Cardiovascular health 1
Track 3
| Thursday, October 26, 2023 |
| 10:45 AM - 12:40 PM |
| Meeting Room C2.1 |
Speaker
Dr Bruce Willett
RACGP Vice President and Chair, RACGP QLD
Royal Australian College of General Practitioners
Chairperson
Biography
Prof Oswald Peter Adams
Dean
The University of the West Indies
The impact of measuring blood pressure in both arms on hypertension and cardiovascular risk assessment: The ECHORN cohort study
10:45 AM - 11:00 AMPresentation type
Research presentation
Summary
Introduction
Guidelines recommend measuring blood pressure (BP) in both arms and using the arm with the higher BP. Few Family Physicians do this. We aimed to determine the impact of measuring BP in both arms on hypertension and atherosclerotic cardiovascular risk (ASCVD) classification.
Methods
Residents ≥ 40 years of age on the Caribbean islands or Barbados, Puerto Rico, Trinidad and the USVI were recruited to a cohort study. A survey was completed, HbA1c, glucose and lipid tests done, and BP was measured in both arms simultaneously after the participant was seated for 5 minutes. Recorded BP was the average of three readings taken one minute apart.
Results
Of 2912 participants (mean age 57.2 years, 65.0% female, mean BMI 29.2 Kg/m2) with valid BP measurements, 1204 (41.4%) were on antihypertensive medication and 452 (15.6%) reported a heart condition. The interarm systolic BP difference was ≥ 5, ≥10 and ≥15 mm Hg in 1080 (37.1%), 312 (10.7%) and 95 (3.3%) participants respectively. In 26.2% of participants higher systolic and diastolic pressure were in different arms. Mean differences between the higher and lower systolic and diastolic BP readings were 4.5 (137.6 vs 133.1) (p < 0.0001) and 3.1 (81.9 vs 78.8) mm Hg (p < 0.0001) respectively. Higher vs lower arm systolic BP would reclassify 299 (10.3%) and 241 (8.3%) participants at the 130 and 140 mm Hg cut-offs respectively. For diastolic BP, 316 (10.8%) and 202 (6.9%) participants would be reclassified at the 80 and 90 mm Hg cut-offs. Using the higher vs lower systolic BP, the ASCVD 10-year risk score would be ≥7.5% in 41.7% vs 40.0% of participants respectively (p<0.0001).
Discussion
Measuring BP in both arms is needed for accurate hypertension diagnosis, BP control assessment and to identify the 10.7% of people with a ≥10 mm Hg interarm systolic difference.
Guidelines recommend measuring blood pressure (BP) in both arms and using the arm with the higher BP. Few Family Physicians do this. We aimed to determine the impact of measuring BP in both arms on hypertension and atherosclerotic cardiovascular risk (ASCVD) classification.
Methods
Residents ≥ 40 years of age on the Caribbean islands or Barbados, Puerto Rico, Trinidad and the USVI were recruited to a cohort study. A survey was completed, HbA1c, glucose and lipid tests done, and BP was measured in both arms simultaneously after the participant was seated for 5 minutes. Recorded BP was the average of three readings taken one minute apart.
Results
Of 2912 participants (mean age 57.2 years, 65.0% female, mean BMI 29.2 Kg/m2) with valid BP measurements, 1204 (41.4%) were on antihypertensive medication and 452 (15.6%) reported a heart condition. The interarm systolic BP difference was ≥ 5, ≥10 and ≥15 mm Hg in 1080 (37.1%), 312 (10.7%) and 95 (3.3%) participants respectively. In 26.2% of participants higher systolic and diastolic pressure were in different arms. Mean differences between the higher and lower systolic and diastolic BP readings were 4.5 (137.6 vs 133.1) (p < 0.0001) and 3.1 (81.9 vs 78.8) mm Hg (p < 0.0001) respectively. Higher vs lower arm systolic BP would reclassify 299 (10.3%) and 241 (8.3%) participants at the 130 and 140 mm Hg cut-offs respectively. For diastolic BP, 316 (10.8%) and 202 (6.9%) participants would be reclassified at the 80 and 90 mm Hg cut-offs. Using the higher vs lower systolic BP, the ASCVD 10-year risk score would be ≥7.5% in 41.7% vs 40.0% of participants respectively (p<0.0001).
