Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka

Kumanan, T.; Sujanitha, Vathulan; Guruparan, Mahesan; Rajeshkannan, Nadarajah

doi:10.1155/2019/6450281

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…Hypertension and diabetes usually co-exist, and diabetes independently contributes to the development of atherosclerosis, but hypertension increases the incidence and progression of cardiovascular events [17]. Diabetes has also been significantly associated with visit-to-visit variability in blood pressure measurements [18]. Many diabetic guidelines recommend SBP and DBP targets below 140 and 90 mm Hg, respectively, but below 130 and 80 mm Hg when significant proteinuria exists [19,20].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka

Manoharan¹,

Rajeshkannan²,

Suganthan³

2022

Cureus

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IntroductionCardiovascular diseases are the leading cause of death in people with type 2 diabetes. The assessment of additional risk factors for cardiovascular disease among diabetes patients and comparing current practices with the best practices can improve patient care. The aim of this study was to assess these additional risk factors and awareness of them among adult patients with diabetes mellitus. Materials and methodsThis cross-sectional study was conducted in the general medical wards at District General Hospital Kilinochchi from June 2021 through August 2021 and included 421 patients. The data were analyzed using SPSS version 28. ResultsMost patients (70.1%) were women, and their mean age was 57.4 years. Their lifestyle-related risk factors included being overweight (9%) or obese (2.1%), smoking (8.8%), consuming alcohol (2.4%), insufficient physical activity (23.5%), and not meeting the Sri Lankan dietary guidelines for the consumption of fruits and vegetable (75.3%). In addition, 3.3% were suffering from chronic kidney disease, 6.2% from microalbuminuria, 49.4% from hypertension, and 67.7% from hypercholesterolemia. Further, 11.4% (CI: 8.6-11.7%) had uncontrolled diabetes, only 40.1% had low-density lipoprotein (LDL) levels within the target range, and only 16.2% had systolic blood pressure within the target range. ConclusionsThe findings presented here indicate the existence of significant gaps similar to those found in the literature regarding lifestyle modifications and recommended practices for reducing the risk of cardiovascular disease. As a result, it may be necessary to address physicians' inertia in regard to the implementation of best practices, and there is a clear need to educate patients during their visits to reinforce the importance of lifestyle modifications.

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Section: Discussionmentioning

confidence: 99%

Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka

Manoharan¹,

Rajeshkannan²,

Suganthan³

2022

Cureus

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“…Kumanan T et al, in their one-year study of longterm blood pressure variability of 406 patients, found that female sex (p=0.023), DM (p=0.013), CKD (p=0.007), and the tendency for developing OSA (p=0.004) were associated with significant variability. 9 A median value of 11.69 differentiated low and high variability groups. In multivariate analysis, only DM and CKD were significantly associated with high variability.…”

Section: Blood Pressure Variability As a Prognostic Markermentioning

confidence: 97%

“…In ARV, the sum of differences between successive BP measurements is divided by the number of total readings minus one and has been shown to provide the best estimate of BPV. 9 The therapeutic impact of BPV is yet to be established. However, certain studies have shown that Calcium channel blockers decrease, whereas beta-blockers and diuretics are inferior in this regards.…”

Section: Introductionmentioning

confidence: 99%

Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance

Hameed

2023

Pak Heart J

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Systemic blood pressure, recorded by various parameters, always shows variation. This is known as ‘variability’, an entity not assessed routinely. Research has shown greater prognostic importance of it than routine parameters. Various intrinsic and extrinsic factors modulate it. Depending on the interval of successive readings, blood pressure variability is of five types, with different non-invasive methods utilized for recording. It is calculated by various statistical parameters, the most common being standard deviation, but average real variability is the most accurate and easily applied. Clinical evidence is increasing rapidly, indicating variability as a prognostic marker for stroke, ischemic heart disease, renal failure, cognitive dysfunction, heart failure, and mortality. Therapeutic measures for the control of variability have also been forwarded. The paucity of clinical application of blood pressure variability is the stimulus to narrate this review, especially for physicians managing hypertensive patients.

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“…cardiovascular illnesses). [43][44][45][46] This method can be applied broadly wherever there is ongoing monitoring of a biological index that is closely dependent on patient behavior (e.g. blood pressure monitoring).…”

Section: Generalizabilitymentioning

confidence: 99%

The improving Medication Adherence in Adolescents and young adults following Liver Transplantation (iMALT) multisite trial: Design and trial implementation considerations

et al. 2023

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Background/aims Medication non-adherence is a leading cause of transplant rejection, organ loss, and death; yet no rigorous controlled study to date has shown compelling clinical benefits from an adherence-improving intervention. Non-adherent patients are less likely to participate in trials, and therefore, most studies enroll a majority of adherent patients who do not stand to benefit from the intervention, as they do not have the condition (non-adherence) under investigation. The improving Medication Adherence in adolescent Liver Transplant recipients trial specifically targets non-adherent patients to investigate whether a remote intervention to improve adherence results in reduced incidence of biopsy-confirmed rejection. Methods Improving Medication Adherence in adolescent Liver Transplant is a randomized single-blind controlled multisite, multinational National Institutes of Health-funded trial involving 13 pediatric transplant centers in the United States and Canada. An innovative, objective adherence biomarker—the Medication Level Variability Index, which is the standard deviation of a series of medication blood levels for each patient, is used to identify non-adherent patients at risk for rejection. The index is computed using electronic health record information for all potentially eligible patients based on repeated reviews of the entire clinic’s roster. Identified patients, after consent, are randomized to intervention versus control (treatment as usual) arms. The remote intervention is delivered for 2 years by trained interventionists who reside in various locations in the United States. The primary outcome is the incidence of biopsy-confirmed acute cellular rejection, as confirmed by a majority vote of three pathologists who are masked to the study allocation and clinical information. Discussion Improving Medication Adherence in adolescent Liver Transplant includes several innovative design elements. The use of a validated, objective adherence index to survey a large cohort of transplant recipients allows the teams to avoid bias inherent in both convenience sampling and referral-based recruitment and enroll only patients whose computed index indicates substantially increased risk of rejection. The remote intervention paradigm helps to engage patients who are by definition hard to engage. The use of an objective, masked medical (rather than behavioral) outcome measure reduces the likelihood of biases related to clinical information and ensures broad acceptance by the field. Finally, monitoring for potential adverse events related to increased medication exposure due to the adherence intervention acknowledges that a successful intervention (increasing adherence) could have detrimental side effects via increased exposure to and potential toxicity of the medication. Such monitoring is almost never attempted in clinical trials evaluating adherence interventions.

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Factors Associated with Visit-to-Visit Variability of Blood Pressure Measured as Part of Routine Clinical Care among Patients Attending Cardiology Outpatient Department of a Tertiary Care Centre in Northern Sri Lanka

Cited by 5 publications

References 30 publications

Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka

Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka

Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance

The improving Medication Adherence in Adolescents and young adults following Liver Transplantation (iMALT) multisite trial: Design and trial implementation considerations

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