358 results on '"Brent M. Egan"'
Search Results
2. Masked hypertension in type 2 diabetes: never take normotension for granted and always assess out-of-office blood pressure
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Krzysztof Narkiewicz, Sverre E. Kjeldsen, Brent M. Egan, Reinhold Kreutz, and Michel Burnier
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Diabetes Mellitus, Type 2 ,Masked Hypertension ,Hypertension ,Internal Medicine ,Humans ,Blood Pressure ,General Medicine ,Blood Pressure Monitoring, Ambulatory ,Cardiology and Cardiovascular Medicine ,White Coat Hypertension - Published
- 2022
3. Self-Reported Antihypertensive Medication Class and Temporal Relationship to Treatment Guidelines
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Keith C. Ferdinand, Susan E Sutherland, Kenneth Jamerson, Gregory Wozniak, Jackson T. Wright, Brent M Egan, Michael Rakotz, and Jianing Yang
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Male ,Class (computer programming) ,medicine.medical_specialty ,business.industry ,Sodium Chloride Symporter Inhibitors ,Calcium channel ,Adrenergic beta-Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,Middle Aged ,Internal medicine ,Hypertension ,Practice Guidelines as Topic ,Internal Medicine ,Humans ,Medicine ,Female ,Self Report ,business ,Initial therapy ,Antihypertensive Agents ,Thiazide ,Aged ,Antihypertensive medication ,medicine.drug - Abstract
The greater antihypertensive responses to initial therapy with calcium channel blockers (CCBs) or thiazide-type diuretics than renin-angiotensin system blockers as initial therapy in non-Hispanic Black (NHB) adults was recognized in the US High BP guidelines from 1988 to 2003. The 2014 Report from Panel Members Appointed to the Eighth Joint National Committee (2014 aJNC8 Report) and the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline were the first to recommend CCBs or thiazide-type diuretics rather than renin-angiotensin system blockers as initial therapy in NHB. We assessed the temporal relationship of these recommendations on self-reported CCB or thiazide-type diuretics monotherapy by NHB and NHW adults with hypertension absent compelling indications for β-blockers or renin-angiotensin system blockers in National Health and Nutrition Examination Surveys 2015 to 2018 versus 2007 to 2012 (after versus before 2014 aJNC8 Report). CCB or thiazide-type diuretics monotherapy was unchanged in NHW adults (17.1% versus 18.1%, P =0.711) and insignificantly higher after 2014 among NHB adults (43.7% versus 38.2%, P =0.204), although CCB monotherapy increased (29.5% versus 21.0%, P =0.021) and renin-angiotensin system blocker monotherapy fell (44.5% versus 31.0%, P =0.008). Although evidence-based CCB monotherapy increased among NHB adults in 2015 to 2018, hypertension control declined as untreated hypertension and monotherapy increased. While a gap between recommended and actual monotherapy persists, evidence-based monotherapy appears insufficient to improve hypertension control in NHB adults, especially given evidence for worsening therapeutic inertia. Initiating treatment with single-pill combinations and timely therapeutic intensification when required to control hypertension are evidence-based, race-neutral options for improving hypertension control among NHB adults.
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- 2022
4. Association of Baseline Adherence to Antihypertensive Medications With Adherence After Shelter-in-Place Guidance for COVID-19 Among US Adults
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Brent M. Egan, Susan E. Sutherland, Cynthia I. Macri, Yi Deng, Ariungeral Gerelchuluun, Michael K. Rakotz, and Stanley V. Campbell
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General Medicine - Abstract
ImportanceAdherence to selected antihypertensive medications (proportion of days covered [PDC]) declined after guidance to shelter in place for COVID-19.ObjectivesTo determine whether PDC for all antihypertensive medications collectively fell from the 6 months before sheltering guidance (September 15, 2019, to March 14, 2020 [baseline]) compared with the first (March 15 to June 14, 2020) and second (June 15 to September 14, 2020) 3 months of sheltering and to assess the usefulness of baseline PDC for identifying individuals at risk for declining PDC during sheltering.Design, Setting, and ParticipantsThis retrospective cohort study included a random sample of US adults obtained from EagleForce Health, a division of EagleForce Associates Inc. Approximately one-half of the adults were aged 40 to 64 years and one-half were aged 65 to 90 years, with prescription drug coverage, hypertension, and at least 1 antihypertensive medication prescription filled at a retail pharmacy during baseline.Main Outcomes and MeasuresPrescription claims were used to assess (1) PDC at baseline and changes in PDC during the first and second 3 months of sheltering and (2) the association of good (PDC ≥ 80), fair (PDC 50-79), and poor (PDC < 50) baseline adherence with adherence during sheltering.ResultsA total of 27 318 adults met inclusion criteria (mean [SD] age, 65.0 [11.7] years; 50.7% women). Mean PDC declined from baseline (65.6 [95% CI, 65.2-65.9]) during the first (63.4 [95% CI, 63.0-63.8]) and second (58.9 [95% CI, 58.5-59.3]) 3 months after sheltering in all adults combined (P P P Conclusions and RelevanceThese findings suggest that individuals with poor baseline adherence are candidates for adherence-promoting interventions irrespective of sheltering guidance. Interventions to prevent poor adherence during sheltering may be more useful for individuals with fair vs good baseline adherence.
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- 2022
5. TIME to face the reality about evening dosing of antihypertensive drugs in hypertension
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Sverre E. Kjeldsen, Brent M. Egan, Krzysztof Narkiewicz, Reinhold Kreutz, Michel Burnier, Suzanne Oparil, and Giuseppe Mancia
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Humans ,Antihypertensive Agents ,Hypertension/drug therapy ,Blood Pressure ,Circadian Rhythm ,Hypertension ,Internal Medicine ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
6. Free Text to Standardized Concepts to Clinical Decisions
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Eva K. Lee and Brent M. Egan
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This article discusses the establishment of interoperability among electronic medical records from 800 clinical sites and the use of machine learning for best practice discovery. A novel extraction-mapping algorithm is designed that accurately extracts, summarizes, and maps free text and content to concise structured medical concepts. Clinical decision processes and disease progression are also generated. The machine learning model (DAMIP) uncovers discriminatory feature sets that can predict the quality of treatment outcomes (blind prediction accuracies of 89% – 97%) for multiple diseases including heart, hypertension, and chronic kidney disease (CKD). For each disease, the best practice was used at fewer than 5% of the clinical sites, opening up excellent opportunities for knowledge sharing and rapid learning. This work led to the implementation of a new treatment policy for CKD pre-dialysis care management. The new policy offers better outcomes, saves lives, improves the quality of life, and reduces 35% of treatment costs. The system is scalable and generalizable.
