Storytelling may help control blood pressure in African-Americans

ScienceDaily (Jan. 18, 2011) — Controlling blood pressure is not only a medical challenge, but a social one as well. Because patients are required to strictly adhere to a treatment plan that may include medication, dietary restrictions and regular doctor visits, the ideas of wellness and health are also powerful parts of the social reinforcement needed for behavioral change.

This is especially true in the African American population, which is particularly susceptible to hypertension. Social and cultural barriers have been found to contribute to African American patients being far more likely than white patients to suffer from uncontrolled high blood pressure and resulting complications.

A new study suggests that a storytelling approach -- in which recognizable members of a community provide positive messages aimed at controlling hypertension through diet and medication adherence -- may offer a unique opportunity to communicate positive disease management choices in a culturally appropriate context.

Researchers at UMass Medical School, working with colleagues at Cooper Green Mercy Hospital and the University of Alabama at Birmingham have identified one promising approach. They identified "exceptionally eloquent and persuasive" patients with hypertension from focus groups where blood pressure control and the benefits of intervention were discussed; these volunteers were then videotaped, and edited DVDs, distilled from 80 hours of taping, were created.

The study appears in the Jan. 18 issue of the Annals of Internal Medicine. Researchers randomly assigned 299 African American patients with hypertension to receive either usual care or to view three videos that presented stories of real patients with hypertension. Among patients who had uncontrolled hypertension, those assigned to view the stories had better blood pressure control than those assigned to usual care -- the first such study that based a health intervention for hypertensive African Americans on positive, culturally sensitive storytelling.

"Overall," the authors wrote, "Among the 300 patients randomized, we found a difference in blood pressure favoring the intervention group, and the significance of this difference was driven by the positive effect among those with uncontrolled blood pressure. Patients with uncontrolled hypertension who were randomized to the intervention group experienced a 10 mmHg advantage in systolic blood pressure reduction relative to control Meaningful advantages were also found for diastolic pressure among the uncontrolled substrata. Blood pressures for both groups subsequently increased over time, but the relative advantage for the intervention group was maintained until the end of follow up."

What accounts for the result? Although there is no direct evidence about the mechanism by which the intervention worked, the researchers believe that the DVDs provided a "parasocial" interaction, one that rendered the viewer of the messages more susceptible to behavior change. "In prior hypertension work, we…translated patient stories into re-enactments using trained actors using high production quality in studio. To maximize [the] para-social interaction [in this study], we enhanced the realism of the current intervention by purposefully avoiding the studio, taping patients in the actual hypertension clinic."

Authors included Thomas K. Houston, MD, MPH, professor of quantitative health sciences and division chief, health informatics and implementation science; Jeroan J. Allison, MD, MSc, vice chair and professor of quantitative health sciences; John Trobaugh, MFA; Yendelela L. Cuffee, MPH; Bruce Barton PhD, research professor of quantitative health sciences; and Catarina I. Kiefe, PhD, MD, professor and chair of quantitative health sciences.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Massachusetts Medical School, via EurekAlert!, a service of AAAS.

Journal Reference:

Houston et al. Culturally Appropriate Storytelling to Improve Blood Pressure: A Randomized Trial. Annals of Internal Medicine, 2011;

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Blood pressure control system found in kidney's structural units

ScienceDaily (Jan. 14, 2011) — A new finding shows how the million working units in the kidney regulate salt handling. This identifies a new possible therapeutic target for treating high blood pressure. The kidney is made up of roughly 1 million working units called nephrons. These basic structural units remove waste products from the blood, recycle some substances to be reused and eliminate what is left as urine. The end segment of nephrons, called the distal nephron, helps set blood pressure by controlling the amount of sodium in our blood.

Scientists at The University of Texas Health Science Center San Antonio have reported how this essential function of the distal nephron is regulated. They demonstrated that sodium handling by the distal nephron is under the control of a local regulatory system.

