Interventions used to improve control of blood pressure in patients with hypertension.

BACKGROUND: It is well recognized that patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals - a condition labeled as "uncontrolled" hypertension. The optimal way in which to organize and deliver care to patients who have hypertension so that they reach treatment goals has not been clearly identified. OBJECTIVES: To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. To evaluate the effectiveness of reminders on improving the follow-up of patients with hypertension. SEARCH STRATEGY: All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR), Medline and Embase from June 2000. SELECTION CRITERIA: Randomized controlled trials (RCTs) of patients with hypertension that evaluated the following interventions: (1) self-monitoring (2) educational interventions directed to the patient (3) educational interventions directed to the health professional (4) health professional (nurse or pharmacist) led care (5) organisational interventions that aimed to improve the delivery of care (6) appointment reminder systems. Outcomes assessed were: (1) mean systolic and diastolic blood pressure( 2) control of blood pressure (3) proportion of patients followed up at clinic. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Collaboration Handbook. MAIN RESULTS: 56 RCTs met our inclusion criteria. The methodological quality of included studies was variable. An organized system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure (weighted mean difference -8.2/-4.2 mmHg, -11.7/-6.5 mmHg, -10.6/-7.6 mmHg for 3 strata of entry blood pressure) and all-cause mortality at five years follow-up (6.4% versus 7.8%, difference 1.4%) in a single large RCT- the Hypertension Detection and Follow-Up study. Other interventions had variable effects. Self-monitoring was associated with moderate net reduction in diastolic blood pressure (weighted mean difference (WMD): -2.0 mmHg, 95%CI: -2.7 to -1.4 mmHg, respectively. Appointment reminders increased the proportion of individuals who attended for follow-up. RCTs of educational interventions directed at patients or health professionals were heterogeneous but appeared unlikely to be associated with large net reductions in blood pressure by themselves. Health professional (nurse or pharmacist) led care may be a promising way of delivering care, with the majority of RCTs being associated with improved blood pressure control, but requires further evaluation. AUTHORS' CONCLUSIONS: Family practices and community-based clinics need to have an organized system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels

Enhanced Heterogeneous Photodegradation of Organic Pollutants by a Visible Light Harvesting CoO@meso–CN@MoS2 Nanocomposites

Developing simple and effective synthetic strategies regarding the formation of heterostructure photocatalytic semiconductors remains an intense challenge in research matters. Uniform heterostructure cobalt oxide@meso–CN@MoS2 (CoO@meso–CN@MoS2) photocatalyst exhibits excellent photocatalytic redox performance for pollutant degradation under visible light. By adjusting the weight ratio of CoO@meso–CN and MoS2, we fabricated a CoO@meso–CN@MoS2 heterostructure photocatalyst, and the established heterostructure between CoO@meso–CN and MoS2 was indicated by various physicochemical and morphological characterizations. The photocatalytic response to the fabricated hybrid was determined by rodamine B (RhB), methylene blue (MB), and congo red (CR) degradation in aqueous solution under visible light, and the nanocomposites with a slight content consisting of CoO@meso–CN achieved better catalysis than pure MoS2. This finding confirmed the propriety of this heterostructure as a valuable photocatalyst. The experimental results demonstrated that the apparent reaction rate constant of the 3 wt% CoO@meso–CN modified MoS2 was about two times higher than that of pure MoS2. The present work serves as a new approach for designing highly efficient visible light-induced heterostructure-based photocatalysts for environmental applications in the future

COVER-GLASS FORCEPS.

n/