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- 2022
7. Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions
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Brent M. Egan, Sverre E. Kjeldsen, Krzysztof Narkiewicz, Reinhold Kreutz, and Michel Burnier
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Drug Combinations ,Hypertension ,Internal Medicine ,Humans ,Blood Pressure ,General Medicine ,Cardiology and Cardiovascular Medicine ,Antihypertensive Agents ,Tablets - Published
- 2022
8. Thirty years with LIFE-a randomized clinical trial with more than 200 published articles on clinical aspects of left ventricular hypertrophy
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Sverre E. Kjeldsen, Brent M. Egan, Krzysztof Narkiewicz, Reinhold Kreutz, Michel Burnier, and Suzanne Oparil
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Hypertension ,Internal Medicine ,Humans ,Hypertrophy, Left Ventricular ,General Medicine ,Cardiology and Cardiovascular Medicine ,Antihypertensive Agents ,Ventricular Function, Left - Published
- 2022
9. Baseline Heart Rate Predicts the Blood Pressure Response to Renal Denervation in Untreated Hypertension
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Brent M. Egan
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Denervation ,medicine.medical_specialty ,business.industry ,Blood Pressure ,Kidney ,Untreated hypertension ,Blood pressure ,Heart Rate ,Internal medicine ,Hypertension ,Heart rate ,Cardiology ,Humans ,Medicine ,Sympathectomy ,Cardiology and Cardiovascular Medicine ,business ,Baseline (configuration management) - Published
- 2021
10. Limited Long-Term Efficacy of Lifestyle-Mediated Weight Loss on Blood Pressure Control and the Biology of Weight Regain
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Brent M. Egan, Susan Sutherland, and Michael E. Hall
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- 2021
11. Abortion as a Moral Good? Contrasting Secular and Judeo-Christian Views and a Potential Pathway for Promoting Life
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Brent M. Egan
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Poverty ,Judeo-Christian ,media_common.quotation_subject ,Blessing ,Beneficence ,Agape ,Perspective (graphical) ,Abortion ,Psychology ,Social psychology ,Unconditional love ,media_common - Abstract
Objective: This review aims to summarize key facets of the Pro Choice and Pro Life perspectives and outline a resolution pathway that minimizes abortion. Main Results: Approximately 1.3 billion abortions occurred worldwide from 1990 through 2014. In the United States, more than 61 million abortions were performed between 1973 and 2017. The Pro Choice perspective posits that: 1) A fetus is not a person; therefore, a person is not harmed. 2) Forced childbearing includes significant health and psychological risks to the mother and can exacerbate poverty. Since a person is not harmed and the mother is benefited, abortion is a moral good. From a Judeo-Christian, Pro Life perspective: 1) God creates every person in his image and has a pre-conception life plan for them. 2) God commanded us to be fruitful and multiply and identified children as a blessing. Hence, abortion harms a person and is rebellion against God. Conclusion: In working toward a solution, agape love, which is sacrificial and giving, not selfish or condemning, is a good starting point. In that light, the Judeo-Christian community can begin bridging the chasm between the Pro Life and Pro Choice communities by sharing truth in love and helping to meet the material and emotional needs of pregnant women who see no alternative to abortion. Proactive, unconditional love provides the foundation for making the womb a sanctuary for life.
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- 2021
12. Abstract EP69: Age, Sex And Race Disparities In Hypertension Control: The Multi-Ethnic Study Of Atherosclerosis (MESA)
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Siddharth Bhayani, Ramon Durazo-Arvizu, Kiang Liu, Martha L Daviglus, Erin Michos, Talar Markossian, Michael Rakotz, Greg Wozniak, Brent M Egan, and Holly J Kramer
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Hypertension control is lower among women than men after age 65 years, but it is unknown whether age and sex disparities in hypertension control differ by race and ethnicity. We used data from the Multi-Ethnic Study of Atherosclerosis (MESA), to assess the association of age, sex, and race with hypertension control. Methods: At baseline, MESA enrolled 6814 adults aged 45 to 84 years without clinical CVD during years 2000-2002 followed by 5 follow-up exams. Due to loss of follow-up after exam 5, analysis was limited to participants with use of BP lowering medications at any of the first 5 MESA exams (n=2017). Hypertension control was defined as BP < 140/90 mmHg based on average of second and third BP readings at each exam. Among 873 men and 1144 women with treated hypertension, mean baseline age was 64.1 (9.1 [SD]) years and race/ethnicity was non-Hispanic white in 34.1%, 10.1% Chinese, 35.1% Non-Hispanic Black and 20.7% Hispanic. Results: Figure 1 shows the fully adjusted proportion of participants with hypertension control at any of the first five MESA exams by age group, sex and by race and ethnicity. In all racial and ethnic groups, hypertension control declined with age among women and was lowest at age 75+ years. However, this decline in hypertension control with advancing age was most pronounced among Hispanic women, a group with the lowest adjusted proportion with hypertension control at age 75+ years (45.2%; 95% CI 35.3, 55.1). Hypertension control increased with advancing age among non-Hispanic Black men and stayed stable among Chinese men. Among white and Hispanic men, the adjusted proportion with hypertension control decreased from 81.1% (95% CI 76.7, 85.5) and 70.9% (95% CI 64.1, 77.8), respectively, at age 45-64 years, to 75.4% (95% CI 69.6, 81.3) and 61.5% (95% CI 55.3, 70,8), respectively, at age 75+ years. Conclusion: Age and sex differences in hypertension control are present in these four race and ethnic groups but declines in hypertension control with advancing age appear more prominent among Hispanic women.
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- 2022
13. Sociodemographic Determinants of Life’s Simple 7: Implications for Achieving Cardiovascular Health and Health Equity Goals
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Yuling Hong, Keith C. Ferdinand, Brent M Egan, Jiexiang Li, Eduardo Sanchez, Susan E Sutherland, and Daniel W. Jones
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Adult ,Blood Glucose ,Male ,Epidemiology ,Ethnic group ,Blood Pressure ,Disease ,White People ,Body Mass Index ,Cigarette Smoking ,Young Adult ,03 medical and health sciences ,Risk Factors ,Humans ,Medicine ,Exercise ,Life Style ,Socioeconomic status ,Hispanic paradox ,030505 public health ,Health Equity ,business.industry ,Confounding ,Age Factors ,Hispanic or Latino ,General Medicine ,Odds ratio ,Middle Aged ,Nutrition Surveys ,United States ,Health equity ,Black or African American ,Cholesterol ,Cardiovascular Diseases ,Income ,Educational Status ,Original Report: Cardivascular Disease and Risk Factors ,Female ,Diet, Healthy ,0305 other medical science ,business ,Goals ,Body mass index ,Demography - Abstract
