398 results on '"Brent M. Egan"'
Search Results
2. Acute physical and mental stress resulted in an increase in fatty acids, norepinephrine, and hemodynamic changes in normal individuals: A possible pathophysiological mechanism for hypertension—Pilot study
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Josiane Motta e Motta, Ludmila Neves Souza, Bianca Bassetto Vieira, Humberto Delle, Fernanda Marciano Consolim‐Colombo, Brent M. Egan, and Heno Ferreira Lopes
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catecholamines ,fatty acids ,hemodynamic response ,insulin ,mental stress ,metabolism ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Hypertension is often associated with metabolic changes. The sustained increase in sympathetic activity is related to increased blood pressure and metabolic changes. Environmental stimuli may be related to increased sympathetic activity, blood pressure, and metabolic changes, especially in genetically predisposed individuals. The aim of this study was to evaluate the response of fatty acids to physical and mental stress in healthy volunteers and the hemodynamic, hormonal, and metabolic implications of these stimuli. Fifteen healthy individuals with a mean age of 31 ± 7 years, of both sexes, were evaluated. They were assessed at baseline and after combined physical and mental stress (isometric exercise test, Stroop color test). Blood samples were collected at baseline and after stimulation for glucose, insulin, fatty acid, and catecholamine levels. Blood pressure, heart rate, cardiac output, systemic vascular resistance, and distensibility of the large and small arteries were analyzed. The data obtained at baseline and after stimuli were from the same individual, being the control itself. Compared to baseline, after physical and mental stress there was a statistically significant increase (p
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- 2021
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3. Defining Hypertension by Blood Pressure 130/80 mm Hg Leads to an Impressive Burden of Hypertension in Young and Middle‐Aged Black Adults: Follow‐Up in the CARDIA Study
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Brent M. Egan
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Editorials ,definition ,hypertension ,incidence ,prevention ,racial differences ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2018
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4. Cholesterol Control Among Uninsured Adults Did Not Improve From 2001‐2004 to 2009‐2012 as Disparities With Both Publicly and Privately Insured Adults Doubled
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Brent M. Egan, Jiexiang Li, Sara M. Sarasua, Robert A. Davis, Kevin A. Fiscella, Jonathan N. Tobin, Daniel W. Jones, and Angelo Sinopoli
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adult treatment panel‐3 ,cholesterol ,health disparities ,healthcare insurance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundLow‐density lipoprotein cholesterol (LDL‐C) control is higher among insured than uninsured adults, but data on time trends and contributing factors are incomplete and important for improving health equity. Methods and ResultsAwareness, treatment, and control of elevated LDL‐C were compared among insured versus uninsured and publicly versus privately insured adults, aged 21 to 64 years, in National Health and Nutrition Examination Surveys from 2001 to 2004, 2005 to 2008, and 2009 to 2012 using Adult Treatment Panel‐3 criteria. Compared with insured adults, uninsured adults were younger; were more often minority; reported lower incomes, less education, and fewer healthcare encounters; and had lower awareness and treatment of elevated LDL‐C (P
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- 2017
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5. The impact of metabolic syndrome on metabolic, pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion
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Juliana S. Gil, Luciano F. Drager, Grazia M. Guerra-Riccio, Cristiano Mostarda, Maria C. Irigoyen, Valeria Costa-Hong, Luiz A. Bortolotto, Brent M. Egan, and Heno F. Lopes
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Hypertension ,Sympathetic Activity ,Insulin Resistance ,Inflammation ,Prothrombosis ,Metabolic Syndrome ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome. METHODS: We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (≥130/≥85 mmHg). RESULTS: Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels. CONCLUSIONS: High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome.
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- 2013
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6. 2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals
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Brent M. Egan, Jiexiang Li, Kellee White, Douglas O. Fleming, Kenneth Connell, German T. Hernandez, Daniel W. Jones, Keith C. Ferdinand, and Angelo Sinopoli
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cardiovascular disease ,cholesterol ,epidemiology ,guideline ,primary prevention ,secondary prevention ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundHealthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated. Methods and ResultsNational Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was
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- 2016
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7. Desequilíbrio autonômico e síndrome metabólica: parceiros patológicos em uma pandemia global emergente Autonomic dysregulation and the metabolic syndrome: pathologic partners in an emerging global pandemic
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Heno Ferreira Lopes and Brent M. Egan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2006
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8. Handling Imbalanced and Poorly Separated Data: a Multi-Stage Multi-Group Machine Learning Approach.
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Eva K. Lee, Fan Yuan, Barton J. Mann, and Brent M. Egan
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- 2023
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9. A Multi-stage Multi-group Classification Model: Applications to Knowledge Discovery for Evidence-based Patient-centered Care.
