Patient preferences for cardiovascular preventive medication:A systematic review

Objective To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event that patients feel would justify daily intake of a preventive medication. Methods We used the Web of Science to track the forward and backward citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit - in absolute values - of a cardiovascular disease preventive medication among a sample of the general population and required participants to choose if they would consider taking the medication. Results Of 341 studies screened, we included 22, involving a total of 17 751 participants: 6 studied prolongation of life (POL), 12 studied absolute risk reduction (ARR) and 14 studied number needed to treat (NNT) as measures of risk reduction communicated to the patients. In studies framed using POL, 39%-54% (average: 48%) of participants would consider taking a medication if it prolonged life b

Impact of a Workplace Stress Reduction Program on Blood Pressure and Emotional Health in Hypertensive Employees

This study examined the impact of a workplace-based stress management program on blood pressure (BP), emotional health, and workplace-related measures in hypertensive employees of a global information technology company

Evaluation of the angiotensin II receptor blocker azilsartan medoxomil in African-American patients with hypertension

The efficacy and safety of azilsartan medoxomil (AZL-M) were evaluated in African-American patients with hypertension in a 6-week, double-blind, randomized, placebo-controlled trial, for which the primary end point was change from baseline in 24-hour mean systolic blood pressure (BP). There were 413 patients, with a mean age of 52years, 57% women, and baseline 24-hour BP of 146/91mmHg. Treatment differences in 24-hour systolic BP between AZL-M 40mg and placebo (-5.0mmHg; 95% confidence interval, -8.0 to -2.0) and AZL-M 80mg and placebo (-7.8mmHg; 95% confidence interval, -10.7 to -4.9) were significant (P.001 vs placebo for both comparisons). Changes in the clinic BPs were similar to the ambulatory BP results. Incidence rates of adverse events were comparable among the treatment groups, including those of a serious nature. In African-American patients with hypertension, AZL-M significantly reduced ambulatory and clinic BPs in a dose-dependent manner and was well tolerated

Interpreting and acting upon home blood pressure readings: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 Vasileiou et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Recent guidelines recognize the importance of home blood pressure monitoring (HBPM) as an adjunct to clinical measurements. We explored how people who have purchased and use a home blood pressure (BP) monitor make sense of, and act upon, readings and how they communicate with their doctor about the practice of home monitoring. Methods: A qualitative study was designed and participants were purposively recruited from several areas in England, UK. Semi-structured in-depth interviews were conducted with 18 users of home BP monitors. The transcribed data were thematically analysed. Results: Interpretation of home BP readings is complex, and is often characterised by uncertainty. People seek to assess value normality using ‘rules of thumb’, and often aim to identify the potential causes of the readings. This is done by drawing on lay models of BP function and by contextualising the readings to personal circumstances. Based on the perceived causes of the problematic readings, actions are initiated, mostly relating to changes in daily routines. Contacting the doctor was more likely when the problematic readings persisted and could not be easily explained, or when participants did not succeed in regulating their BP through their other interventions. Most users had notified their doctor of the practice of home monitoring, but medical involvement varied, with some participants reporting disinterest or reservations by doctors. Conclusions: Involvement from doctors can help people overcome difficulties and resolve uncertainties around the interpretation of home readings, and ensure that the rules of thumb are appropriate. Home monitoring can be used to strengthen the patient-clinician relationship

Blood pressure, antihypertensive treatment and cognitive decline in older adults

PhD ThesisHypertension is prevalent in older adults and associated with impaired cognitive function compared to normotensive peers. The effect of antihypertensive therapy on preventing or reducing the rate of cognitive decline is unclear. The studies in this thesis examined the association of elevated blood pressure in older adults on changes in specific cognitive domains and tested the hypothesis that antihypertensive treatment reduces the rate of cognitive decline in older adults with mild hypertension. 507 older individuals (70-89 years) were recruited from a general practice population (250 normotensives, and 257 hypertensives who participated in an international, placebo- controlled trial of candesartan). Cognition was assessed annually for 3-5 years using a comprehensive computerised assessment battery and tests of executive function. Analysis of cognitive function at baseline showed hypertensive subjects performed worse than normotensives across a range of tasks (Chapter 3). Exploratory factor analyses were conducted on the baseline data to derive composite scores used to characterise five domains of cognition and reduce the number of statistical comparisons (Chapter 4). Regression analyses were performed for each participant to calculate individual slopes of decline on the five domains, to provide a sensitive method of analysing repeated assessment data with differential length of follow-up. The primary analysis showed that candesartan-based therapy reduced cognitive decline associated with hypertension on Attention and Episodic Memory, with a trend for Speed of Cognition; effect sizes were small-to-moderate. There were no effects on Working Memory or Executive Function (Chapter 6). The normotensive subjects showed less cognitive decline than the hypertensives (Chapter 7). These data suggest that the rate of cognitive decline associated with hypertension in older adults may be reduced by blood-pressure-lowering. Analysing individual slopes of decline on empirically-derived domains of cognition provides a sensitive and feasible methodology for assessing the effects

Adverse Maternal Outcomes in Nevada: Does Asthma Matter?

Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada. Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma. Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced hypertension (OR [CI] 1.89 [1.42, 2.53]), gestational diabetes (OR [CI] 1.89 [1.32, 2.72]), infection of the amniotic cavity (OR [CI] 2.15 [1.29, 3.58]), and cesarean section (OR [CI] 1.87 [1.56, 2.23] ). Conclusion. Women with asthma experienced a greater risk of having adverse maternal outcomes. Community-based education programs, as well as, services offered in traditional healthcare settings should be supported to educate pregnant women about the potential risk factors and the relationship between asthma and maternal outcomes