Background: Life’s Simple 7 (LS7; nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol, glucose) predicts cardiovascular health. The principal objective of our study was to define demographic and socioeconomic factors associated with LS7 to better inform programs addressing cardiovascular health and health equity.Methods: National Health and Nutrition Examination Surveys 1999–2016 data were analyzed on non-Hispanic White [NHW], NH Black [NHB], and Hispanic adults aged ≥20 years without cardiovascular disease. Each LS7 variable was assigned 0, 1, or 2 points for poor, intermediate, and ideal levels, respectively. Composite LS7 scores were grouped as poor (0–4 points), intermediate (5–9), and ideal (10–14).Results: 32,803 adults were included. Mean composite LS7 scores were below ideal across race/ethnicity groups. After adjusting for confounders, NHBs were less likely to have optimal LS7 scores than NHW (multivariable odds ratios (OR .44; 95% CI .37–.53), whereas Hispanics tended to have better scores (1.18; .96–1.44). Hispanics had more ideal LS7 scores than NHBs, although Hispanics had lower incomes and less education, which were independently associated with fewer ideal LS7 scores. Adults aged ≥45 years were less likely to have ideal LS7 scores (.11; .09–.12) than adults aged
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- 2020
14. Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial
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Jennifer Dahne, K. Michael Cummings, Brent M. Egan, Elizabeth Garrett-Mayer, Kevin M. Gray, Matthew J. Carpenter, Robert A. Davis, and Amy E. Wahlquist
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Adult ,Male ,medicine.medical_specialty ,South Carolina ,Nicotine patch ,medicine.medical_treatment ,media_common.quotation_subject ,030508 substance abuse ,Medicine (miscellaneous) ,Context (language use) ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Behavior Therapy ,law ,Internal medicine ,Ambulatory Care ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,media_common ,Smokers ,Primary Health Care ,business.industry ,Odds ratio ,Middle Aged ,Abstinence ,Nicotine replacement therapy ,Tobacco Use Cessation Devices ,Clinical trial ,Psychiatry and Mental health ,Smoking cessation ,Female ,Smoking Cessation ,0305 other medical science ,business - Abstract
Background and aims Within the context of busy clinical settings, health-care providers need practical, evidence-based options to engage smokers in quitting. Sampling of nicotine replacement therapy [i.e. provision of nicotine replacement therapy (NRT starter kits)] is a brief, pragmatic strategy to address this need. We aimed to compare the effects of NRT sampling plus standard care (SC), relative to SC alone, provided by primary care providers during routine clinic visits. Design Cluster-randomized clinical trial. Setting Twenty-two primary care clinics in South Carolina, USA. Participants Adult smokers [n = 1245; 61% female, mean age = 50.7, standard deviation (SD) = 13.5] both motivated and unmotivated to quit, seen during routine clinical visit. Interventions were provider-delivered SC (n = 652, 12 clinics) cessation advice or SC + a 2-week supply of both nicotine patch and lozenge, with minimal instructions on use (n = 593; 10 clinics). Measurements The primary outcome was 7-day point prevalence smoking abstinence at 6-month follow-up, using intent-to-treat. Additional outcomes included NRT use and quit attempts, assessed at 1, 3 and 6 months following baseline. Findings Seven-day point prevalence abstinence rates were significantly higher in the NRT sampling group throughout follow-up, including at 6 months [12 versus 8%, odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0-2.4]. NRT sampling increased prevalence of any use of NRT (65 versus 25%, OR = 5.8, 95% CI = 4.3-7.7), with higher prevalence of use at 6 months (25 versus 14%, OR = 2.0, 95% CI = 1.5-2.7). NRT sampling increased the rate of quit attempts in the initial month (24 versus 18%, OR = 1.5, 95% CI = 1.0-2.3) but had no significant effect on overall rate of quit attempts (48 versus 45%, OR = 1.2, 95% CI = 0.8-1.7). Conclusion Providing smokers with a free 2-week starter kit of nicotine replacement therapy increased quit attempts, use of stop smoking medications and smoking abstinence compared with standard care in a primary care setting.
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- 2020
15. Multi-Site Best Practice Discovery: From Free Text to Standardized Concepts to Clinical Decisions
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Eva K Lee, Zhunan Li, Yuanbo Wang, Matthew S Hagen, Robert Davis, and Brent M Egan
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- 2021
16. Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension
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Yvonne Commodore-Mensah, Fleetwood Loustalot, Cheryl Dennison Himmelfarb, Patrice Desvigne-Nickens, Vandana Sachdev, Kirsten Bibbins-Domingo, Steven B Clauser, Deborah J Cohen, Brent M Egan, A Mark Fendrick, Keith C Ferdinand, Cliff Goodman, Garth N Graham, Marc G Jaffe, Harlan M Krumholz, Phillip D Levy, Glen P Mays, Robert McNellis, Paul Muntner, Gbenga Ogedegbe, Richard V Milani, Linnea A Polgreen, Lonny Reisman, Eduardo J Sanchez, Laurence S Sperling, Hilary K Wall, Lori Whitten, Jackson T Wright, Janet S Wright, and Lawrence J Fine
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Adult ,Hypertension ,Internal Medicine ,Humans ,Blood Pressure ,Blood Pressure Determination ,Centers for Disease Control and Prevention, U.S ,National Heart, Lung, and Blood Institute (U.S.) ,United States - Abstract
Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as
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- 2021
17. Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association
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Michael E. Hall, Jun Ma, Philip R Schauer, Daichi Shimbo, John E. Hall, Carl J. Lavie, Chiadi E Ndumele, Vascular Biology, Brent M. Egan, Jordana B. Cohen, and Jamy D. Ard
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Phentermine ,medicine.medical_specialty ,Psychological intervention ,Bariatric Surgery ,Disease ,law.invention ,Randomized controlled trial ,law ,Weight loss ,Appetite Depressants ,Weight Loss ,Internal Medicine ,medicine ,Humans ,Obesity ,Risk factor ,Medical prescription ,Intensive care medicine ,Exercise ,Orlistat ,business.industry ,American Heart Association ,medicine.disease ,United States ,Blood pressure ,Hypertension ,Anti-Obesity Agents ,medicine.symptom ,business - Abstract
Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.
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- 2021
18. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association
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Wanpen Vongpatanasin, David J. Hyman, Antoinette Schoenthaler, Brent M. Egan, Niteesh K. Choudhry, Valory N. Pavlik, Nancy Houston Miller, Ian M. Kronish, and Keith C. Ferdinand
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Blood pressure control ,medicine.medical_specialty ,education.field_of_study ,Hypertension control ,Heart disease ,business.industry ,Public health ,Population ,Medication adherence ,Blood Pressure ,American Heart Association ,medicine.disease ,United States ,Medication Adherence ,Blood pressure ,Hypertension ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,education ,business ,Stroke ,Antihypertensive Agents - Abstract
The widespread treatment of hypertension and resultant improvement in blood pressure have been major contributors to the dramatic age-specific decline in heart disease and stroke. Despite this progress, a persistent gap remains between stated public health targets and achieved blood pressure control rates. Many factors may be important contributors to the gap between population hypertension control goals and currently observed control levels. Among them is the extent to which patients adhere to prescribed treatment. The goal of this scientific statement is to summarize the current state of knowledge of the contribution of medication nonadherence to the national prevalence of poor blood pressure control, methods for measuring medication adherence and their associated challenges, risk factors for antihypertensive medication nonadherence, and strategies for improving adherence to antihypertensive medications at both the individual and health system levels.