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Eva K. Lee and Brent M. Egan
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- 2022
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10. A General-Purpose Multi-stage Multi-group Machine Learning Framework for Knowledge Discovery and Decision Support.
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Eva K. Lee, Fan Yuan, Barton J. Mann, and Brent M. Egan
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- 2022
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11. 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 0001, Matthew S. Hagen, Robert A. Davis, and Brent M. Egan
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- 2021
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12. An Efficient, Robust, and Customizable Information Extraction and Pre-processing Pipeline for Electronic Health Records.
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Eva K. Lee, Yuanbo Wang 0001, Yuntian He, and Brent M. Egan
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- 2019
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13. Designing a low-cost adaptable and personalized remote patient monitoring system.
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Eva K. Lee, Yuanbo Wang 0001, Robert A. Davis, and Brent M. Egan
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- 2017
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14. Machine Learning: Multi-site Evidence-Based Best Practice Discovery.
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Eva K. Lee, Yuanbo Wang 0001, Matthew S. Hagen, Xin Wei 0005, Robert A. Davis, and Brent M. Egan
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- 2016
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15. Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival
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Renata F Dominguez, Valeria A da Costa-Hong, Luan Ferretti, Fabio Fernandes, Luiz A Bortolotto, Fernanda M Consolim-Colombo, Brent M Egan, and Heno F Lopes
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Medicine (General) ,R5-920 - Abstract
Objectives: The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods: Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results: Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%–47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values
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- 2019
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16. Hypertension Control Among US Adults, 2009 to 2012 Through 2017 to 2020, and the Impact of COVID-19
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Brent M. Egan
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Adult ,SARS-CoV-2 ,Hypertension ,Internal Medicine ,COVID-19 ,Humans ,United States - Published
- 2022
17. 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
18. 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
19. 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
20. 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
21. A Low-cost Adaptable and Personalized Remote Patient Monitoring System.
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Eva K. Lee, Yuanbo Yu, Robert A. Davis, and Brent M. Egan
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- 2017
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22. 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
23. Editorial commentary: Racial and Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018
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Brent M. Egan
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Gerontology ,Male ,Health Knowledge, Attitudes, Practice ,Ethnic group ,White People ,Hypertension prevalence ,Ethnicity ,Internal Medicine ,Prevalence ,Medicine ,Humans ,Healthcare Disparities ,Control (linguistics) ,Antihypertensive Agents ,Racial/Ethnic Disparities in Hypertension ,Asian ,business.industry ,Racial Groups ,Original Articles ,Health Status Disparities ,Hispanic or Latino ,Middle Aged ,United States ,Black or African American ,Editorial ,Hypertension ,Female ,business - Abstract
[Figure: see text].
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- 2021
24. 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
25. 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
26. 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
27. 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
28. Acute physical and mental stress resulted in an increase in fatty acids, norepinephrine, and hemodynamic changes in normal individuals: A possible pathophysiological mechanism for hypertension—Pilot study
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Humberto Dellê, Josiane Motta E Motta, Brent M. Egan, Heno Ferreira Lopes, Fernanda Marciano Consolim-Colombo, Bianca Bassetto Vieira, and Ludmila Neves Souza
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Adult ,Male ,medicine.medical_specialty ,insulin ,Haemodynamic response ,Endocrinology, Diabetes and Metabolism ,Short Report ,Hemodynamics ,Blood Pressure ,Pilot Projects ,030204 cardiovascular system & hematology ,Norepinephrine (medication) ,03 medical and health sciences ,Norepinephrine ,Young Adult ,0302 clinical medicine ,Heart Rate ,Internal medicine ,Heart rate ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,chemistry.chemical_classification ,business.industry ,Fatty Acids ,Fatty acid ,Blood pressure ,medicine.anatomical_structure ,chemistry ,physical stress ,mental stress ,Hypertension ,Catecholamine ,Cardiology ,Vascular resistance ,Female ,Cardiology and Cardiovascular Medicine ,business ,hemodynamic response ,catecholamines ,metabolism ,Stress, Psychological ,medicine.drug - Abstract
Hypertension is often associated with metabolic changes. The sustained increase in sympathetic activity is related to increased blood pressure and metabolic changes. Environmental stimuli may be related to increased sympathetic activity, blood pressure, and metabolic changes, especially in genetically predisposed individuals. The aim of this study was to evaluate the response of fatty acids to physical and mental stress in healthy volunteers and the hemodynamic, hormonal, and metabolic implications of these stimuli. Fifteen healthy individuals with a mean age of 31 ± 7 years, of both sexes, were evaluated. They were assessed at baseline and after combined physical and mental stress (isometric exercise test, Stroop color test). Blood samples were collected at baseline and after stimulation for glucose, insulin, fatty acid, and catecholamine levels. Blood pressure, heart rate, cardiac output, systemic vascular resistance, and distensibility of the large and small arteries were analyzed. The data obtained at baseline and after stimuli were from the same individual, being the control itself. Compared to baseline, after physical and mental stress there was a statistically significant increase (p, Arterial hypertension is highly prevalent worldwide. The real mechanisms of pathophysiology are not well understood. Stress, the sympathetic nervous system, and the release of fatty acids seem to play an important role in the pathophysiology of hypertension.