Discussion
Measuring BP in both arms is needed for accurate hypertension diagnosis, BP control assessment and to identify the 10.7% of people with a ≥10 mm Hg interarm systolic difference.
Takeaways
1. Measuring BP in both arms is simple and is essential if the almost one in 9 people, 40 years of age and over with ≥10 mm Hg systolic BP difference between arms are to be identified. This difference predicts an increased risk of cardiovascular events and mortality.
2. Using the arm with the higher instead of the lower systolic BP and a 130 mm Hg systolic cut-off, would cause 10.3% of people to have their hypertension or BP control status reclassified. The impact would be half of this if only one arm were measured and compared to the higher systolic pressure.
3. This study used a multi-cuff oscillometric device to measure the BP of both arms simultaneously. Family Physicians may not have such devices available, and many do not measure BP in both arms.
2. Using the arm with the higher instead of the lower systolic BP and a 130 mm Hg systolic cut-off, would cause 10.3% of people to have their hypertension or BP control status reclassified. The impact would be half of this if only one arm were measured and compared to the higher systolic pressure.
3. This study used a multi-cuff oscillometric device to measure the BP of both arms simultaneously. Family Physicians may not have such devices available, and many do not measure BP in both arms.
Biography
Dr Peter Adams is a Professor of Family Medicine. He was Dean of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill campus between 2015 and 2023.
He completed secondary school at Queens College in Guyana, received a BSc in Biochemistry from Imperial College of Science and Technology, University of London and a MBBS and DM from the University of the West Indies. He is a primary care researcher, educator and clinician who has been practising medicine for 37 years in Barbados. Prior to becoming Dean in 2015, he coordinated both the undergraduate and postgraduate Family Medicine programmes at Cave Hill Campus. He introduced a Diploma in Family Medicine by distance with doctors in several Eastern Caribbean islands enrolled.
His research focuses on aspects of chronic noncommunicable diseases and sexually transmitted infections relevant to the practice of Family Medicine. He is the Barbados site Principal Investigator of the NIH funded Eastern Caribbean Health Outcomes Network (ECHORN) cohort project.
Dr Marshell Timotius Handoko
Lecturer
Pelita Harapan University
Effectiveness of Community Programs to Prevent Hypertension: A Systematic Review of RCTs
11:00 AM - 11:15 AMPresentation type
Research presentation
Summary
Hypertension is a significant public health problem that can cause cardiovascular disease and premature death worldwide. Approximately 46% of adults are unaware of having hypertension.
To reduce its incidents in the society, community-based programs that include education, self-screening, and family empowerment were proposed. However, there is little to none data regarding the effectiveness of this programme. Thus, this systematic review was designed to acknowledge the effect of community programs on preventing hypertension.
Studies used for this systematic review were collected from PubMed, Scopus, ScienceDirect and Google Scholar databases. Keywords that related to hypertension, community program, prevention, primary care, and effectiveness were used for searching in the database.
Newcastle-Ottawa Scale (NOS) was used to assess the included studies.
Fourteen studies of randomized controlled trials were included in this review consisting of 30,970 participants. The results of all RCTs show that community programs may reduce hypertension through interactive education such as workshops, classes, and other sessions (including family education). Blood pressure monitoring through health workers’ home visit and self-monitoring also increases the prevention of hypertension. Based on quality assessment using NOS, ten studies have good quality, and four have moderate quality.
Community Programs including interactive education and blood pressure monitoring by
healthcare professionals are effective in preventing hypertension. However, the implementation of the existing program in primary health care settings must be monitored and assessed routinely to ensure the quality of intervention.
To reduce its incidents in the society, community-based programs that include education, self-screening, and family empowerment were proposed. However, there is little to none data regarding the effectiveness of this programme. Thus, this systematic review was designed to acknowledge the effect of community programs on preventing hypertension.
Studies used for this systematic review were collected from PubMed, Scopus, ScienceDirect and Google Scholar databases. Keywords that related to hypertension, community program, prevention, primary care, and effectiveness were used for searching in the database.
