How effective are hypertension self-care interventions?

Simplification of the dosing regimen (eg, once-daily instead of multiple dosing) improves patients' adherence to anti- hypertensive medications (strength of recommendation [SOR]: B, based on a high- quality systematic review of lower-quality randomized controlled trials). Dietary advice promotes modest short-term improvements in self-reported fat intake and fruit and vegetable consumption (SOR: B, based on a high-quality systematic review of lower-quality, randomized controlled trials)

Ambulatory Blood Pressure Phenotypes and the Risk for Hypertension

Ambulatory blood pressure (BP) monitoring provides valuable information on a person’s BP phenotype. Abnormal ambulatory BP phenotypes include white-coat hypertension, masked hypertension, nocturnal nondipping, nocturnal hypertension, and high BP variability. Compared to people with sustained normotension (normal BP in the clinic and on ambulatory BP monitoring), the limited research available suggests that the risk of developing sustained hypertension (abnormal BP in the clinic and on ambulatory BP monitoring) over 5 to 10 years is approximately two to three times greater for people with white-coat or masked hypertension. More limited data suggest that nondipping might predate hypertension, and no studies, to our knowledge, have examined whether nocturnal hypertension or high ambulatory BP variability predict hypertension. Ambulatory BP monitoring may be useful in identifying people at increased risk of developing sustained hypertension, but the clinical utility for such use would need to be further examined

Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial

<p>Abstract</p> <p>Background</p> <p>Achieving a high response rate in a physician survey is challenging. Monetary incentives increase response rates but obviously add cost to a survey project. We wondered whether an offer of a free continuing medical education (CME) activity would be effective in improving survey response rate.</p> <p>Results</p> <p>As part of a survey of a national sample of physicians, we randomized half to an offer for a free on-line CME activity upon completion of a web-based survey and the other half to no such offer. We compared response rates between the groups. A total of 1214 out of 8477 potentially eligible physicians responded to our survey, for an overall response rate of 14.3%. The response rate among the control group (no offer of CME credit) was 16.6%, while among those offered the CME opportunity, the response rate was 12.0% (<it>p </it>< 0.0001).</p> <p>Conclusions</p> <p>An offer for a free on-line CME activity did not improve physician survey response rate. On the contrary, the offer for a free CME activity actually appeared to worsen the response rate.</p

Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature

Nutrition labels are one strategy being used to combat the increasing prevalence of overweight and obesity in the United States. The Patient Protection and Affordable Care Act of 2010 mandates that calorie labels be added to menu boards of chain restaurants with 20 or more locations. This systematic review includes seven studies published since the last review on the topic in 2008. Authors searched for peer-reviewed studies using PUBMED and Google Scholar. Included studies used an experimental or quasi-experimental design comparing a calorie-labeled menu with a no-calorie menu and were conducted in laboratories, college cafeterias, and fast food restaurants. Two of the included studies were judged to be of good quality, and five of were judged to be of fair quality. Observational studies conducted in cities after implementation of calorie labeling were imprecise in their measure of the isolated effects of calorie labels. Experimental studies conducted in laboratory settings were difficult to generalize to real world behavior. Only two of the seven studies reported a statistically significant reduction in calories purchased among consumers using calorie-labeled menus. The current evidence suggests that calorie labeling does not have the intended effect of decreasing calorie purchasing or consumption

Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

Abstract: Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not taking antihypertensive medication show elevated blood pressure in a clinical setting but show nonelevated blood pressure averages when assessed by ambulatory blood pressure monitoring. In addition, readings can be segmented into time windows of particular interest, for example, mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A nondipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals have blood pressure dips of ≥10% at night, whereas 30% have nondipping patterns, when blood pressure remains similar to daytime average or occasionally increases above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure because they increase the accuracy for diagnosis and the prediction of cardiovascular risk. Keywords: Ambulatory blood pressure monitoring; High blood pressure; Masked hypertension; Nocturnal blood pressure; White-coat hypertensio

A School-based Program to Improve Hypertension Awareness and Blood Pressure Control in the Community: Rationale, Design, and Planned Pilot Testing

