Hypertension Treatment and Concern About Falling: Baseline Data from the Systolic Blood Pressure Intervention Trial.

OBJECTIVES: To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure (BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. DESIGN: Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). SETTING: Approximately 100 outpatient sites. PARTICIPANTS: SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). MEASUREMENTS: Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. RESULTS: Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BP<120 mmHg, diastolic BP <70 mmHg) nor orthostatic hypotension was associated with concern about falling (P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. CONCLUSION: Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT.

Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes.

OBJECTIVE: Our objective was to compare the clinical effectiveness of home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) on blood pressure (BP) control and patient outcomes. DESIGN: A systematic review was conducted. We also appraised the methodological quality of studies. DATA SOURCES: PubMed, Scopus, CINAHL, and the Cochrane Central Register of Control Trials (CENTRAL). INCLUSION CRITERIA: Randomized control trials, prospective and retrospective cohort studies, observational studies, and case-control studies published in English from any year to present that describe HBPM and 24-hour ABPM and report on systolic and/or diastolic BP and/or heart attack, stroke, kidney failure and/or all-cause mortality for adult patients. Due to the nature of the question, studies with only untreated patients were not considered. RESULTS: Of 1,742 titles and abstractions independently reviewed by two reviewers, 137 studies met predetermined criteria for evaluation. Nineteen studies were identified as relevant and included in the paper. The common themes were that HBPM and ABPM correlated with cardiovascular events and mortality, and targeting HBPM or ABPM resulted in similar outcomes. Associations between BP measurement type and mortality differed by study population. Both the low sensitivity of office blood pressure monitoring (OBPM) to detect optimal BP control by ABPM and the added association of HBPM with cardiovascular mortality supported the routine use of HBPM in clinical practice. There was insufficient data to determine the benefit of using HBPM as a measurement standard for BP control. CONCLUSION: HBPM encourages patient-centered care and improves BP control and patient outcomes. Given the limited number of studies with both HBPM and ABPM, these measurement types should be incorporated into the design of randomized clinical trials within hypertensive populations.

Results of an Academic, Health Care Worksite Weight Loss Contest for Southeastern Americans: Scale Back Alabama 2011-2013.

Few studies have assessed the effectiveness of competitive incentivized worksite weight loss programs. Scale Back Alabama (SBA) is a free, state-supported program designed to promote weight loss among overweight and obese citizens. The purpose of this manuscript is to describe the design and preliminary findings of SBA as a worksite intervention among employees at a collegiate institution and university hospital. In teams of 4 employees, SBA participants volunteered to engage in a 10-week competitive weight loss contest; both teams and individuals who lost significant weight were eligible for randomly drawn cash incentives. Trained staff objectively measured participants' weight before and at the conclusion of the contest. Preliminary analyses suggest that SBA as a worksite program can promote weight loss among employees, but future analyses are warranted to understand the context of these findings and determine if current results are confounded by unmeasured factors.

Characterizing workers participating in a worksite wellness health screening program using blood pressure control, self-monitoring, medication adherence, depression, and exercise.

Blood pressure control remains a serious public health issue because hypertension is the most common risk factor for cardiovascular disease. Effective management of hypertension often requires lifestyle modification and medication adherence. The objective of this study was to identify the prevalence of blood pressure control, medication adherence, self-monitoring of blood pressure, depression, and exercise among workers with access to health resources. Faculty and staff (N = 484) from a university and health care institution in the southeastern United States participated in biometric and questionnaire screening. The researchers used initial screening data from this worksite wellness program to describe baseline blood pressure control (< 140/90 mm Hg), self-monitoring of blood pressure, medication adherence, depression, and exercise. Overall, 63% of the workers' blood pressure was controlled; however, 23% of the sample had been prescribed antihypertensive medication to control their blood pressure. Thirty percent of the sample reported practicing blood pressure self-monitoring, 72.2% reported that they exercised, and 22% reported feeling down and depressed. More than half (64.9%) who used prescribed antihypertensive medication reported adherence to these medications.

Relationship of blood pressure self-monitoring, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with hypertension.

Uncontrolled blood pressure remains a major public health issue. Medication adherence is a key factor in blood pressure management; however, adherence behavior is not clearly understood and the most significant factors contributing to poor medication adherence and blood pressure control are unknown. The purpose of this study was to determine the relationship of self-monitoring of blood pressure, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with access to health insurance. Stage of change was a significant independent predictor of self-monitoring of blood pressure, but not blood pressure control. A strong relationship was found between medication adherence and medication adherence self-efficacy (r = .549, p < .05).

Prevalence of blood pressure self-monitoring, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with hypertension.

Despite the availability of effective medications, hypertension remains inadequately managed in the United States. It has been established that medication adherence is a major strategy for controlling blood pressure. Combined interventions to promote adherence are promising, but further research is needed to understand which behaviors to target. The frequency of self-monitoring of blood pressure among municipal workers is unknown, and the literature is limited regarding assessing individuals' readiness and confidence to engage in medication adherence. The purpose of this study was to determine the prevalence of medication adherence, readiness, self-efficacy, self-monitoring of blood pressure, and blood pressure control among hypertensive municipal workers. The study population was enrolled in a wellness program established more than 20 years ago to promote health and safety for a work force in a large southeastern U.S. city. The majority of the study participants (75.7%) demonstrated controlled blood pressure, reported adherence to antihypertensive medication (70%), and self-monitored blood pressure (70%).