Newcastle-Ottawa Scale (NOS) was used to assess the included studies.
Fourteen studies of randomized controlled trials were included in this review consisting of 30,970 participants. The results of all RCTs show that community programs may reduce hypertension through interactive education such as workshops, classes, and other sessions (including family education). Blood pressure monitoring through health workers’ home visit and self-monitoring also increases the prevention of hypertension. Based on quality assessment using NOS, ten studies have good quality, and four have moderate quality.
Community Programs including interactive education and blood pressure monitoring by
healthcare professionals are effective in preventing hypertension. However, the implementation of the existing program in primary health care settings must be monitored and assessed routinely to ensure the quality of intervention.
Takeaways
1. Indonesia Primary Health Care
2. Community Prevention
3. Indonesia Hypertension condition
2. Community Prevention
3. Indonesia Hypertension condition
Biography
Marshell is a family doctor practitioner, UPH medical faculty lecturer, primary care researcher and active in Wonca Young Doctors Movement Indonesia
Dr OZIEGBE OGHIDE
CONSULTANT FAMILY PHYSICIAN
LAGOS UNIVERSITY TEACHING HOSPITAL
Blood pressure parameter among young adults with hypertensive and normotensive parents attending the out-patient clinic of a public tertiary hospital
11:15 AM - 11:30 AMPresentation type
Research presentation
Summary
Background
Hypertension was traditionally believed to be a disease of advancing age but recent studies have shown increased incidence in young adults. Family history especially parental history of hypertension have been associated with increased incidence of hypertension in their progeny. However, some studies have suggested that this association is secondary to life style and other environmental factors
Objectives
This study was aimed at determining the blood pressure patterns of young adult with hypertensive and normotensive parents attending the General Out-Patient Clinic of the Lagos University Teaching Hospital. The findings from this study may provide a template for recommending protocol for screening of young adult at risk of hypertension.
Methods
The study was a hospital based, cross-sectional study of 524 young adults aged 18-35years comprising of 260 offspring of hypertensive and 264 offspring of normotensive parents respectively who were closely matched for age and sex. Data was collected using a validated, structured interviewer-based questionnaire to get information on the sociodemographic characteristics, lifestyle, anthropometric indices and other clinical parameters such as blood pressure. Data was analysed using SPSS 22 and was summed as proportions and means. Chi-square, Fisher's exact, student t-test and logistic regression were used where applicable. The test of significance was set at p-value of 0.05.
Results
The overall prevalence of prehypertension and hypertension among young adults in this study was 29.8% and 9% respectively. Parental hypertension status was not significantly associated with hypertension status of respondent (p=0.802). The prevalence of diagnosed hypertension and incidental findings among respondents were 7.25% and 1.72% respectively.
Conclusion
The prevalence of hypertension was low but pre-hypertension was very high and both conditions were without significant relationship with parental hypertension status hence the need for routine blood pressure screening among young adults irrespective of their parental hypertensive status.
Hypertension was traditionally believed to be a disease of advancing age but recent studies have shown increased incidence in young adults. Family history especially parental history of hypertension have been associated with increased incidence of hypertension in their progeny. However, some studies have suggested that this association is secondary to life style and other environmental factors
Objectives
This study was aimed at determining the blood pressure patterns of young adult with hypertensive and normotensive parents attending the General Out-Patient Clinic of the Lagos University Teaching Hospital. The findings from this study may provide a template for recommending protocol for screening of young adult at risk of hypertension.
Methods
The study was a hospital based, cross-sectional study of 524 young adults aged 18-35years comprising of 260 offspring of hypertensive and 264 offspring of normotensive parents respectively who were closely matched for age and sex. Data was collected using a validated, structured interviewer-based questionnaire to get information on the sociodemographic characteristics, lifestyle, anthropometric indices and other clinical parameters such as blood pressure. Data was analysed using SPSS 22 and was summed as proportions and means. Chi-square, Fisher's exact, student t-test and logistic regression were used where applicable. The test of significance was set at p-value of 0.05.