Loss or dysfunction of this system leads to hypertension resulting from improper salt retention by the kidneys, the scientists found in mouse studies.

"These studies provide the first unequivocal evidence of a blood pressure control system in the distal nephron of the kidney," said senior author James Stockand, Ph.D., professor of physiology at the Health Science Center. "It turns out control of sodium re-absorption by this system is as important to normal blood pressure regulation as is a better-understood system, called the renin-angiotensin-aldosterone system, which works outside the kidney."

Many medications that treat high blood pressure target salt handling in the kidney. "Our work identifies a possible new therapeutic target," Dr. Stockand said.

The research was funded by the U.S. National Institutes of Health and American Heart Association and included colleagues at the University of Southern California. The findings are in the Jan. 14 issue of the Journal of Biological Chemistry.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Texas Health Science Center at San Antonio, via EurekAlert!, a service of AAAS.

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Blood pressure checks performed by barbers improve hypertension control in African-American men

ScienceDaily (Oct. 26, 2010) — Neighborhood barbers, by conducting a monitoring, education and physician-referral program, can help their African-American customers better control high blood pressure problems that pose special health risks for them, a new study from the Cedars-Sinai Heart Institute shows.

The study -- the first to subject increasingly popular barbershop-based health programs to a scientific scrutiny with randomized, controlled testing -- demonstrates the haircutters' heart health efforts work well enough that they could save hundreds of lives annually, according to results to be published online in Archives of Internal Medicine in the peer-reviewed medical journal's Feb. 28, 2011, print issue.

In the research -- led by Ronald G. Victor, MD, a hypertension expert and associate director of the Cedars-Sinai Heart Institute -- barbers for 10 months offered blood pressure checks during men's haircuts and promoted physician follow-up with personalized health education for customers with high blood pressure. This enhanced screening program markedly improved blood pressure levels among the barbershops' patrons. Although blood pressure levels also fell in a comparison group whose members received only educational brochures about high blood pressure, the improvement was greater in the barber-assisted group.

Uncontrolled hypertension is one of the most prevalent causes of premature disability and death among African-Americans. African-American men have the highest death rate from hypertension of any race, ethnic and gender group in the United States -- three times higher than white men.

"What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become healthcare extenders to help combat this epidemic of the silent killer in their community"," said Victor, the Burns and Allen Chair in Cardiology Research. "Barbers, whose historical predecessors were barber-surgeons, are a unique work force of potential community health advocates because of their loyal clientele."

Since the 1980s, African-American-owned barbershops and hair salons have hosted screening programs for medical conditions that disproportionately affect African-Americans. Victor's study concludes that if hypertension intervention programs were put in place in the estimated 18,000 African-American barbershops in the U.S., it would result in the first year in about 800 fewer heart attacks, 550 fewer strokes and 900 fewer deaths.

Seventeen African-American-owned barbershops in Dallas and approximately 1,300 male patrons with confirmed hypertension participated in this study, which ran from March, 2006, to December, 2008, when Victor was professor of medicine at the University of Texas Southwestern Medical Center in Dallas.

All African-American men patronizing the participating shops were offered baseline blood pressure screenings for hypertension. The shops then were assigned randomly to the intervention or comparison group.

Barbers at the nine shops in the intervention group were trained to measure blood pressure properly and they offered free checks with every cut. If a customer's reading was high, the barber encouraged him to see his doctor, and, if he did not, the barber called the study's nursing staff to arrange a physician visit. The customer, in turn, got a free haircut if he returned to the shop with a doctor-signed referral card.

In the eight shops in the comparison group, customers received a blood pressure check at the study's outset, and then were offered standard educational pamphlets about hypertension.

At the study's conclusion, 20 percent more hypertensive patrons in the intervention group had their blood pressure controlled with medication compared to 10 percent in the control group.

"We need further exploration to make this kind of program scalable and sustainable," said Victor, who is launching a new study with African-American barbershops in Southern California. "If this kind of program could be applied to large numbers of African-American men, that would be an enormous asset in preventing heart attacks, strokes, kidney failure and other serious complications of hypertension,"

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Cedars-Sinai Medical Center.

