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hypertension in blacks guidelines

Elizabeth M Goldberg, Sarah J Marks, Roland C Merchant
Emergency department (ED)-based screening and referral of patients with elevated blood pressure (BP) are recommended by 2006 and 2013 American College of Emergency Physicians guidelines; however, it is unknown if these recommendations or disparities in care impact clinical practice. The objectives of the study were to assess temporal trends in antihypertensive prescriptions, outpatient follow-up referrals, and diagnosis of hypertension (HTN)/elevated BP and to identify potential disparities by patient characteristics...
October 14, 2018: Journal of the American Society of Hypertension: JASH
Andrea Kolkenbeck-Ruh, Angela J Woodiwiss, Ravi Naran, Eitzaz Sadiq, Chanel Robinson, Tshegofatso H Motau, Taalib Monareng, Philanathi Mabena, Nomvuyo Manyatsi, Pitchou Z Gazwa, Talib Abdool-Carrim, Olebogeng H I Majane, Martin Veller, Girish Modi, Gavin R Norton
AIM: Although chronic kidney disease (CKD) as determined from estimated glomerular filtration rate (eGFR) is recommended for risk prediction by current hypertension guidelines, the equations to derive eGFR may not perform well in black Africans. We compared whether across the adult lifespan, eGFR or CKD are as closely associated with noncardiac arterial vascular events, as carotid intima-media thickness (IMT), in Africa. METHODS: In 1152 black South Africans [480 with noncardiac arterial events (294 with critical lower limb ischemia, 186 with stroke) of which 37% were premature] and 672 age, sex and ethnicity-matched controls from a randomly selected community sample, we assessed relations between eGFR, CKD or carotid IMT (B-mode ultrasound) and arterial events...
September 17, 2018: Journal of Hypertension
Omar Mukhtar, Joseph Cheriyan, John R Cockcroft, David Collier, James M Coulson, Indranil Dasgupta, Luca Faconti, Mark Glover, Anthony M Heagerty, Teck K Khong, Gregory Y H Lip, Adrian P Mander, Mellone N Marchong, Una Martin, Barry J McDonnell, Carmel M McEniery, Sandosh Padmanabhan, Manish Saxena, Peter J Sever, Julian I Shiel, Julie Wych, Phil J Chowienczyk, Ian B Wilkinson
BACKGROUND: Ethnicity, along with a variety of genetic and environmental factors, is thought to influence the efficacy of antihypertensive therapies. Current UK guidelines use a "black versus white" approach; in doing so, they ignore the United Kingdom's largest ethnic minority: Asians from South Asia. STUDY DESIGN: The primary purpose of the AIM-HY INFORM trial is to identify potential differences in response to antihypertensive drugs used as mono- or dual therapy on the basis of self-defined ethnicity...
October 2018: American Heart Journal
Samia Mora, Nanette K Wenger, Nancy R Cook, Jingmin Liu, Barbara V Howard, Marian C Limacher, Simin Liu, Karen L Margolis, Lisa W Martin, Nina P Paynter, Paul M Ridker, Jennifer G Robinson, Jacques E Rossouw, Monika M Safford, JoAnn E Manson
Importance: Atherosclerotic cardiovascular disease (ASCVD) kills approximately 1 in every 3 US women. Current cholesterol, hypertension, and aspirin guidelines recommend calculating 10-year risk of ASCVD using the 2013 Pooled Cohort Equations (PCE). However, numerous studies have reported apparent overestimation of risk with the PCE, and reasons for overestimation are unclear. Objective: We evaluated the predictive accuracy of the PCE in the Women's Health Initiative (WHI), a multiethnic cohort of contemporary US postmenopausal women...
September 1, 2018: JAMA Internal Medicine
Natasha J Williams, Chimene Castor, Azizi Seixas, Joseph Ravenell, Girardin Jean-Louis
Introduction: Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with metabolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symptoms, in a cohort of adult Black men and women with MetS. Methods: Patients (n=1,013) from the Metabolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program's Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep characteristics, and physician-reported diagnosis of a sleep disorder...
2018: Ethnicity & Disease
Valy Fontil, Reena Gupta, Nathalie Moise, Ellen Chen, David Guzman, Charles E McCulloch, Kirsten Bibbins-Domingo
BACKGROUND: Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%. METHODS AND RESULTS: We adapted Kaiser Permanente's evidence-based treatment protocols in a racially and ethnically diverse population at 12 safety-net clinics in the San Francisco Health Network. The intervention consisted of 4 elements: a hypertension registry, a simplified treatment intensification protocol that included fixed-dose combination medications containing diuretics, standardized BP measurement protocol, and BP check visits led by registered nurse and pharmacist staff...
