Impacting Population Cardiovascular Health Through a Community‐Based Practice Network: Update on an ASH‐Supported Collaborative

Egan, Brent M.; Laken, Marilyn; Wagner, C. Shaun; Mack, Sheryl S.; Seymour-Edwards, Kim; Dodson, John A.; Zhang, Yanru; Lackland, Daniel T.

doi:10.1111/j.1751-7176.2011.00491.x

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…There are several common reasons for therapeutic ineffectiveness in these groups that might be remedied by changing improvement targets 40. For instance, failure to change or increase therapy for patients who are not at goal (“therapeutic inertia”)41, 42 can be addressed by leveraging EHRs to implement treatment algorithms and protocols,16, 28, 38 utilizing clinical decision support tools embedded within EHRs including a 2‐week follow‐up process and patient reminders,19 and changes in team care 43, 44, 45, 46.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Wozniak

Khan

Gillespie

et al. 2015

J of Clinical Hypertension

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Evidence‐based interventions differ for increasing hypertension awareness, treatment, and control and should be targeted for specific patient panels. This study developed a hypertension control cascade to identify patients with a usual source of care represented at each level of the cascade using the 2007–2012 National Health and Nutrition Examination Survey. Overall, 10.7 million adults in the United States were unaware of their condition, 3.8 million were aware but untreated, and 15.8 million were treated but uncontrolled. The results also suggest that failure to attain hypertension control because of lack of awareness or lack of treatment despite awareness occurs mainly among younger individuals and those with no annual healthcare visits, while the elderly and minorities are more likely to remain uncontrolled when aware and treated. Opportunities to leverage population health management functions in electronic health information systems to align the specific patient subgroups facing barriers to hypertension control at each level of the cascade with targeted hypertension management interventions are discussed.

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Section: Discussionmentioning

confidence: 99%

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Wozniak

Khan

Gillespie

et al. 2015

J of Clinical Hypertension

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show abstract

“…13,14 Each clinic signed a Business Associate Agreement approved by legal counsel and the Office of Research Protection at the Medical University of South Carolina. The Agreement authorized use of de-identified data for research.…”

Section: Methodsmentioning

confidence: 99%

Initial Monotherapy and Combination Therapy and Hypertension Control the First Year

et al. 2012

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Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. We assessed the effectiveness of initial antihypertensive monotherapy, free combinations, and single-pill combinations in controlling untreated, uncontrolled hypertensives during their first treatment year. Electronic record data were obtained from 180 practice sites; 106,621 hypertensive patients seen from 01/2004–06/2009 had uncontrolled blood pressure, were untreated for ≥6 months before therapy, and had ≥1 one-year follow-up blood pressure data. Control was determined by the first follow-up visit with blood pressure <140/<90 mm Hg for patients without diabetes mellitus or chronic kidney disease and <130/<80 for patients with either or both conditions. Multivariable hazards regression ratios (HR) and 95% confidence intervals (95%CI) for time-to-control were calculated adjusting for age, sex, baseline blood pressure, body mass index, diabetes, chronic kidney disease, cardiovascular disease, initial therapy, final blood pressure medication number, and therapeutic inertia. Patients on initial single-pill combinations (N=9,194) were more likely to have Stage 2 hypertension than those on free combinations (N=18,328) or monotherapy (N=79,099 [all p<0.001]). Initial therapy with single-pill combinations (HR 1.53, 95%CI 1.47–1.58) provided better hypertension control in the first year than free combinations (HR 1.34, 95%CI 1.31–1.37) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year.

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“…17 OQUIN captures data on patients from the Southeast U.S who are receiving healthcare at practices with electronic health record systems. Data collection is facilitated through a Business Associate Agreement with each clinic.…”

Section: Methodsmentioning

confidence: 99%

Progression Is Accelerated From Prehypertension to Hypertension in Blacks

et al. 2011

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Pre-hypertension is a major risk factor for hypertension. African Americans (blacks) have more prevalent and severe hypertension than whites, but it is unknown whether progression from pre-hypertension is accelerated in blacks. We examined this question in a prospective cohort study of 18,865 non-hypertensive persons (5,733 [30.4% black, 13,132 [69.6%]) white) 18–85 years old. Electronic health record data were obtained from 197 community-based outpatient clinics in the Southeast U.S. Days elapsing from study entry to hypertension diagnosis, mainly blood pressure [BP] ≥140 systolic and/or ≥90 mmHg diastolic on two consecutive visits established conversion time within a maximum observation period of 2550 days. Cox regression modeling was used to examine conversion to hypertension as a function of race, while controlling for age, sex, baseline systolic and diastolic BP, body mass index [BMI], diabetes mellitus and chronic kidney disease. The covariable adjusted median conversion time when 50% became hypertensive was 365 days earlier for blacks than whites (626 vs 991 days, p<0.001). Among covariables, baseline systolic BP 130–139 (Hazard Ratio 1.77, 95% Confidence Intervals [1.69–1.86]) and 120–129 mmHg (1.52 [1.44–1.60] as well as age ≥75 (1.40 [1.29–1.51] and 55–74 years (1.29 [1.23–1.35] were the strongest predictors of hypertension. Additional predictors included age 35–54 years, diastolic BP 80–89 mmHg, overweight and obesity, and diabetes mellitus (all p<0.001). Conversion from pre-hypertension to hypertension is accelerated in blacks, which suggests that effective interventions in pre-hypertension could reduce racial disparities in prevalent hypertension.

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Impacting Population Cardiovascular Health Through a Community‐Based Practice Network: Update on an ASH‐Supported Collaborative

Cited by 20 publications

References 33 publications

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Initial Monotherapy and Combination Therapy and Hypertension Control the First Year

Progression Is Accelerated From Prehypertension to Hypertension in Blacks

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