How Well Do We Care for Patients With Hypertension?

Weber, Michael A.

doi:10.1111/jch.12022

Cited by 5 publications

(8 citation statements)

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“…Home blood pressure monitoring is recommended to guide hypertension treatment, especially for young adults given their blood pressure variability [33, 35, 36]. Blood pressures measured at home average 6–8 mmHg (systolic)/5–6 mmHg (diastolic) lower than clinic values, which can affect providers’ treatment plans [37].…”

Section: Discussionmentioning

confidence: 99%

“They’re younger… it’s harder.” Primary providers’ perspectives on hypertension management in young adults: a multicenter qualitative study

et al. 2017

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BackgroundYoung adults (18–39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers’ perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care.MethodsPrimary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed.ResultsPrimary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation.ConclusionsTailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the “health identity” of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2332-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“They’re younger… it’s harder.” Primary providers’ perspectives on hypertension management in young adults: a multicenter qualitative study

et al. 2017

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“…It is interesting to note the relatively high utilization of β‐blockers in both study groups (Table ). In a recent editorial, Dr Michael Weber highlighted several studies that also found high rates of β‐blocker use . Axon and colleagues evaluated antihypertensive drug use in 5668 inpatients and found that 61% received β‐blockers while only 39% received angiotensin‐converting enzyme inhibitors .…”

Section: Discussionmentioning

confidence: 99%

“…The reason for high utilization of β‐blockers in the present trial is not known since few patients had heart failure or a previous myocardial infarction. As noted by Dr Weber, it would be interesting to determine why physicians, and presumably clinical pharmacists, are using β‐blockers so frequently when there are no compelling reasons to do so unless there are comorbidities such as coronary artery disease …”

Section: Discussionmentioning

confidence: 99%

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Physician‐Pharmacist Co‐Management and 24‐Hour Blood Pressure Control

Chen

Ernst

Ardery

et al. 2013

J of Clinical Hypertension

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The objectives of this study were: to compare indices of 24-hour BP following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster-randomized clinical trial conducted in 6 family medicine clinics randomized to co-managed (n=3 clinics, 176 subjects) or control (n=3 clinics, 198 subjects) groups. Mean ambulatory systolic BP was significantly lower in the co-managed versus the control group: daytime SBP 122.8 mm Hg versus 134.4 mm Hg (p<0.001); nighttime SBP 114.8 mm Hg versus 123.7 mm Hg (p<0.001); and 24-hour SBP 120.4 mm Hg versus 131.8 mm Hg (p<0.001), respectively. Significantly more drug changes were made in the co-managed than in the control group (2.7 versus 1.1 changes/subject, p<0.001), and there was greater diuretic use in co-managed subjects (79.6% versus 62.6%, p<0.001). Ambulatory BPs were significantly lower for the subjects who had a diuretic added during the first month compared with those who never had a diuretic added (p<0.01). Physician-pharmacist co-management significantly improved ambulatory BP compared with a control group. Anti-hypertensive drug therapy was intensified much more for subjects in the co-managed group.

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“…Hypertension is common and affects one in three adults in Sweden, as well as, for example, in the USA (Cohen & Townsend ). Controlled blood pressure (BP) is internationally and nationally accepted as below 140/90 mmHg (Weber ). Of those in Sweden receiving treatment for hypertension, 20% reach controlled BP (Weber ).…”

Section: Introductionmentioning

confidence: 99%