An innovative program of management of hypertension in primary care practices.
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Humans↗
Biomedical subjects
J G Fodor
Publications and source records attributed to J G Fodor.
Errors in assessment of blood pressure: patient factors.
This article reviews patient-related factors affecting blood pressure measurement and provides the scientific rationale underlying current recommendations for the measurement of blood pressure in the evaluation of hypertension. Information is included on the magnitude of errors that can occur when the recommendations are not followed. A variety of factors relating to the patient's emotions, activity, bodily function and environment cause blood pressure to fluctuate throughout the day such that peak systolic and diastolic blood pressures are often twice as high as trough levels. Many physicians fail to account for these factors when assessing a patient's blood pressure. Errors in the classification and treatment of a patient's blood pressure and the finding of labile blood pressure can occur often when patients are not adequately prepared in advance of the blood pressure measurement.
Bias↗
Errors in assessment of blood pressure: blood pressure measuring technique.
This article reviews the recommended techniques for accurate and reproducible blood pressure measurements. The scientific basis underlying current recommendations for blood pressure measurement is presented. Many of the current recommendations are not followed in ambulatory care clinics and this paper will show how measurement errors in excess of 15 mm Hg or more can occur. Many patients will be misclassified and treated inappropriately when errors in blood pressure measurement of this magnitude are made. Rigorous adherence to proper blood pressure measurement is necessary to evaluate a patient's risk of cardiovascular disease, and to assess the need or efficacy of antihypertensive therapy.
Antihypertensive Agents↗
Errors in assessment of blood pressure: sphygmomanometers and blood pressure cuffs.
This article reviews the current recommendations on equipment when blood pressure is measured by sphygmomanometer. The scientific rationale underlying the current recommendations for selection and maintenance of blood pressure measuring equipment is presented. The errors that can occur when the recommendations are not followed are quantified whenever the data are available. Inadequate assessment and maintenance of equipment often lead to the use of faulty equipment, and as a result errors in the assessment of patients' blood pressure are likely to be common. If followed, the current guidelines for use and maintenance of equipment would remove most of the problems noted. Physicians must ensure that properly maintained and appropriate equipment is used to measure blood pressure.
Bias↗
Guidelines for measurement of blood pressure, follow-up, and lifestyle counselling. Canadian Coalition for High Blood Pressure Prevention and Control.
As part of the Coalition's mandate to promote the prevention and control of high blood pressure in Canada, an interdisciplinary Workgroup was established to review and update the existing standards (1987) for blood pressure measurement and referral guidelines. The intent was to prepare a scientifically based document which contained practical guidelines for the measurement of blood pressure and criteria for follow-up, and one which promoted the concept of cardiovascular health in the assessment and interpretation of blood pressure readings. These guidelines were primarily developed to assist primary health care providers and/or clinicians to assess, monitor, counsel, refer, and develop treatment plans for adults-at-risk for high blood pressure or those with the confirmed diagnosis of hypertension. Readers are referred to The Canadian Hypertension Society Consensus Conference series (Canadian Medical Association Journal 1993) for specific guidelines on the evaluation, diagnosis, and treatment of hypertension. The document is divided into three sections: 1. Measurement of blood pressure 2. Criteria for follow-up 3. Guidelines for lifestyle counselling Each section cites the references used in developing the guidelines and where relevant, identifies other resources which can be used in clinical practice.
Adolescent↗
Hypertension control: historic perspectives--25 years of progress in Canada and around the world.
Hypertension has been estimated to affect over 15% of the general population in North America, and is a leading risk factor for coronary artery disease, congestive heart failure, stroke, kidney disease, and retinopathy. Since the early 70s there has been rapid development in the pharmacotherapy of hypertension and a concomitant effort to evaluate the efficacy of non-pharmacological interventions in controlling high blood pressure. At the same time it has become obvious that hypertension is not only a clinical but also a public health problem. Twenty five years ago only half of hypertensive patients were aware of their condition, and only 16% of the total number were under satisfactory control. In the past two decades the proportion of treated patients with well-controlled hypertension increased to over 40%. Even today, however, one third are either unaware of their condition, or the reduction of blood pressure in those treated is unsatisfactory. A continuing effort is warranted to improve the management of hypertensive patients and to develop innovative public health measures in controlling this condition at a community level.
Canada↗
Comparative efficacy and tolerability of nisoldipine coat core and hydrochlorothiazide in mild-to-moderate hypertension.
This study compared the efficacy and tolerability of nisoldipine coat core (CC) 10-40 mg o.d. and hydrochlorothiazide (HCTZ) 25-50 mg o.d. Patients with mild-to-moderate essential hypertension received either nisoldipine CC 10 mg o.d. or HCTZ 25 mg o.d. Treatment was titrated at two-weekly intervals as necessary. The primary efficacy endpoint was a defined reduction in diastolic blood pressure (DBP). Response rates were similar for both the nisoldipine CC- and HCTZ-treated groups (74% and 70%, respectively). Secondary efficacy endpoints were reductions in both diastolic and systolic blood pressures (SBP). At treatment endpoint, the change from baseline in SBP was 16.2 mmHg for the nisoldipine CC group and 14.9 mmHg for the HCTZ group. Both drugs were well tolerated, and adverse events were generally minor and typical of these antihypertensive agents. Drug-related adverse events were greater in the nisoldipine CC- than the HCTZ-treated patients (50% and 37%, respectively). Nisoldipine CC was shown to demonstrate antihypertensive efficacy similar to HCTZ in the treatment of mild-to-moderate hypertension.
Adult↗