Results
The overall prevalence of prehypertension and hypertension among young adults in this study was 29.8% and 9% respectively. Parental hypertension status was not significantly associated with hypertension status of respondent (p=0.802). The prevalence of diagnosed hypertension and incidental findings among respondents were 7.25% and 1.72% respectively.
Conclusion
The prevalence of hypertension was low but pre-hypertension was very high and both conditions were without significant relationship with parental hypertension status hence the need for routine blood pressure screening among young adults irrespective of their parental hypertensive status.
Takeaways
1. Detection of hyperension among young adult in developing countries is still very low.
2. There is increasing prevalence of pre-hypertension among young adults in developing countries
3. There is need for training and retraining of healthcare providers on the need for early detection of Hypertension among young adults
2. There is increasing prevalence of pre-hypertension among young adults in developing countries
3. There is need for training and retraining of healthcare providers on the need for early detection of Hypertension among young adults
Biography
Oziegbe Oghide is a family physician who works at the emergency Triage of the biggest Tertiary Hospital in Nigeria(Lagos University Teaching Hospital). He is a consultant Family physician,certified health manager and has certifications in emergency medicine and acute care.He was trained in Nigeria and had practiced in Nigeria ever since. He has worked with several renowned physician and played a key role during the Ebola and Lassa fever outbreak in his community in Nigeria.He has continued to ensure quality patient centered care to all his clients.
He loves football and table Tennis and is married.
Mr Reuben Tan
Medical Student
National University of Singapore
Identifying gaps in interprofessional practice: A qualitative study exploring pharmacists' perspectives on hypertension care
11:30 AM - 11:50 AMPresentation type
Rapid impact presentation
Summary
Introduction
Providing care for patients with hypertension involves a multidisciplinary healthcare team, which requires an effective interprofessional practice (IP). Few studies have explored the challenges faced by pharmacist as a member of the healthcare team. This study therefore aimed to explore the IP barriers faced by pharmacists when delivering hypertension care in a Singapore primary care setting.
Methods
A qualitative study was conducted in 2022 at five public primary care clinics in Singapore. A trained qualitative researcher used a semi-structured topic guide to conduct individual interviews with pharmacists, purposively sampled based on their roles and working experience. Recruitment stopped when the study reached data saturation. The interviews were audio-recorded, transcribed verbatim and checked. The transcripts were managed using NVivo and analysed thematically by three researchers.
Results
The pharmacists identified two key IP barriers: communication and documentation. There was difficulty in reaching the doctors in a timely manner when there was a need for prompt communication, for example, to clarify indications or errors in prescriptions. The pharmacists were concerned about disrupting the doctor's consultation. This had led to prolonged patient waiting time, dissatisfaction and complaints. The pharmacists struggled to dispense when there was inadequate and inappropriate documentation on the electronic medical records, often by the doctors. This often occurred when there was a change or cancellation of medications, but the reason was not documented. This can potentially affect patient safety. The pharmacists were aware of doctors’ heavy clinical workload, and expressed the need for a more effective and less disruptive IP communication platform.
Conclusion
This study highlighted communication and documentation barriers faced by pharmacists when delivering IP hypertension care at a primary care clinic. There is a need to relook at the care pathway and electronic medical record system to address these barriers.
Providing care for patients with hypertension involves a multidisciplinary healthcare team, which requires an effective interprofessional practice (IP). Few studies have explored the challenges faced by pharmacist as a member of the healthcare team. This study therefore aimed to explore the IP barriers faced by pharmacists when delivering hypertension care in a Singapore primary care setting.
Methods
A qualitative study was conducted in 2022 at five public primary care clinics in Singapore. A trained qualitative researcher used a semi-structured topic guide to conduct individual interviews with pharmacists, purposively sampled based on their roles and working experience. Recruitment stopped when the study reached data saturation. The interviews were audio-recorded, transcribed verbatim and checked. The transcripts were managed using NVivo and analysed thematically by three researchers.