Context: Despite the existence of national guidelines and over 70 antihypertensive medications, 42% of hypertensives are not being treated, and up to 75% of those treated are not at goal blood pressure. Over 30% of adults are not even aware that they have hypertension. Innovative strategies aimed at the community level might lead to improved hypertension awareness and control. Objectives: (1) To describe the rationale behind a school-based intervention designed to raise children's awareness of the health risks of high blood pressure as well as strategies that can help reduce those health risks and to serve as an innovative means of deploying home blood pressure monitors in an effort to raise community awareness of high blood pressure. (2) To describe planned pilot testing of the program. Design: Pilot, crossover trial. Setting: Public school in a suburban community. Participants: Fifth grade students and their parents/guardians. Intervention: (1) Classroom didactic about hypertension followed by an in-class laboratory consisting of measurement of blood pressure using automatic oscillometric devices. (2) Automatic blood pressure devices taken home by students for measurement of parent/guardian blood pressures with a form of immediate feedback. Main and Secondary Outcomes: (1) Child and parent/guardian knowledge about high blood pressure, (2) Parent/guardian intent to have blood pressure checked by health professional, (3) Parent/guardian reported control of blood pressure. Results/Conclusions: The pilot study (n=60 students) is currently ongoing. Results will not be available until June/July 2006-05. Importantly, as a pilot study, the goal is not to demonstrate effectiveness but to assess feasibility in preparation for a larger trial.Master of Public Healt

Interactive media for parental education on managing children chronic condition: a systematic review of the literature

BackgroundAlthough some research has examined the use of games for the education of pediatric patients, the use of technology for parental education seems like an appropriate application as it has been a part of the popular culture for at least 30years. The main objective of this systematic review is to examine the literature for research evaluating the use of interactive media in the education of parents of children with chronic conditions.MethodsWe searched the MEDLINE, PSYCHINFO, CINAHL, Cochrane database of systematic reviews and EMBASE databases from 1986 to 2014 seeking original investigations on the use of interactive media and video games to educate parents of children with chronic conditions. Cohort studies, randomized control trials, and observational studies were included in our search of the literature.Two investigators reviewed abstracts and full texts as necessary. The quality of the studies was assessed using the GRADE guidelines.Overall trend in the results and the degree of certainty in the results were considered when assessing the body of literature pertaining to our focused questions.ResultsOur initial search identified 4367 papers, but only 12 fulfilled the criterion established for final analysis, with the majority of the studies having flaws that reduced their quality. These papers reported mostly positive results supporting the idea that parent education is possible through interactive media.ConclusionWe found limited evidence of the effectiveness of using serious games and or interactive media to educate parents of children with chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0517-2) contains supplementary material, which is available to authorized users

Cross-sectional survey of Good Samaritan behaviour by physicians in North Carolina

ObjectiveTo assess the responses of physicians to providing emergency medical assistance outside of routine clinical care. We assessed the percentage who reported previous Good Samaritan behaviour, their responses to hypothetical situations, their comfort providing specific interventions and the most likely reason they would not intervene.SettingPhysicians residing in North Carolina.ParticipantsConvenience sample of 1000 licensed physicians.InterventionMailed survey.DesignCross-sectional study conducted May 2015 to September 2015.Main outcome and measuresWillingness of physicians to act as Good Samaritans as determined by the last opportunity to intervene in an out-of-office emergency.ResultsThe adjusted response rate was 26.1% (253/970 delivered). 4 out of 5 physicians reported previous opportunities to act as Good Samaritans. Approximately, 93% reported acting as a Good Samaritan during their last opportunity. There were no differences in this outcome between sexes, practice setting, specialty type or experience level. Doctors with greater perceived knowledge of Good Samaritan law were more likely to have intervened during a recent opportunity (p=0.02). The most commonly cited reason for potentially not intervening was that another health provider had taken charge.ConclusionsWe found the frequency of Good Samaritan behaviour among physicians to be much higher than reported in previous studies. Greater helping behaviour was exhibited by those who expressed more familiarity with Good Samaritan law. These findings suggest that physicians may respond to legal protections

Potential Effect of Physical Activity Calorie Equivalent (PACE) Labeling on Adult Fast Food Ordering and Exercise

IntroductionNumeric calorie content labels show limited efficacy in reducing the number of calories ordered from fast food meals. Physical activity calorie equivalent (PACE) labels are an alternative that may reduce the number of calories ordered in fast food meals while encouraging patrons to exercise.MethodsA total of 1000 adults from 47 US states were randomly assigned via internet survey to one of four generic fast food menus: no label, calories only, calories + minutes, or calories + miles necessary to walk to burn off the calories. After completing hypothetical orders participants were asked to rate the likelihood of calorie-only and PACE labels to influence (1) food choice and (2) physical activity.ResultsRespondents (n = 823) ordered a median of 1580 calories from the no-label menu, 1200 from the calories-only menu, 1140 from the calories + minutes menu, and 1210 from the calories + miles menu (p = 0.0001). 40% of respondents reported that PACE labels were “very likely” to influence food item choice vs. 28% for calorie-only labels (p<0.0001). 64% of participants reported that PACE labels were “somewhat likely” or “very likely” to influence their level of physical activity vs. 49% for calorie-only labels (p<0.0001).ConclusionsPACE labels may be helpful in reducing the number of calories ordered in fast food meals and may have the added benefit of encouraging exercise

Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions

‘Masked hypertension’ is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15–30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared with sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment and areas for future research