July 2018: Circulation. Cardiovascular Quality and Outcomes
Kirsten S Dorans, Katherine T Mills, Yang Liu, Jiang He
BACKGROUND: Hypertension is a major risk factor for cardiovascular disease and all-cause mortality. Compared with prior guidelines, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommends lower blood pressure thresholds for defining hypertension, for initiating antihypertensive medication, and for antihypertensive medication treatment goals. METHODS AND RESULTS: To better understand potential impacts of the 2017 guideline, we studied trends in mean systolic blood pressure and diastolic blood pressure, prevalence and burden of hypertension, and proportion of controlled hypertension in the US adult population aged ≥20 from 1999 through 2016...
June 1, 2018: Journal of the American Heart Association
Allison Helmer, Nicole Slater, Sean Smithgall
OBJECTIVE: To review current guidelines and recent data evaluating the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in black hypertensive patients. DATA SOURCES: Articles evaluating race-specific outcomes in hypertension were gathered using a MEDLINE search with keywords black, African American, ACE inhibitor, angiotensin receptor blocker, angiotensin system, and hypertension. Studies published from 2000 through April 2018 were reviewed...
May 1, 2018: Annals of Pharmacotherapy
Dike B Ojji, Neil Poulter, Albertino Damasceno, Karen Sliwa, Wynand Smythe, Nicky Kramer, Motasim Badri, Veronica Francis, Akinyemi Aje, Felix Barasa, Anastase Dzudie, Erika Jones, Shehu S Kana, Pindile Mntla, Charles Mondo, Okechukwu Ogah, Elijah N Ogola, Gboyega Ogunbanjo, Ikechi Okpechi, Gabriel Shedul, Mahmoud U Sani, Grace Shedul, Bongani M Mayosi
BACKGROUND: Current hypertension guidelines recommend the use of combination therapy as first-line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)-lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue. METHODS: The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single-blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub-Saharan Africa (SSA)...
August 2018: American Heart Journal
Andrew Smart, Kate Weiner
This article examines the articulation and enactment of racialised classifications in clinical practice guidelines and in accounts of clinical practice. It contributes to debates about racialisation in medicine and its consequences. The research centred on the case study of prescribing guidelines for hypertension in England and Wales, drawing on documentary sources and semi-structured expert interviews. We found that conceptual and socio-political uncertainties existed about how to interpret the designation 'Black patients' and about the practices for identifying patients' race/ethnicity...
June 2018: Sociology of Health & Illness
Yechiam Ostchega, Guangyu Zhang, Jeffery P Hughes, Tatiana Nwankwo
BACKGROUND: Factors and trends associated with hypertension control (BP < 130/80 mm Hg) and mean blood pressure (BP) among hypertensive adults (BP ≥1 30/80 mm Hg or medicated for hypertension). METHOD: Data on 22,911 hypertensive US adults from the 1999-2016 National Health and Nutrition Examination Survey. RESULTS: For men, hypertension control prevalence increased from 8.6% in 1999-2000 to 16.2% in 2003-2004 (P < 0.001), and continued the increasing trend afterwards to 23...
July 16, 2018: American Journal of Hypertension
Pegah Golabi, Maria Stepanova, Huong T Pham, Rebecca Cable, Nila Rafiq, Haley Bush, Trevor Gogoll, Zobair M Younossi
Background: Hepatic fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) independently predicts mortality. Given liver biopsy's invasive nature, non-invasive method to assess hepatic steatosis and fibrosis provides NAFLD risk stratification algorithm in clinical practice. NAFLD fibrosis score (NFS) is simple and non-invasive predictive model recommended by American Association for the Study of Liver Disease (AASLD) Guideline to identify patients with NAFLD with fibrosis risk...
2018: BMJ Open Gastroenterology
Mary E Cogswell, Catherine M Loria, Ana L Terry, Lixia Zhao, Chia-Yih Wang, Te-Ching Chen, Jacqueline D Wright, Christine M Pfeiffer, Robert Merritt, Claudia S Moy, Lawrence J Appel
Importance: In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended collecting 24-hour urine to estimate US sodium intake because previous studies indicated 90% of sodium consumed was excreted in urine. Objective: To estimate mean population sodium intake and describe urinary potassium excretion among US adults. Design, Setting, and Participants: In a nationally representative cross-sectional survey of the US noninstitutionalized population, 827 of 1103 (75%) randomly selected, nonpregnant participants aged 20 to 69 years in the examination component of the National Health and Nutrition Examination Survey (NHANES) collected at least one 24-hour urine specimen in 2014...