Results
The pharmacists identified two key IP barriers: communication and documentation. There was difficulty in reaching the doctors in a timely manner when there was a need for prompt communication, for example, to clarify indications or errors in prescriptions. The pharmacists were concerned about disrupting the doctor's consultation. This had led to prolonged patient waiting time, dissatisfaction and complaints. The pharmacists struggled to dispense when there was inadequate and inappropriate documentation on the electronic medical records, often by the doctors. This often occurred when there was a change or cancellation of medications, but the reason was not documented. This can potentially affect patient safety. The pharmacists were aware of doctors’ heavy clinical workload, and expressed the need for a more effective and less disruptive IP communication platform.
Conclusion
This study highlighted communication and documentation barriers faced by pharmacists when delivering IP hypertension care at a primary care clinic. There is a need to relook at the care pathway and electronic medical record system to address these barriers.
Takeaways
1. Pharmacists face difficulty in communicating with doctors in a timely manner regarding patient's prescription
2. Inadequate and inappropriate documentation on the electronic medical records might affect patient safety
3. A more effective and conducive platform is needed to facilitate timely communication between doctors and pharmacists.
2. Inadequate and inappropriate documentation on the electronic medical records might affect patient safety
3. A more effective and conducive platform is needed to facilitate timely communication between doctors and pharmacists.
Biography
CJ Ng is a Clinical Professor at Duke-NUS Medical School, and Senior Consultant at SingHealth Polyclinics, Singapore. His research interests include: shared decision making, men's health, digital health and implementation science. He is currently leading a research programme to find new approaches to support patients and healthcare providers in making day-to-day decisions using technology.
A/Prof Jian Jia
Jiangsu Provincial People's Hospital
Effect of General Practitioner-Specialist management mode on blood pressure and body composition of hypertension patients in rural areas in Guangde
11:50 AM - 11:55 AMPresentation type
Rapid impact presentation
Summary
To improve the management effect of hypertension patients in rural areas, a health management mode combining both general practitioners and specialists was used in hypertension patient intervention. A total of 387 hypertensive patients in Shijie Town, Guangde County, Anhui Province were selected from January to June 2022 and randomly divided into an experimental group and a control group. The experimental group was managed by the GP-Specialist hypertension management team. The control group was managed under a family doctor contract. The body composition was determined by InbodyS10 analyser using Bioelectrical Impedance Analysis. T-test and one-way analysis of variance were used for comparison and analysis. Before the management, there were no significant differences in blood pressure, fasting blood glucose, uric acid, LDL cholesterol, triglyceride, and HDL cholesterol between the two groups (P>0.05). After the management, blood pressure, fasting blood glucose, uric acid, LDL cholesterol, triglyceride and BMI in both groups decreased significantly (P<0.05), and HDL cholesterol was significantly increased (P<0.05). Overall cholesterol levels were significantly decreased in the experimental group (P<0.001), but there was no significant change in total cholesterol level in the control group (>0.05). Systolic blood pressure, diastolic blood pressure, total cholesterol level, LDL cholesterol, triglyceride and BMI levels in the experimental group were significantly lower than the control (P<0.05). Before the management, there were no significant differences in bone mass, protein mass, fat mass, muscle mass, body fat percentage and visceral fat between two groups (P>0.05). After the management, fat mass, body fat percentage and visceral fat in both groups were significantly decreased, while bone mass, protein mass and fat mass were significantly increased (P<0.05). The fat mass, body fat percentage and visceral fat of the experimental group were significantly lower than the control, and the muscle mass of the experimental group was significantly higher than the control (P<0.05).
Takeaways
1. Family doctor contract system is an important guarantee mechanism for the establishment of hierarchical diagnosis and treatment system. However, the hypertension patients in rural areas do not know enough about family doctor contract, and most rural residents do not have a strong awareness of disease prevention.
2. The General Practitioner-Specialist management mode is a new chronic disease management mode, in which general practitioners and specialists cooperate in the diagnosis, treatment and management of patients, and provide guidance to patients from the aspects of professional pertinence and whole-course follow-up, which is conducive to the prevention and treatment of diseases. The General Practitioner-Specialist management mode of hypertension patients can increase patients' trust, reduce communication barriers, and enhance patients' family and social to support family. Studies have shown that family members and social support can help prevent hypertension.
3. The General Practitioner-Specialist health management mode for the management of elderly hypertension patients can optimize body composition, stabilize lipid levels and significantly reduce blood pressure.
