Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)

Kaczorowski, Janusz; Chambers, Larry W.; Dolovich, Lisa; Paterson, J. Michael; Karwalajtys, Tina; Gierman, Tracy; Farrell, Barbara; McDonough, Beatrice; Thabane, Lehana; Tu, Karen; Zagorski, Brandon; Goeree, Ron; Levitt, Cheryl; Hogg, William; Laryea, Stephanie; Carter, Megan Ann; Cross, Dana; Sabaldt, Rolf J

doi:10.1136/bmj.d442

Cited by 162 publications

(153 citation statements)

References 26 publications

(20 reference statements)

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“…12 This mean value represents subjects with a wide range of white coat effect, so that it is not possible to use a simple correction factor to translate routine BP readings into AOBP. This feature could explain why the subjects in different categories of AOBP in our study were receiving the same mean number of antihypertensive drugs.…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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T wo aspects of hypertension that have received considerable attention in recent years are the threshold blood pressure (BP) for diagnosing hypertension and the optimum BP target after drug therapy has been initiated. In each instance, greater emphasis is now given to systolic BP, primarily because it has been shown in numerous studies to be the best predictor of cardiovascular risk. Thresholds for the initiation of therapy based on increases in future cardiovascular events in relation to BP have been determined 1-3 for 24-hour ambulatory BP monitoring, home BP, and electronic, automated office BP (AOBP). As for conventional manual office BP, treatment thresholds were mainly derived from placebo-controlled clinical trials. For example, in the SHEP trial (Systolic Hypertension in the Elderly Program), 4 hypertension was defined as a systolic BP of 160 mm Hg or higher, and the target BP was a decrease of at least 20 mm Hg to <150 mm Hg. This study provided evidence to support treating isolated systolic hypertension of 160 mm Hg or higher in the elderly. Clinical outcome data that would justify treating uncomplicated, mild diastolic hypertension (90-99 mm Hg) based on placebo-controlled clinical trials are lacking. Other epidemiological studies 5 have shown an increase in cardiovascular events in mixed treated and untreated populations starting at a BP ≥115/75 mm Hg. However, these findings only relate BP to the future risk of a cardiovascular event and do not address the optimum BP after drug therapy has been started. Overall, convincing evidence for initiating drug therapy for uncomplicated, mild hypertension (BP 140-159/90-99 mm Hg) based on office BP is limited.There has also not been a specific target BP for treating systolic hypertension, with some guidelines recommending a <150 mm Hg target in the elderly based on the results of the SHEP trial, whereas others have maintained the Abstract-The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category.

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Section: Discussionmentioning

confidence: 99%

“…12 CHAP was a cluster randomized trial involving 39 medium-sized Ontario communities with the aim of demonstrating that a multifactorial community-based BP awareness program could reduce hospitalization caused by cardiovascular events. Details of the CHAP trial have been published previously.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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“…In the CHAP trial, 16 subjects attended 129 pharmacies during a 10 week period. Among the 15 889 individuals who participated in a CHAP session and had their AOBP measured, 13 449 (84.6%) provided consent and sufficient information to link their session results with Ontario administrative health data.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…14,15 The Cardiovascular Health Awareness Program (CHAP) was a BP screening program in which community-dwelling residents in Ontario over age 65 years had their BP recorded in a local pharmacy using the same standard AOBP procedures used as in the above-mentioned pharmacy study. 16 Participants in CHAP were followed for the development of nonfatal and fatal cardiovascular events, thus providing an opportunity to relate AOBP readings to future cardiovascular end points.…”

Section: Hypertensionmentioning

confidence: 99%

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Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk

et al. 2015

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Abstract--The risk of cardiovascular events in relation to blood pressure is largely based on readings taken with a mercury sphygmomanometer in populations which differ from those of today in terms of hypertension severity and drug therapy. Given replacement of the mercury sphygmomanometer with electronic devices, we sought to determine the blood pressure threshold for a significant increase in cardiovascular risk using a fully automated device, which takes multiple readings with the subject resting quietly alone. Participants were 3627 community-dwelling residents aged >65 years untreated for hypertension. Automated office blood pressure readings were obtained in a community pharmacy with subjects seated and undisturbed. This method for recording blood pressure produces similar readings in different settings, including a pharmacy and family doctor's office providing the above procedures are followed. Subjects were followed for a mean (SD) of 4.9 (1.0) years for fatal and nonfatal cardiovascular events. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in blood pressure (mm Hg) using Cox proportional hazards regression and the blood pressure category with the lowest event rate as the reference category. A total of 271 subjects experienced a cardiovascular event. There was a significant (P=0.02) increase in the hazard ratio of 1.66 (1.09, 2.54) at a systolic blood pressure of 135 to 144 and 1.72 (1.21, 2.45; P=0.003) at a diastolic blood pressure of 80 to 89. A significant (P=0.03) increase in hazard ratio of 1.73 (1.04, 2.86) occurred with a pulse pressure of 80 to 89. These findings are consistent with a threshold of 135/85 for diagnosing hypertension in older subjects using automated office blood pressure.

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Screening for Hypertension in Adults

Guirguis-Blake

Evans

Webber

et al. 2021

JAMA

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Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)

Cited by 162 publications

References 26 publications

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk

Screening for Hypertension in Adults

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