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- 2021
19. Blood Pressure Control Among Non-Hispanic Black Adults Is Lower Than Non-Hispanic White Adults Despite Similar Treatment With Antihypertensive Medication: NHANES 2013-2018
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Donald K Hayes, Sandra L Jackson, Yanfeng Li, Gregory Wozniak, Stavros Tsipas, Yuling Hong, Angela M Thompson-Paul, Hilary K Wall, Cathleen Gillespie, Brent M Egan, Matthew D Ritchey, and Fleetwood Loustalot
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Adult ,Hypertension ,Internal Medicine ,Humans ,Blood Pressure ,Calcium Channel Blockers ,Diuretics ,Nutrition Surveys ,Antihypertensive Agents ,United States - Abstract
BACKGROUND Controlled blood pressure can prevent or reduce adverse health outcomes. Social and structural determinants may contribute to the disparity that despite equivalent proportions on antihypertensive medication, non-Hispanic Black (Black) adults have lower blood pressure control and more cardiovascular events than non-Hispanic White (White) adults. METHODS Data from 2013 to 2018 National Health and Nutrition Examination Survey were pooled to assess control among Black and White adults by antihypertensive medication use and selected characteristics using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Guideline definition (systolic blood pressure RESULTS Among those treated with antihypertensive medication, an estimated 34.9% of Black and 45.0% of White adults had controlled blood pressure. Control was lower for Black and White adults among most subgroups of age, sex, education, insurance status, usual source of care, and poverty–income ratio. Black adults had higher use of diuretics (28.5%—Black adults vs. 23.5%—White adults) and calcium channel blockers (24.2%—Black adults vs. 14.7%—White adults) compared with White adults. Control among Black adults was lower than White adults across all medication classes including diuretics (36.1%—Black adults vs. 47.3%—White adults), calcium channel blockers (30.2%—Black adults vs. 40.1%—White adults), and number of medication classes used. CONCLUSIONS Suboptimal blood pressure control rates and disparities warrant increased efforts to improve control, which could include addressing social and structural determinants along with emphasizing implementation of the 2017 ACC/AHA Blood Pressure Guideline into clinical practice.
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- 2021
20. Hypertension Control in the United States 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age- and Race-Ethnicity Groups
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Susan E Sutherland, Gregory Wozniak, Michael Rakotz, Jiexiang Li, and Brent M Egan
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Adult ,Race ethnicity ,Adolescent ,Blood Pressure ,030204 cardiovascular system & hematology ,White People ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,Control (linguistics) ,Antihypertensive Agents ,geography ,geography.geographical_feature_category ,Hypertension control ,business.industry ,Fell ,Middle Aged ,United States ,Black or African American ,Falling (accident) ,Hypertension ,medicine.symptom ,business ,Demography - Abstract
Hypertension control (United States) increased from 1999 to 2000 to 2009 to 2010, plateaued during 2009 to 2014, then fell during 2015 to 2018. We sought explanatory factors for declining hypertension control and assessed whether specific age (18–39, 40–59, ≥60 years) or race-ethnicity groups (Non-Hispanic White, NH [B]lack, Hispanic) were disproportionately impacted. Adults with hypertension in National Health and Nutrition Examination Surveys during the plateau (2009–2014) and decline (2015–2018) in hypertension control were studied. Definitions: hypertension, blood pressure (mm Hg) ≥140 and/or ≥90 mm Hg or self-reported antihypertensive medications (Treated); Aware, ‘Yes” to, “Have you been told you have hypertension?”; Treatment effectiveness, proportion of treated adults controlled; control, blood pressure P P =0.01), treatment (−4.6%, P =0.004), and treatment effectiveness (−6.0%, P P =0.97]). Antihypertensive monotherapy rose (+4.2%, P =0.04), although treatment resistance factors increased (obesity +4.0%, P =0.02, diabetes +2.3%, P =0.02). Hypertension control fell across age (18–39 [−4.9%, P =0.30]; 40–59 [−9.9%, P =0.0003]; ≥60 years [−6.5%, P =0.005]) and race-ethnicity groups (Non-Hispanic White [−8.5%, P =0.0007]; NHB −7.4%, P =0.002]; Hispanic [−5.2%, P =0.06]). Racial/ethnic disparities in hypertension control versus Non-Hispanic White were attenuated after adjusting for modifiable factors including education, obesity and access to care; NHB (odds ratio, 0.79 unadjusted versus 0.84 adjusted); Hispanic (odds ratio 0.74 unadjusted versus 0.98 adjusted). Improving hypertension control and reducing disparities require greater and more equitable access to high quality health care and healthier lifestyles.
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- 2021
21. Editorial commentary on 'Country of birth and mortality risk in hypertension with and without diabetes: the Swedish Primary Care Cardiovascular Database'
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Susan E. Sutherland and Brent M. Egan
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Sweden ,medicine.medical_specialty ,Databases, Factual ,Primary Health Care ,Physiology ,business.industry ,MEDLINE ,Primary care ,medicine.disease ,Family medicine ,Diabetes mellitus ,Hypertension ,Internal Medicine ,medicine ,Diabetes Mellitus ,Humans ,Country of birth ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
22. The global burden of hypertension exceeds 1.4 billion people
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G. Mancia, Sverre E. Kjeldsen, Murray D. Esler, Brent M. Egan, Guido Grassi, Egan, B, Kjeldsen, S, Grassi, G, Esler, M, and Mancia, G
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medicine.medical_specialty ,Primary Health Care ,Systole ,Physiology ,business.industry ,blood pressure, cardiovascular disease, clinical guidelines, hypertension ,Blood Pressure ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal medicine ,Hypertension ,Internal Medicine ,Cardiology ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Antihypertensive Agents ,Randomized Controlled Trials as Topic ,circulatory and respiratory physiology - Abstract
In 2010, 1.4 billion people globally had hypertension, with 14% controlled to systolic blood pressure (SBP, mmHg) below 140, which contributes to 18 million cardiovascular deaths annually. Recent hypertension guidelines endorsed SBP targets below 130 or lower for all or some hypertensive patients to reduce cardiovascular events (CVEs) more than the prior SBP target less than 140. In 2016, the Australian Guideline strongly recommended target SBP below 120 for adults at very high risk for CVE or aged above 75 years. In 2017 and 2018, the Canadian Guideline recommended automated office SBP (AOSBP) below 120 in adults at high risk and aged above 75 years (grade B). In 2017, the US Guideline recommended SBP below 130 for all adults (moderate-to-high risk class I; lower-risk grade IIb). In 2018, the European Guideline recommended SBP below 140 for all adults, and, if tolerated, a SBP range of 120-129 for adults aged below 65 years and 130-139 for adults aged at least 65 years (class I). The guidelines were variably influenced by Systolic blood PRessure INTervention trial and meta-analyses indicating fewer CVE when mean in-trial SBP was below 130 versus above 130. Clinicians considering lower SBP targets should be aware that: AOSBP preceded by 5-min rest is approximately 10-15 mmHg lower than usual office SBP; hypertensive patients with office SBP consistently versus intermittently below 140 have fewer CVE; benefits of mean office SBP or AOSBP below 120 remain unproven and could increase adverse events. Clinicians worldwide will do well to control SBP to below 140 in most hypertensive patients on most visits, which should lead to mean in-clinic SBP of 120-129.