2. The General Practitioner-Specialist management mode is a new chronic disease management mode, in which general practitioners and specialists cooperate in the diagnosis, treatment and management of patients, and provide guidance to patients from the aspects of professional pertinence and whole-course follow-up, which is conducive to the prevention and treatment of diseases. The General Practitioner-Specialist management mode of hypertension patients can increase patients' trust, reduce communication barriers, and enhance patients' family and social to support family. Studies have shown that family members and social support can help prevent hypertension.
3. The General Practitioner-Specialist health management mode for the management of elderly hypertension patients can optimize body composition, stabilize lipid levels and significantly reduce blood pressure.
Biography
Jian Jia is an Associate Professor undertaking Deputy Director and Deputy Chief Physician in the General Practice Department of Jiangsu Provincial People's Hospital. She is the teaching director of the General Specialty Base of Standardized Training for resident Doctors of Jiangsu Provincial People's Hospital. She sits on several committees including a member of the General Practitioner Branch of the China and Jiangsu Province Medical Doctor Association, and BLS, and ALS mentor in the American Heart Association (AHA). She possesses the qualification of teaching national and provincial general practitioners. She has been engaged in clinical, teaching, and scientific research in general practice for a long time focusing in hypertension, coronary heart disease, hyperlipidemia, heart failure and other cardiovascular disease diagnosis and treatment. She has participated in many research of Jiangsu and National Natural Science Foundation, and her research contribution has been committed to the elderly essential hypertension gene and pharmacogenetics-related research.
A/Prof Eric Kam-Pui Lee
Clinical Assistant Professor
The Chinese University of Hong Kong
Safety, feasibility, and acceptability of telemedicine for hypertension in primary care: a proof-of-concept and pilot randomized controlled trial (SATE-HT)
11:55 AM - 12:00 PMSummary
Hypertension (HT) continues to be a leading cause of cardiovascular death and an enormous burden on the healthcare system. Although telemedicine may provide improved blood pressure (BP) monitoring and control, it remains unclear whether it could replace face-to-face consultations in patients with optimal BP control. We hypothesized that an automatic drug refill coupled with a telemedicine system tailored to patients with optimal BP would lead to non-inferior BP control. In this pilot, multicenter, randomized control trial (RCT), participants receiving anti-HT medications were randomly assigned (1:1) to either the telemedicine or usual care group. Patients in the telemedicine group measured and transmitted their home BP readings to the clinic. The medications were refilled without consultation when optimal control (BP <135/85 mmHg) was confirmed. The primary outcome of this trial was the feasibility of using the telemedicine app. Office and ambulatory BP readings were compared between the two groups at the study endpoint. Acceptability was assessed through interviews with the telemedicine study participants. Overall, 49 participants were recruited in 6 months and retention rate was 98%. Participants from both groups had similar BP control (daytime systolic BP: 128.2 versus 126.9 mmHg [telemedicine vs. usual care], p= 0.41) and no adverse events. Participants in the telemedicine group had fewer general outpatient clinic attendances (0.8 vs. 2, p<0.001). Interviewees reported that the system was convenient, timesaving, cost saving, and educational. The system could be safely used. However, the results must be verified in an adequately powered RCT.
Takeaways
1. the HealthCap telemedicine system is feasible and safe and is well-accepted by patients.
2. Replacing physicians’ consultations with an automated telemedicine system does not appear to lead to inferior BP control.
3.These results need to be further verified in an adequately powered RCT.
2. Replacing physicians’ consultations with an automated telemedicine system does not appear to lead to inferior BP control.
3.These results need to be further verified in an adequately powered RCT.
Biography
Dr Lee finished medical school and graduated from the University of Hong Kong in 2007. He practiced in family medicine in Hong Kong for more than 10 years and he obtained his specialist qualification in Hong Kong 2016. He had a master degree in mental health from CUHK in year 2014 and another Master degree in Evidence-Based Health Care from the University of Oxford in year 2020.
Dr Lee started to work as a clinical assistant professor since 2016 in the Chinese University of Hong Kong. He is currently a member of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. His main research interest is on different blood pressure measurements and treatment of hypertension, especially nocturnal hypertension.
