The importance of frequent return visits and hypertension control among US young adults: a multidisciplinary group practice observational study

King, Cecile C.; Bartels, Christie M.; Magnan, Elizabeth; Fink, Jennifer; Smith, Maureen A.; Johnson, Heather M.

doi:10.1111/jch.13096

Cited by 10 publications

(12 citation statements)

References 39 publications

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“…These findings are supported by prior studies demonstrating improved hypertension control rates with more frequent hypertension follow-up and with increased awareness of BP outside the clinical setting. 45 , 46 Physical activity, sodium reduction, and home BP monitoring are guideline-recommended health behavior changes to improve hypertension control.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

et al. 2023

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ImportanceUncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden.ObjectiveTo evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months.Design, Setting, and ParticipantsThis randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022.InterventionsThe My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care.Main Outcomes and MeasuresThe co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure &lt;130 mm Hg and diastolic blood pressure &lt;80 mm Hg or clinic systolic blood pressure &lt;140 mm Hg and diastolic blood pressure &lt;90 mm Hg) and changes in hypertension self-management behavior.ResultsA total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, −4.19 [9.77] mm Hg; P &lt; .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P &lt; .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures.Conclusions and RelevanceThe MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension.Trial RegistrationClinicalTrials.gov Identifier: NCT03158051

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Section: Discussionmentioning

confidence: 99%

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

et al. 2023

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“…For example, low-income low-wage workers may be employed at multiple jobs without the ability to take time off for a healthcare visit; patients who rely on public transit or reside in rural areas may spend hours commuting to and from an office visit. These barriers result in fewer clinical visits and therefore fewer blood pressure measurements and opportunities to identify uncontrolled hypertension [ 57 , 58 ]; missed visits can result in disparities in hypertension outcomes [ 20 ]. SMBP monitoring facilitates equity through earlier identification of uncontrolled hypertension and provides more opportunities for clinicians to intensify medications in response to uncontrolled blood pressure values.…”

Section: How Smbp Monitoring Could Address Equity In Hypertension Con...mentioning

confidence: 99%

Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity

et al. 2022

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Purpose of Review To evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity. Recent Findings While a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations. Summary Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs.

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“…Although the importance of medical supervision may be an apparently obvious concept, valid not only for obesity, but also for other chronic diseases such as blood hypertension [9] or diabetes mellitus [10], to the best of our knowledge, the real-world evidence of the association of a pressing medical supervision with a progressively increasing weight loss after an initially effective BWRP has only been partially investigated.…”

Section: Introductionmentioning

confidence: 99%

Frequent Medical Supervision Increases the Effectiveness of a Longitudinal Multidisciplinary Body Weight Reduction Program: A Real-World Experience in a Population of Children and Adolescents with Obesity

et al. 2021

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Regular medical supervision represents a fundamental component of the clinical management of obesity. In fact, when frequently supplied it reduces the risk of failure associated with any body weight reduction program (BWRP), resulting in body weight gain. The aim of the present study was to establish the potential beneficial effects of increasing medical supervision on weight loss and other auxometric and cardiometabolic parameters in a population of children and adolescents with obesity (n = 158; F/M = 94/64; age range 9.7–17.3 years; body mass index, BMI = 37.8 ± 6.9 kg/m2), followed up for one year in a real-world setting, after and before a 3-week in-hospital BWRP. Weight loss was significantly associated with medical supervision and changes in several auxometric and cardiometabolic parameters such as fat mass, fat-free mass, waist and hip circumferences, total and LDL cholesterols, triglycerides, glucose, insulin, HOMA-IR, systolic blood pressure and IDF criteria for the diagnosis of metabolic syndrome. As expected, weight loss and, congruently, medical supervision, were significantly higher in responsive and stable subjects than in those belonging to the non-responsive group and in responsive subjects than those belonging to the stable group. While weight loss was significantly higher in subjects having class 2 and 3 obesity than those belonging to class 1 obesity group, medical supervision was significantly higher in subjects having class 3 than those having class 1 obesity. Weight loss was significantly higher in subjects suffering from metabolic syndrome than those without; nevertheless, no significant difference was found in medical supervision between these groups. Finally, sex was associated with no differences in weight loss and medical supervision. In conclusion, based on the results of a real-world experience, frequent medical supervision increases the weight loss associated with a longitudinal multidisciplinary BWRP, with a parallel improvement of a set of auxometric and cardiometabolic parameters. Prospectively, incentivising regular medical supervision should reduce the risk of BWRP failure and body weight gain, thus contributing to counteract the detrimental transition from simple obesity to metabolic syndrome in pediatric patients.

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The importance of frequent return visits and hypertension control among US young adults: a multidisciplinary group practice observational study

Cited by 10 publications

References 39 publications

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults

Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity

Frequent Medical Supervision Increases the Effectiveness of a Longitudinal Multidisciplinary Body Weight Reduction Program: A Real-World Experience in a Population of Children and Adolescents with Obesity

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