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- 2019
23. Adherence in Hypertension
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Michel Burnier and Brent M. Egan
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medicine.medical_specialty ,Physiology ,business.industry ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Pharmacotherapy ,Poor control ,Noncommunicable disease ,Health care ,medicine ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Socioeconomic status ,Cardiovascular outcomes - Abstract
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
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- 2019
24. Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol
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Jianing Yang, Gregory Wozniak, R. Bruce Hanlin, Michael Rakotz, Susan E. Sutherland, Brent M. Egan, and Robert A. Davis
- Subjects
Protocol (science) ,medicine.medical_specialty ,Quality management ,Hypertension control ,business.industry ,Primary health care ,Measure (physics) ,Primary care ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Emergency medicine ,Internal Medicine ,medicine ,030212 general & internal medicine ,business - Abstract
Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (P P P =0.01), and systolic BP decreased more per therapeutic intensification (−5.4 to −12.7; P
- Published
- 2018
25. Abstract P164: Self-reported Use Of Recommended Calcium Channel Blockers And Diuretics In Non-hispanic Blacks With Hypertension: An Opportunity To Improve Evidence-based Prescribing
- Author
-
Jianing Yang, Gregory Wozniak, Brent M. Egan, Susan E. Sutherland, and Michael Rakotz
- Subjects
medicine.medical_specialty ,Evidence-based practice ,Hypertension control ,business.industry ,Internal medicine ,Incidence (epidemiology) ,Calcium channel ,Internal Medicine ,medicine ,Evidence-based medicine ,business - Abstract
Background: Non-Hispanic Blacks (NHBs) have a higher prevalence of hypertension and incidence of cardiovascular events than NH(W)hites and Hispanics. To improve hypertension control and outcomes in NHBs, the U.S. High Blood Pressure (BP, mmHg) Guidelines recommended calcium channel blockers (CCBs) and diuretics over other drug classes as initial therapy in 2014 and 2017. Among adults with hypertension, percentages of NHBs who reported taking CCBs and diuretic monotherapy before and after 2014 were assessed and compared to NHWs and Hispanics. Methods: National Health and Nutrition Examination Surveys data in 2-year cycles from 2007-2012 and 2015-2018 were analyzed and included self-identified NHB, NHW, and Hispanic adults ≥18 years with recorded BP values and hypertension defined as self-reported BP medication use in the previous month, which included medication class, e.g., CCBs and diuretics. Multivariable logistic regression was used to assess the independent contribution of NHB race/ethnicity to prevalence of CCB and diuretic use as monotherapy. Results: Self-reported CCB or diuretic monotherapy did not increase significantly from 2007-2012 to 2015-2018 among NHBs (44% vs. 50%, p=0.12) or Hispanics (22% vs 29%, p=0.12) and a non-significant decline in NHWs (26% vs 22%, p=0.14). NHBs were more likely to report taking CCBs or diuretics as monotherapy than NHWs or Hispanics in both time periods (p Conclusions: NHBs had a non-significant increase in self-reported CCB or diuretic as monotherapy from 2007-2012 to 2015-2018, suggesting limited impact for this prescribing recommendation in the 2014 and 2017 High BP Guidelines. NHBs more often reported CCB or diuretic monotherapy than NHWs and Hispanics in both time periods, suggesting some clinicians were aware of evidence prior to the 2014 Guideline. Yet, half of NHBs did not report taking CCBs or diuretics as monotherapy in 2015-2018, indicating further opportunity to prescribe evidence-based initial therapy in NHBs that could improve BP control, cardiovascular outcomes and health equity.
- Published
- 2020
26. Abstract MP33: Hypertension Control In The U.s. 2009 To 2018: Rapidly Reversing Years Of Progress
- Author
-
Michael Rakotz, Gregory Wozniak, Jiexiang Li, Brent M. Egan, and Susan E. Sutherland
- Subjects
Rose (mathematics) ,medicine.medical_specialty ,Blood pressure ,Hypertension control ,business.industry ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,business - Abstract
Background: Prior reports show that blood pressure (BP, mmHg) control to Methods: BP control was assessed in adults ≥18 years in NHANES 2009-2018 (age-adjusted to 2010). BP control and its determinants were assessed by age group 18-39, 40-59, and ≥60 years in NHANES 2009-2012 and 2015-2018 (before/after 2014). Terms: Hypertension, BP ≥140 &/or ≥90 or self-reported current BP medication use (Treated); Aware, ‘Yes” to, “Have you been told you have hypertension?”; Treatment efficiency, proportion of treated adults controlled ([Cont]rolled/Treated); BP control, Results: For all adults, BP control peaked in 2013-2014 at 54.5%, declining to 48.0% in 2015-2016 and 43.4% in 2017-2018 (11.1% fall, p Conclusion: Despite the 2017 BP goal
- Published
- 2020
27. Insights on β-blockers for the treatment of hypertension: A survey of health care practitioners
- Author
-
Mehul D. Patel, Brent M. Egan, John M. Flack, and Sofia Lombera
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Adrenergic beta-Antagonists ,Therapeutics ,030204 cardiovascular system & hematology ,Lower risk ,Physicians, Primary Care ,Nebivolol ,03 medical and health sciences ,Cardiologists ,0302 clinical medicine ,Heart Rate ,Surveys and Questionnaires ,Diabetes mellitus ,Health care ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Formulary ,Carvedilol ,Antihypertensive Agents ,Aged ,Metoprolol ,Aged, 80 and over ,Original Paper ,business.industry ,Atenolol ,medicine.disease ,Black or African American ,Vasodilation ,Hypertension ,Practice Guidelines as Topic ,Emergency medicine ,Perception ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0.05/
- Published
- 2018
28. Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results
- Author
-
Bijal Shah, Gregory Wozniak, Sean T. Bryan, Irfan M. Asif, Susan E. Sutherland, Robert A. Davis, Jianing Yang, Robert B. Hanlin, Brent M. Egan, and Michael Rakotz
- Subjects
Adult ,Male ,medicine.medical_specialty ,hypertension ,Endocrinology, Diabetes and Metabolism ,Medically Underserved Area ,Pilot Projects ,030204 cardiovascular system & hematology ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Antihypertensive Agents ,American Medical Association ,Aged ,health equity ,Therapeutic inertia ,Original Paper ,Hypertension control ,Medicaid ,business.industry ,blood pressure ,Blood Pressure Determination ,Middle Aged ,Clinical Management of Hypertension ,Quality Improvement ,United States ,Hypertension Control ,Blood pressure ,Pill ,Emergency medicine ,Female ,Patient Care ,Cardiology and Cardiovascular Medicine ,business - Abstract
Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence‐based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6‐month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM‐907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self‐monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to
- Published
- 2018
29. Implementation of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline
- Author
-
Brent M. Egan
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,Association (object-oriented programming) ,Internal Medicine ,medicine ,MEDLINE ,Guideline ,business - Published
- 2019
30. Trends in Prehypertension and Hypertension Risk Factors in US Adults
- Author
-
Liwei Chen, John N. Booth, Brent M Egan, Jiexiang Li, Paul Muntner, and Lu Zhang
- Subjects
medicine.medical_specialty ,business.industry ,Diastole ,Disease ,030204 cardiovascular system & hematology ,Overweight ,medicine.disease ,Obesity ,Prehypertension ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,Medicine ,030212 general & internal medicine ,Prediabetes ,medicine.symptom ,business - Abstract
Prehypertension is associated with increased risk for hypertension and cardiovascular disease. Data are limited on the temporal changes in the prevalence of prehypertension and risk factors for hypertension and cardiovascular disease among US adults with prehypertension. We analyzed data from 30 958 US adults ≥20 years of age who participated in the National Health and Nutrition Examination Surveys between 1999 and 2012. Using the mean of 3 blood pressure (BP) measurements from a study examination, prehypertension was defined as systolic BP of 120 to 139 mm Hg and diastolic BP P trend=0.007). During this time period, the prevalence of several risk factors for cardiovascular disease and incident hypertension increased among US adults with prehypertension, including prediabetes (9.6% to 21.6%), diabetes mellitus (6.0% to 8.5%), overweight (33.5% to 37.3%), and obesity (30.6% to 35.2%). There was a nonstatistically significant increase in no weekly leisure-time physical activity (40.0% to 43.9%). Also, the prevalence of adhering to the Dietary Approaches to Stop Hypertension eating pattern decreased (18.4% to 11.9%). In contrast, there was a nonstatistically significant decline in current smoking (25.9% to 23.2%). In conclusion, the prevalence of prehypertension has decreased modestly since 1999–2000. Population-level approaches directed at adults with prehypertension are needed to improve risk factors to prevent hypertension and cardiovascular disease.
