Are BP readings taken after a patient-physician encounter in a real-world clinic scenario the lowest of all the readings in a clinic visit

To determine the difference in Blood Pressure [BP] readings taken before, during and after the clinic encounter. Descriptive study. Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013. Hypertensive and normotensive participants aged >/= 18 years were recruited. Pre-clinic BP was measured by a nurse and in-clinic BP by a physician. After 15 minutes, two post-clinic BP readings were taken at 1 minute interval. All readings were taken using Omron HEM7221-E. Out of 180 participants, males were 57% and 130 [71%] were hypertensive. Mean SBP [Systolic BP] taken preclinic, in-clinic, post-clinic 1 and post-clinic 2 were: 126 +/- 20 mmHg, 131 +/- 23 mmHg, 126 +/- 20 mmHg and 121 +/- 21 mmHg respectively [p < 0.001]. Mean DBP [Diastolic BP] taken pre-clinic, in-clinic, post-clinic 1 and post-clinic 2 were 77 +/- 12 mmHg, 81 +/- 13 mmHg, 79 +/- 12 mmHg and 79 +/- 11 mmHg respectively [p < 0.001]. BP taken in the post-clinic setting may significantly be the lowest reading in a clinic encounter, making in-clinic BP unreliable to diagnose or manage hypertension

Diuretic induced hyponatremia in hypertensive patients

Diuretics are the recommended antihypertensive by several international guidelines. This study was designed to determine the association of hyponatremia in hypertensive patients on diuretic therapy. This was a case control study conducted at the Aga Khan University Hospital, Karachi in adult inpatients [> 18 years] who were known hypertensive. Cases were defined as hypertensives with hyponatremia and controls were defined as hypertensives without hyponatremia. Outcome was hyponatremia. Exposed were those using diuretics. Out of 1800 hypertensive patients sampled by the ICD-9-Coding; 1191 [66%] fulfilled the inclusion criteria. Cases n [%] were 553 [46.4] and controls were 638 [53.5]. Among 553 cases [%] 180 [32.5] were exposed [on diuretics] and in controls 189 [29.6] were exposed [on diuretics] p=0.15. The association of hyponatremia with diuretic use was not significant with OR=1.11 [95% CI=0.86 - 1.45, p=0.40], after adjusting for chronic kidney disease, ischemic heart disease and chronic liver disease, in the final model. Diuretics were not associated with hyponatremia in hypertensive adult patients in this study

Better physician-patient communication; an important milestone in control of hypertension, a multicenter study from Karachi, Pakistan

Control of hypertension is an important cornerstone in prevention of cardiovascular morbidity and mortality. This study was designed to compare physician encounter score in patients with controlled and uncontrolled hypertension. It was conducted at three tertiary care hospitals in Karachi. Patients were categorized into controlled and uncontrolled hypertension based on their initial blood pressure readings on presentation. Primary outcome variable was control of hypertension and physician encounter score [a composite score of 12 item question] was the main candidate variable. Higher scores reflected favorable encounter with physician. Mean age of participants was 57.7 +/- 12 years; 224 [50.1%] were men. Controlled hypertension was present in 72.3% [323] and uncontrolled hypertension was present in 27.4% [124]. Mean physician encounter score in uncontrolled hypertensive was 7.25 +/- 2.64 versus 7.83 +/- 2.22 [p=0.02] in controlled hypertensive. Patient-physician encounter is an important milestone in control of hypertension in hypertensive patients and directly translates into better adherence to antihypertensives in these patients

Validity and reliability testing: Urdu translated modified response to symptoms questionnaire

To determine validity and reliability of the Urdu translated, modified "Response to symptoms questionnaire" [RSQ] among acute coronary syndrome [ACS] patients in Karachi. A qualitative, tool validation study. Two tertiary care hospitals in Karachi, the Aga Khan University Hospital, Karachi and the Karachi Institute of Heart Diseases, from December 2010 to April 2011. After making certain modifications, the original tool in English was translated into Urdu. Next, five cardiology experts evaluated the tool for its content and face validity. Test retest and inter rater reliabilities were computed for the RSQ using 5% of the total sample size of the parent study. Sufficient conceptual and semantic equivalence was found between the Urdu and English versions of the modified RSQ. Content validity index was calculated to be 1 for both relevance and linguistic clarity. Test retest and inter rater reliabilities were calculated to be 95.9% and K = 0.97, respectively. The Urdu translated modified RSQ has sufficiently acceptable content validity, test retest and inter rater reliability; hence, it should be used by the researchers for the evaluation of factors associated with pre-hospital delay among Urdu speaking ACS patient populations