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- 2021
29. 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
30. 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
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
- Subjects
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
37. Age and sex disparities in hypertension control: The multi-ethnic study of atherosclerosis (MESA)
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Gregory Wozniak, Brent M Egan, Nkiru Osude, Talar Markossian, Michael Rakotz, Kiang Liu, Ramón A Durazo-Arvizu, Holly Kramer, and Erin D. Michos
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Aging ,Ethnic group ,Disparities ,Age and sex ,Mesa ,Odds ,Original Research Contribution ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,computer.programming_language ,Hypertension control ,business.industry ,General Medicine ,Odds ratio ,Cardiovascular disease ,Blood pressure ,RC666-701 ,Cohort ,Hypertension ,Sex ,Public aspects of medicine ,RA1-1270 ,business ,computer ,Demography - Abstract
Highlights • Improving hypertension control will reduce heart disease and mortality. • After age 65 years, women are less likely than men to have controlled hypertension. • Sex differences in hypertension control widen with advancing age. • Sex differences in hypertension control appear independent of obesity and diabetes., Objective Determine sex differences in hypertension control by age group in a diverse cohort of adults age 45–84 years at baseline followed for an average of 12 years. Methods The Multi-Ethnic Study of Atherosclerosis enrolled 3213 men and 3601 women from six communities in the U.S. during years 2000–2002 with follow-up exams completed approximately every two years. At each exam, resting blood pressure (BP) was measured in triplicate, and the last two values were averaged. Hypertension was defined as a BP ≥ 140/90 mmHg and/or use of antihypertensive medications. Hypertension control was defined as a BP < 140/90 mmHg and in separate analyses as < 130/90 mmHg. Generalized linear mixed effects models with a binomial function were used to calculate the odds of hypertension control by age group (45–64,75–74, 75+) at a given exam and by sex, while accounting for the intra-individual correlation, and adjustment for demographics, co-morbidities, smoking, alcohol use, education and site among participants with hypertension at any of the first five exams. Results At baseline, mean age was 64.1 (9.1 [SD]) years, 48.0% were men, and race/ethnicity was Non-Hispanic white in 34.1%, 10.1% Chinese, 35.1% Non-Hispanic Black and 20.7% Hispanic. Average SBP was lower while average DBP was higher among men vs. women at each exam. Adjusted odds ratios of hypertension control defined as BP < 140/90 mmHg among men vs. women was 0.89 (95% CI 0.67, 1.19) for age 45–64 years, 1.37 (95% CI 1.04, 1.81) for age 65–74 years and 2.08 (95% CI 1.43, 3.02) for age 75+ years. When defined as < 130/80 mmHg, adjusted odds of hypertension control among men vs. women was 0.60 (OR 0.60; 95% CI 0.46, 0.79) at age 45–64 years, 1.01 (OR 1.01; 95% CI 0.77, 1.31) at age 65–74 years and 1.71 (95% CI 1.19, 2.45) at age 75+ years. Conclusion Sex disparities in hypertension control increase with advancing age and are greatest among adults age 75+ years.