- Published
- 2017
31. Increased Sympathetic Drive, Elevated Heart Rate, and the Cardiovascular Continuum
- Author
-
Brent M Egan
- Subjects
medicine.medical_specialty ,Cardiovascular continuum ,business.industry ,Internal medicine ,Cardiology ,medicine ,business ,Elevated heart rate - Published
- 2017
32. Controlling Systolic Blood Pressure below 140 mm Hg in Most Hypertensive Patients matches Systolic Blood Pressure Intervention Trial Intensive Treatment: Practical Implications for Patient Care
- Author
-
C Venkata S Ram, C. Shaun Wagner, Jiexiang Li, and Brent M. Egan
- Subjects
medicine.medical_specialty ,Ambulatory blood pressure ,Blood pressure ,business.industry ,Intensive treatment ,Medicine ,Intervention trial ,business ,Intensive care medicine ,Practical implications ,Prehypertension ,Patient care - Published
- 2017
33. Hypertension in military veterans is associated with combat exposure and combat injury
- Author
-
Brent M. Egan
- Subjects
medicine.medical_specialty ,Physiology ,business.industry ,MEDLINE ,Poison control ,Human factors and ergonomics ,Combat exposure ,Suicide prevention ,Occupational safety and health ,Military personnel ,Military Personnel ,Hypertension ,Injury prevention ,Emergency medicine ,Internal Medicine ,Humans ,Medicine ,Medical History Taking ,Cardiology and Cardiovascular Medicine ,business ,Veterans - Published
- 2020
34. Relationship between risk factor control and vascular events in the SAMMPRIS trial
- Author
-
Jean Montgomery, Ngoc-Anh Le, Brent M. Egan, Michael J. Lynn, L. Scott Janis, Kathie L. Hermayer, Tanya N. Turan, David Fiorella, Jamie Harrell, Bethany F Lane, M.I. Chimowitz, Azhar Nizam, Colin P. Derdeyn, and Maria F. Lopes-Virella
- Subjects
medicine.medical_specialty ,Time Factors ,Myocardial Infarction ,Blood Pressure ,030204 cardiovascular system & hematology ,Body Mass Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,Internal medicine ,Secondary Prevention ,Humans ,Medicine ,Myocardial infarction ,Risk factor ,Exercise ,Stroke ,business.industry ,Smoking ,Odds ratio ,medicine.disease ,Confidence interval ,Clinical trial ,Cholesterol ,Logistic Models ,Treatment Outcome ,Blood pressure ,Multivariate Analysis ,Cardiology ,Stents ,Neurology (clinical) ,business ,Biomarkers ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Objective:The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocol-driven intensive management of multiple risk factors. In this prespecified analysis, we aimed to investigate the relationship between risk factor control during follow-up and outcome of patients in the medical arm of SAMMPRIS.Methods:Data from SAMMPRIS participants in the medical arm (n = 227) were analyzed. Risk factors were recorded at baseline, 30 days, 4 months, and then every 4 months for a mean follow-up of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target.Results:Participants who were out of target for systolic blood pressure and physical activity, as well as those with higher mean low-density lipoprotein cholesterol and non–high-density lipoprotein, were more likely to have a recurrent vascular event (stroke, myocardial infarction, or vascular death) at 3 years compared to those who had good risk factor control. In the multivariable analysis, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death (odds ratio 0.6, confidence interval 0.4–0.8).Conclusions:Raised blood pressure, cholesterol, and physical inactivity should be aggressively treated in patients with intracranial atherosclerosis to prevent future vascular events. Physical activity, which has not received attention in stroke prevention trials, was the strongest predictor of a good outcome in the medical arm in SAMMPRIS.ClinicalTrials.gov identifier:NCT00576693.
- Published
- 2016
35. Is life's simple 7 a practical paradigm for promoting healthy blood pressure, preventing cardiovascular disease and improving total health?
- Author
-
Brent M. Egan
- Subjects
0301 basic medicine ,medicine.medical_specialty ,business.industry ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Blood pressure ,Internal Medicine ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Simple (philosophy) - Published
- 2018
36. Is Trump's cardiovascular health 'excellent' or are there 'serious heart concerns'? and comments on the president's blood pressure
- Author
-
Brent M. Egan
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Blood pressure ,business.industry ,Cardiovascular health ,Internal Medicine ,medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2018
37. Abstract 001: Hypertension Control to Systolic Blood Pressure <140 and <130. Implications for Hypertension Guidelines and Performance Metrics Based on Sprint Pop Data
- Author
-
Susan E. Sutherland and Brent M. Egan
- Subjects
medicine.medical_specialty ,Percentile ,Hypertension control ,business.industry ,Patient care ,Clinical trial ,Blood pressure ,Sprint ,Health care ,Internal Medicine ,Physical therapy ,medicine ,business ,Value (mathematics) - Abstract
Background: Value-based healthcare rewards quality, e.g. 90 th percentile performance, which requires more than 77% of eligible adults 18 - 85 years with hypertension have BP below 140/90 on the last visit of 2019. Systolic (S)BP (mmHg) below140 on most visits leads to fewer cardiovascular events (CVE) than less consistent control. Goal SBP was lowered to below 130 in the 2017 ACC / AHA Hypertension Guideline as treated patient groups with mean SBP 120-124 had fewer CVE than groups with higher mean SBP. Stricter treatment targets and incentives for excellent performance may lead to group mean SBP less than 120, i.e., below the evidence. Methods: SPRINT POP Year 2 data were analyzed given more treatment adjustments in Year 01 and fewer patients active in Year 3 and later. The % of patients controlled on various % of visits and mean SBP on the last visit for each group are provided (Table). SEM for SBP less than 0.5 mmHg. Results: Standard and intensive therapy, respectively, consistently controlled (more than 75% visits) SBP to less than 140 in 29.9% and 78.0% (mean 128.4, 117.6) and SBP to less than 130 in 5.1% and 53.8% (mean 118.5, 114.8) of SPRINT participants. Discussion: Group mean SBP falls as the (% visits and patients at goal rise. Consistent control to SBP less than 140 likely requires group mean SBP 118-128 on the last yearly visit. Consistent control to SBP less than 130 likely requires group mean SBP 115-119, which is below the evidence of 120-124. BP variability, the impact of single point assessment, and incentives for excellent control are items to consider in hypertension guideline and performance metrics as mean SBP below the evidence may be attained.
