and Cluster 3 (HR=0.72, 95%CI 0.43–0.94, p=0.048) imaging phenotype was associated with the adverse-events-free survival.Conclusion:Patients with controlled hypertension showed better adverse-events-free survival, while those with the Cluster 1 imaging phenotype were more likely to suffer from worse adverse-events-free survival. Hypertension occurred in 30-80% of TAK patients around the world. The occurrence of hypertension might severely worsen TAK prognosis.References:[1]Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol 2002; 55:481–6.[2]Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from a cross-country research in Japan: age and sex specificity. Circulation 2015; 132:1701–9.[3]Yilmaz N, Can M, Oner FA, et al. Impaired quality of life, disability and mental health in Takayasu’s arteritis. Rheumatol. (Oxford) 2013; 52:1898–904.[4]Laurent A, Julien H, Nicolas L, et al. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine 2010; 89:1–17.[5]Mwipatayi BP, Jeffery PC, Beningfield SJ, et al. Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg 2005; 75:110–7.Disclosure of Interests:None declared

scholarly journals Acceptability and feasibility of a mobile health application for blood pressure monitoring in rural Uganda

JAMIA Open ◽  
2021 ◽  
Author(s):  
Beatrice Mugabirwe ◽  
Tabor Flickinger ◽  
Lauren Cox ◽  
Pius Ariho ◽  
Rebecca Dillingham ◽  
...  
Keyword(s):  
Social Support ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Mobile App ◽  
People Living With Hiv ◽  
Resource Limited Settings ◽  
Self Monitoring ◽  
Resource Limited

Abstract Background Mobile technologies to improve blood pressure control in resource-limited settings are needed. We adapted and evaluated the acceptability and feasibility of PositiveLinks, a mobile phone application for self-monitoring, social support, and engagement in care for people living with HIV, among patients with hypertension in rural Uganda. Methods We enrolled adults on treatment for hypertension at Mbarara Regional Referral Hospital and Mbarara Municipal health center IV, southwestern Uganda. We provided and educated all participants on the use of PositiveLinks application and automated blood pressure monitors. We administered a baseline questionnaire and performed in-depth interviews 30 days later to explore acceptability, feasibility, medication adherence, social support, and blood pressure control. Results A total of 37 participants completed the interviews, mean age of 58 years (SD 10.8) and 28 (75.7%) were female. All participants embraced the PositiveLinks mobile app and were enthusiastic about self-monitoring of blood pressure, 35 (94.6%) experienced peer to peer support. Among the 35 participants non-adherent to medications at baseline, 31 had improved medication adherence. All except 1 of the 31(83.8%) who had uncontrolled blood pressure at baseline, had self-reported controlled blood pressure after 30 days of use of PositiveLinks. Conclusion Patients with hypertension in rural Uganda embraced the PositiveLinks mobile application and had improved medication adherence, social support, and blood pressure control. Further assessment of cost-effectiveness of the application in blood pressure control in resource-limited settings will be pursued in future studies.

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