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- 2021
38. 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
39. 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
40. 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
41. 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
42. 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
43. Blood pressure, heart rate and CNS stimulant medication use in children with and without ADHD: analysis of NHANES data
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Susan M Hailpern, Brent M Egan, Kimberly D Lewis, Carol eWagner, Ghassan F Shattat, Doaa I Al Qaoud, and Ibrahim F. Shatat
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Central Nervous System Stimulants ,Heart Rate ,Hypertension ,Pediatrics ,Attention Deficit Hyperactivity Disorder ,NHANES ,RJ1-570 - Abstract
It is estimated that 2-3% of children in the US have hypertension (HTN) and 8% of children ages 4-17 carry the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). The prevalence of HTN and cardiovascular (CV) risk factors in children with ADHD on CNS stimulant treatment (stimulants) compared to no treatment and compared to their healthy counterparts is not well described. Using NHANES data, we examined demographic, BP and CV risk factors of 4,907 children aged 12-18 years with and without the diagnosis of ADHD, and further examined the CV risk in a subgroup of ADHD patients on stimulants. 383 (10.7%) children were reported to have ADHD; of whom 111 (3.4%) were on stimulants. Children with ADHD on stimulants were significantly younger, male, and white compared to those with ADHD not on medication and those without ADHD. BMI, eGFR, cholesterol, the prevalence of albuminuria and poverty were not significantly different between the three groups. 160 (2.7%) had BP in the hypertensive and 637 (12.4%) in the prehypertensive range. The prevalence of elevated BP (HTN and/or pre-HTN range) was not different between children with ADHD on stimulants compared to ADHD without medication and those without ADHD. Heart Rate (HR) was significantly higher in the ADHD group on stimulants vs. the groups ADHD on no stimulants and without ADHD. When the relationship between stimulants and the risk of abnormal BP was examined, there was a significant interaction between having BP in the HTN range and sex. After adjusting for BMI, race and age, females with ADHD on stimulants tended to be older and had significantly more BP in the hypertensive range. On the other hand, males were more likely to be of a white race and older, but not hypertensive.Children with ADHD on stimulants have significantly higher HR than children with ADHD on no stimulants and children without ADHD. On the other hand, the prevalence of abnormal BP classification is comparable between the three groups.
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- 2014
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44. 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
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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
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- 2018
45. 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
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Jianing Yang, Gregory Wozniak, Brent M. Egan, Susan E. Sutherland, and Michael Rakotz
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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.
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- 2020
46. Abstract MP33: Hypertension Control In The U.s. 2009 To 2018: Rapidly Reversing Years Of Progress
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Michael Rakotz, Gregory Wozniak, Jiexiang Li, Brent M. Egan, and Susan E. Sutherland
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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
47. Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol
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Brent M, Egan, Susan E, Sutherland, Michael, Rakotz, Jianing, Yang, R Bruce, Hanlin, Robert A, Davis, and Gregory, Wozniak
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Male ,hypertension ,blood pressure ,Pilot Projects ,Original Articles ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Hypertension Primary Care ,cardiovascular diseases ,quality improvement ,primary health care ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Humans ,Female ,Antihypertensive Agents ,Aged - Abstract
Supplemental Digital Content is available in the text., 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 (
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- 2018
48. Insights on β-blockers for the treatment of hypertension: A survey of health care practitioners
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Mehul D. Patel, Brent M. Egan, John M. Flack, and Sofia Lombera
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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/
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- 2018
49. Risk of Hospitalization for Cardiovascular Events with β-Blockers in Hypertensive Patients: A Retrospective Cohort Study
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Brent M. Egan, Henry Punzi, Qian Li, Mehul D. Patel, Sanjida Ali, Joel M. Neutel, and Jan Basile
- Subjects
Cardiovascular event ,Agonist ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Antihypertensive agents ,medicine.drug_class ,030204 cardiovascular system & hematology ,Nebivolol ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,cardiovascular diseases ,Metoprolol ,Original Research ,business.industry ,Antagonist ,Retrospective cohort study ,Atenolol ,Retrospective studies ,Cardiovascular diseases ,lcsh:RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Introduction β-Blockers are a heterogenous class of drugs that are no longer recommended for initial antihypertension monotherapy due to unfavorable long-term cardiovascular events observed with non-vasodilatory β-blockers. However, the comparative cardiovascular event risk between the vasodilatory β1-selective antagonist/β3 agonist nebivolol and non-vasodilatory β1-blockers, atenolol and metoprolol, is unknown. Methods Incident nebivolol, atenolol, or metoprolol monotherapy users with hypertension were identified using US claims data (2007–2014). The first β-blocker claim on/after 1/1/2008 defined the index drug/date. Hypertensive patients without pre-index cardiovascular history were followed until index drug discontinuation (> 90 day supply gap), use of other β-blockers, or end of continuous plan enrollment. Patients were pair-wise propensity score-matched using logistic regression, adjusted for baseline demographics, Charlson Comorbidity Index score, comorbid chronic pulmonary disease, rheumatic disease, renal disease, and diabetes, and use of other antihypertensive drugs during baseline. Time to first hospital claim for a cardiovascular event was assessed via Cox proportional hazards regression, adjusted for the variables above. Results Inclusion criteria were met by 81,402 patients (n = 27,134 in each matched treatment cohort), with no between-cohort differences in baseline characteristics, comorbid conditions, or average follow-up duration. Atenolol and metoprolol cohorts had greater risk of hospitalization for a composite event (myocardial infarction, angina, congestive heart failure, stroke) than nebivolol users (adjusted hazard ratios [95% confidence interval] atenolol: 1.68 [1.29, 2.17]; metoprolol: 2.05 [1.59, 2.63]; P
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- 2018
50. 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
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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
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