- Published
- 2019
38. Abstract P2060: Life's Simple 7 for Cardiovascular and Total Health: How are We Doing?
- Author
-
Jiexiang Li, Daniel W. Jones, Keith C. Ferdinand, Brent M. Egan, Susan E. Sutherland, Angelo Sinopoli, and Yuling Hong
- Subjects
medicine.medical_specialty ,chemistry.chemical_compound ,Blood pressure ,chemistry ,Cholesterol ,Simple (abstract algebra) ,business.industry ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,Physical activity ,business - Abstract
Background: Life’s Simple 7 (LS7; diet, physical activity, smoking, BMI, BP, cholesterol, glucose) was developed by AHA to track and improve CV risk and outcomes. Individuals with high vs. low LS7 scores have 30%-80% lower incidence rates of hypertension, diabetes, heart disease, stroke, dementia, kidney and lung disease, and cancer. Since LS7 serves as a population health marker, national trends in demographic groups can inform efforts to optimize health and health equity. Methods: LS7 was assessed in 35,562 NHANES 1999-2016 participants 20 years and older, free of CVD with all LS7 data and either non-Hispanic White (NHW), non-Hispanic Black (NHB) or Hispanic. Data were disaggregated by time, age, race / ethnicity and sex. For each LS7 item, 0 points were assigned for poor, 1 point for intermediate, and 2 points for optimal levels; maximum LS7 score = 14. Results: LS7 scores fell with age, were higher in NHWs and Hispanics than NHBs, and higher in women than men (Table). Conclusions: Demographic factors were associated with large differences in LS7 scores. No group had optimal scores or is improving with time. LS7 scores are sharply lower in middle-age and older than younger adults, in NHBs than NHWs and Hispanics, and in men than women. Hispanics had similar LS7 scores to NHWs, despite less income, education and health insurance. Findings highlight the need for culturally tailored and complementary public and population health programs beginning early in life to promote healthy lifestyle patterns and timely access to and adherence with evidence-based care. Successful programs could reduce the age-related rise in cardiometabolic and other chronic diseases and improve health equity.
- Published
- 2019
39. The prevalence of concurrently raised blood glucose and blood pressure in India
- Author
-
Brent M. Egan
- Subjects
Adult ,Blood Glucose ,Physiology ,business.industry ,India ,Blood Pressure ,Blood pressure ,Cross-Sectional Studies ,Internal Medicine ,Prevalence ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
40. Adherence in Hypertension
- Author
-
Michel, Burnier and Brent M, Egan
- Subjects
Treatment Outcome ,Risk Factors ,Hypertension ,Practice Guidelines as Topic ,Humans ,Blood Pressure ,Guideline Adherence ,Practice Patterns, Physicians' ,Antihypertensive Agents ,Medication Adherence - Abstract
The global epidemic of hypertension is largely uncontrolled and hypertension remains the leading cause of noncommunicable disease deaths worldwide. Suboptimal adherence, which includes failure to initiate pharmacotherapy, to take medications as often as prescribed, and to persist on therapy long-term, is a well-recognized factor contributing to the poor control of blood pressure in hypertension. Several categories of factors including demographic, socioeconomic, concomitant medical-behavioral conditions, therapy-related, healthcare team and system-related factors, and patient factors are associated with nonadherence. Understanding the categories of factors contributing to nonadherence is useful in managing nonadherence. In patients at high risk for major adverse cardiovascular outcomes, electronic and biochemical monitoring are useful for detecting nonadherence and for improving adherence. Increasing the availability and affordability of these more precise measures of adherence represent a future opportunity to realize more of the proven benefits of evidence-based medications. In the absence of new antihypertensive drugs, it is important that healthcare providers focus their attention on how to do better with the drugs they have. This is the reason why recent guidelines have emphasize the important need to address drug adherence as a major issue in hypertension management.
- Published
- 2019
41. Prognostic value of blood pressure control delay in newly diagnosed hypertensive patients
- Author
-
Brent M. Egan
- Subjects
Blood pressure control ,medicine.medical_specialty ,Physiology ,business.industry ,Blood Pressure ,Blood Pressure Determination ,Newly diagnosed ,Prognosis ,Internal medicine ,Hypertension ,Internal Medicine ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) - Published
- 2019
42. Implementation of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline
- Author
-
Brent M, Egan
- Subjects
Hypertension ,Practice Guidelines as Topic ,Cardiology ,Humans ,Blood Pressure Determination ,American Heart Association ,United States - Published
- 2019
43. Response
- Author
-
Brent M. Egan
- Subjects
Internal Medicine - Published
- 2019
44. Neurogenic Mechanisms in Prehypertension and Pharmacologic Approaches to the Prevention and Treatment of Hypertension: Highlights of Professor Stevo Julius’ Scientific Contributions
- Author
-
Brent M. Egan
- Subjects
education.field_of_study ,medicine.medical_specialty ,Cardiac output ,business.industry ,Population ,030204 cardiovascular system & hematology ,medicine.disease ,Prehypertension ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Blood pressure ,Internal medicine ,Heart rate ,Hyperinsulinemia ,Cardiology ,Medicine ,030212 general & internal medicine ,business ,education ,Dyslipidemia - Abstract
Professor Stevo Julius’ extraordinary scientific contributions during the past half-century advanced our understanding on the pathogenesis, prevention, and treatment of hypertension. His early work showed a relationship between anger, increased sympathetic drive, and reduced parasympathetic tone was fundamental to hyperkinetic borderline hypertension. The investigators provided evidence that sympathetic overactivity led to β-adrenoceptor downregulation and structural and functional cardiac and vascular changes. These changes, rather than autoregulation, contributed to the transition from high to normal cardiac output with a progressive rise in blood pressure. Through population-based studies, Professor Julius confirmed a key role for sympathetic activation, especially faster heart rates, in the early phase of hypertension. Faster heart rates coincided with cardiometabolic abnormalities including hyperinsulinemia, insulin resistance, and dyslipidemia. The investigators subsequently showed that increased vascular α-adrenergic tone induced resistance to insulin-mediated glucose disposal in skeletal muscle. Professor Julius and colleagues documented that angiotensin-receptor blockade safely lowered blood pressure in prehypertensives and slowed the transition to hypertension. He then partnered with long-term colleagues on multinational studies in middle-aged and older hypertensives at high cardiovascular risk. These studies showed that (1) failure to control blood pressure during the first 6 months of a clinical trial led to a significant increase in cardiovascular events, (2) patients controlled on more antihypertensive medications had less benefit of treatment than individuals controlled on monotherapy, and (3) faster heart rates were associated with worse outcomes in treated hypertensives. Clinicians are better prepared to prevent and treat hypertension by understanding the life work of Dr. Julius and colleagues.