March 27, 2018: JAMA: the Journal of the American Medical Association
Aisha James, Seth A Berkowitz, Jeffrey M Ashburner, Yuchiao Chang, Daniel M Horn, Sandra M O'Keefe, Steven J Atlas
BACKGROUND: Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care. OBJECTIVE: To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control...
April 2018: Journal of General Internal Medicine
Tanya S Kenkre, Pankaj Malhotra, B Delia Johnson, Eileen M Handberg, Diane V Thompson, Oscar C Marroquin, William J Rogers, Carl J Pepine, C Noel Bairey Merz, Sheryl F Kelsey
BACKGROUND: The WISE study (Women's Ischemia Syndrome Evaluation) was a prospective cohort study of 936 clinically stable symptomatic women who underwent coronary angiography to evaluate symptoms and signs of ischemia. Long-term mortality data for such women are limited. METHODS AND RESULTS: Obstructive coronary artery disease (CAD) was defined as ≥50% stenosis on angiography by core laboratory. We conducted a National Death Index search to assess the mortality of women who were alive at their final WISE contact date...
December 2017: Circulation. Cardiovascular Quality and Outcomes
Margaret E Gonsoulin, Ramon A Durazo-Arvizu, Karen M Goldstein, Guichan Cao, Qiuying Zhang, Dharani Ramanathan, Denise M Hynes
Background and Objectives: This study characterizes the multiple morbidities experienced by senior-aged women Veterans so that the Veterans Health Administration (VHA) and other healthcare systems may be better prepared to meet the healthcare needs of this growing cohort. Research Design and Methods: Using the VHA's Corporate Data Warehouse (CDW), we conducted a retrospective observational study of the 38,597 female veteran patients who were at least sixty-five years old and received care in the VHA during 2013 and 2014...
September 1, 2017: Innovation in Aging
Amal R Khanolkar, Gillian E Hanley, Ilona Koupil, Patricia A Janssen
OBJECTIVE: To determine whether the Institute Of Medicine's (IOM) 2009 guidelines for weight-gain during pregnancy are predictive of maternal and infant outcomes in ethnic minority populations. METHODS: We designed a population-based study using administrative data on 181,948 women who delivered live singleton births in Washington State between 2006-2008. We examined risks of gestational hypertension, preeclampsia/eclampsia, cesarean delivery, and extended hospital stay in White, Black, Native-American, East-Asian, Hispanic, South-Asian and Hawaiian/Pacific islander women according to whether they gained more or less weight during pregnancy than recommended by IOM guidelines...
November 13, 2017: Ethnicity & Health
Nomsa Musemwa, Crystal A Gadegbeku
PURPOSE OF REVIEW: African Americans are over-burdened with hypertension resulting in excess morbidity and mortality. We highlight the health impact of hypertension in this population, review important observations regarding disease pathogenesis, and outline evidence-based treatment, current treatment guidelines, and management approaches. RECENT FINDINGS: Hypertension accounts for 50% of the racial differences in mortality between Blacks and Whites in the USA. Genome-wide association studies have not clearly identified distinct genetic causes for the excess burden in this population as yet...
October 28, 2017: Current Cardiology Reports
Ioanna Gouni-Berthold, Ruth Hanssen, Lisa Ravarani, Heiner K Berthold
BACKGROUND: In patients with diabetes mellitus (DM) there is a clear association between blood pressure (BP) levels and macrovascular and microvascular complications. However, the BP targets that need to be achieved for optimal outcomes remain controversial. METHODS: The purpose of this narrative review is to discuss BP targets and management in patients with DM. The subject of elevated heart rate, which has been associated with mortality in many populations, and which is observed in some patients with DM will also be addressed...
2017: Current Pharmaceutical Design
Ihab Hajjar, Kristine J Rosenberger, Ambar Kulshreshtha, Hilsa N Ayonayon, Kristine Yaffe, Felicia C Goldstein
Importance: The Eighth Joint National Committee (JNC-8) recommended treating systolic blood pressure (SBP) to a target below 150 mm Hg in older adults, whereas data from the Systolic Blood Pressure Intervention Trial (SPRINT) suggested that a SBP level of lower than 120 mm Hg decreases cardiovascular event rates. Target SBP guidelines have not addressed the potential that black patients may have greater morbidity and mortality from hypertension, especially with regard to cognitive outcomes...
October 1, 2017: JAMA Neurology
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