- Published
- 2018
45. Neurogenic Mechanisms in Pre-hypertension and Pharmacologic Approaches to the Prevention and Treatment of Hypertension: Highlights of Professor Stevo Julius’ Scientific Contributions
- Author
-
Brent M. Egan
- Published
- 2018
46. Aldosterone Antagonists or Renin-Guided Therapy for Treatment-Resistant Hypertension: A Comparative Effectiveness Pilot Study in Primary Care
- Author
-
Brent M. Egan, Susan E. Sutherland, Charles F. Way, Anne G. Cook, Suparna Qanungo, Robert A. Davis, Douglas O. Fleming, Gerard C. Jebaily, Marilyn Laken, Gregory T. Valainis, Mary Beth Wright, Kelly W. Jones, and William H. Hester
- Subjects
Male ,medicine.medical_specialty ,Poor prognosis ,Pilot Projects ,Primary care ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Mineralocorticoid receptor ,Internal medicine ,Renin ,Renin–angiotensin system ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Treatment resistant ,Mineralocorticoid Receptor Antagonists ,Aldosterone ,Primary Health Care ,business.industry ,Antagonist ,Middle Aged ,Blood pressure ,Endocrinology ,chemistry ,Hypertension ,Original Article ,Female ,Angiotensin I ,business - Abstract
BACKGROUND Uncontrolled treatment-resistant hypertension (TRH), i.e., blood pressure (BP, mm Hg) ≥140/≥90mm Hg in and out of office on ≥3 different BP medications at optimal doses, is common and has a poor prognosis. Aldosterone antagonist (AA) and renin-guided therapy (RGT) are effective strategies for improving BP control in TRH but have not been compared. METHODS A comparative effectiveness TRH pilot study of AA vs. RGT was conducted in 4 primary care clinics with 2 each randomized to AA or RGT. The primary outcome was change in clinic BP defined by means of 5 automated office BP values. Eighty-nine patients with apparent TRH were screened and 44 met criteria for true TRH. RESULTS Baseline characteristics of 20 patients in the AA (70% Black, 45% female, mean age: 57.4 years) and 24 patients in RGT (79% Black, 50% female, 57.8 years) arms were similar with baseline BP 162±5/90±3 vs. 153±3/84±3, respectively, P = 0.11/0.20. BP declined to 144±5/86±4 in AA vs. 132±4/75±3 in RGT, P = 0.07/0.01; BP was controlled to JNC7 (Seventh Joint National Committee Report) goal in 25% vs. 62.5%, respectively, P < 0.01. Although BP changes from baseline, the primary outcome, were not different (-17.6±5.1/-4.0±3.0 AA vs. -20.4±3.8/-9.7±2.0 RGT, P = 0.65/0.10.), more BP medications were added with AA than RGT (+0.9±0.1 vs. +0.4±0.1 per patient, P < 0.01). CONCLUSIONS In this TRH pilot study, AA and RGT lowered BP similarly, although fewer additional medications were required with RGT. A larger comparative effectiveness study could establish the utility of these treatment strategies for lowering BP of uncontrolled TRH patients in primary care.
- Published
- 2016
47. Comparative impact of implementing the 2013 or 2014 cholesterol guideline on vascular events in a quality improvement network
- Author
-
Dennis W. Murphy, Ruthanne M. Dahlheimer, George Helmrich, Susan E. Sutherland, Brent M. Egan, Locke Simmons, William F. Childers, Daryl A. Lapeyrolerie, Nancy Markle, Peter L. Tilkemeier, Robert A. Davis, and Angelo Sinopoli
- Subjects
Adult ,Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,South Carolina ,Hypercholesterolemia ,Disease ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Young adult ,Original Research ,Aged ,Aged, 80 and over ,Dose-Response Relationship, Drug ,Cholesterol ,business.industry ,Anticholesteremic Agents ,Cholesterol, LDL ,Guideline ,Middle Aged ,Atherosclerosis ,medicine.disease ,Quality Improvement ,Substance abuse ,chemistry ,Cardiovascular Diseases ,Relative risk ,Heart failure ,Practice Guidelines as Topic ,Emergency medicine ,Physical therapy ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives: The Quality and Care Model Committee for a clinically integrated network requested a comparative analysis on the projected cardiovascular benefits of implementing either the 2013 and 2014 cholesterol guideline in a South Carolina patient population. A secondary request was to assess the relative risk of the two guidelines based on the literature. Methods: Electronic health data were obtained on 1,580,860 adults aged 21–80 years who had had one or more visits from January 2013 to June 2015; 566,688 had data to calculate 10-year atherosclerotic cardiovascular disease (ASCVD10) risk. Adults with end-stage renal disease ( n = 7852), congestive heart failure ( n = 19,818), alcohol or drug abuse ( n = 68,547), or currently on statins ( n = 154,964) were excluded leaving 315,508 for analysis. Estimated reduction in ASCVD10 assumed that: (a) moderate-intensity statins lowered low-density lipoprotein cholesterol (LDL-C) by 35% and high-intensity statins by 50%; (b) ASCVD events declined 22% for each 1 mmol/l fall in LDL-C. Results: Among the 315,508 adults in the analysis, 131,289 (41.6%) were eligible for statins according to the 2013 guideline and 137,375 (43.5%) to the 2014 guideline. The 2013 and 2014 guidelines were estimated to prevent 6780 and 5915 ASCVD events over 10 years with: (a) relative risk reductions of 29.0% and 21.8%; (b) absolute risk reductions of 5.2% and 4.3%; (c) number needed-to-treat (NNT) of 19 and 23, respectively. The greater projected cardiovascular protection with the 2013 guideline was largely related to greater use of high-dose statins, which carry a greater risk for adverse events. The literature indicates that the NNT for benefit with high-intensity versus moderate-intensity statins is 31 in high-risk patients with a number needed-to-harm of 47. Conclusions: The 2013 guideline is projected to prevent more clinical ASCVD events and with lower NNTs than the 2014 guideline, yet both have substantial benefit. The 2013 guideline is also expected to generate more adverse events, but the risk-benefit profile appears favor .
- Published
- 2016
48. Is there a role for very low–dose combination therapy in hypertension management?
- Author
-
Brent M. Egan
- Subjects
medicine.medical_specialty ,Combination therapy ,business.industry ,Low dose ,Hypertension management ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
49. Physical Activity and Hypertension
- Author
-
Brent M. Egan
- Subjects
Gerontology ,business.industry ,Incidence (epidemiology) ,Ethnic group ,Absolute risk reduction ,Context (language use) ,030204 cardiovascular system & hematology ,Confidence interval ,Prehypertension ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal Medicine ,Medicine ,030212 general & internal medicine ,business ,Body mass index ,Demography - Abstract
See related article, pp 421–427 In the United States, the prevalence of hypertension is ≈50% higher among individuals of African than Euro-Caucasian or Hispanic Latino descent.1 Moreover, the transition from prehypertension to hypertension is faster in African than Caucasian Americans.2 Although treatment and control of hypertension reduce the excess risk of cardiovascular disease, the risk remains higher than in race- age-, and sex-matched normotensive individuals.3 Thus, cardiovascular health equity will require implementation of effective strategies that reduce the excess incidence and, ultimately, the greater prevalence of hypertension in African Americans than in other racial and ethnic groups. In this context, the report by Diaz et al4 is the first study to provide clear evidence that recommended levels of moderate–vigorous physical activity reduce incident hypertension in African American adults by an estimated 24% (95% confidence interval 1%–42%). This estimate was obtained in a fully adjusted multivariate model, including blood pressure and body mass index. Unfortunately
- Published
- 2017
50. Cost-Utility of an Objective Biochemical Measure to Improve Adherence to Antihypertensive Treatment
- Author
-
Caroline Rudisill and Brent M. Egan
- Subjects
Risk analysis (engineering) ,business.industry ,Cost utility ,Hypertension ,Internal Medicine ,Measure (physics) ,Medicine ,Humans ,Blood Pressure ,Health Care Costs ,business ,Antihypertensive Agents - Published
- 2018
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