Journal Reference:

Ronald G. Victor; Joseph E. Ravenell; Anne Freeman; David Leonard; Deepa G. Bhat; Moiz Shafiq; Patricia Knowles; Joy S. Storm; Emily Adhikari; Kirsten Bibbins-Domingo; Pamela G. Coxson; Mark J. Pletcher; Peter Hannan; Robert W. Haley. Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men: The BARBER-1 Study: A Cluster Randomized Trial. Archives of Internal Medicine, 2010; DOI: 10.1001/archinternmed.2010.390

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Tight blood pressure control for patients with diabetes and coronary artery disease not associated with improved cardiovascular outcomes, study finds

ScienceDaily (Sep. 26, 2010) — Patients with hypertension, diabetes and coronary artery disease who maintained their systolic blood pressure at less than 130 mm Hg did not have improved cardiovascular outcomes compared to patients with usual blood pressure control, according to a study in the July 7 issue of JAMA.

"Hypertension guidelines advocate treating systolic blood pressure (BP) to less than 130 mm Hg for patients with diabetes mellitus; however, data are lacking for the growing population who also have coronary artery disease (CAD)," according to background information in the article.

Rhonda M. Cooper-DeHoff, Pharm.D., M.S., of the University of Florida, Gainesville, and colleagues examined whether patients with hypertension, diabetes and CAD who achieved systolic BP of less than 130 mm Hg would have a reduced risk of cardiovascular events compared with those who managed to keep their systolic BP within the range of at least 130 mm Hg to less than 140 mm Hg. The analysis included 6,400 of the 22,576 participants in the International Verapamil SR-Trandolapril Study (INVEST). For this analysis, participants were at least 50 years old and had diabetes and CAD. Participants were recruited between September 1997 and December 2000 from 862 sites in 14 countries and were followed up through March 2003, with an extended follow-up through August 2008 through the National Death index for U.S. participants.

Patients received treatment with either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic, or both to achieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg. Patients were categorized as having tight control if they could maintain their systolic BP at less than 130 mm Hg; usual control if systolic BP ranged from 130 mm Hg to less than 140 mm Hg; and uncontrolled if systolic BP was 140 mm Hg or higher. The primary outcome included the occurrence of all-cause death, nonfatal myocardial infarction (heart attack), or nonfatal stroke.

The primary outcome occurred in 12.7 percent (286 patients) of those in the tight-control group, 12.6 percent (249 patients) of the usual-control group, and 19.8 percent (431 patients) of the uncontrolled groups. When evaluating all-cause mortality for the entire follow-up period, after adjustment, risk of all-cause mortality was significantly greater in the tight-control group (22.8 percent) than in the usual-control group (21.8 percent).

"In this observational study, we have shown for the first time, to our knowledge, that decreasing systolic BP to lower than 130 mm Hg in patients with diabetes and CAD was not associated with further reduction in morbidity beyond that associated with systolic BP lower than 140 mm Hg, and, in fact, was associated with an increase in risk of all-cause mortality. Moreover, the increased mortality risk persisted over the long term," the authors write.

"At this time, there is no compelling evidence to indicate that lowering systolic BP below 130 mm Hg is beneficial for patients with diabetes; thus, emphasis should be placed on maintaining systolic BP between 130 and 139 mm Hg while focusing on weight loss, healthful eating, and other manifestations of cardiovascular morbidity to further reduce long-term cardiovascular risk."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Rhonda M. Cooper-DeHoff; Yan Gong; Eileen M. Handberg; Anthony A. Bavry; Scott J. Denardo; George L. Bakris; Carl J. Pepine. Tight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease. JAMA, 2010; 304 (1): 61-68 [link]

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Two medicines taken together improve control of blood pressure

ScienceDaily (Jan. 13, 2011) — New British-led research shows that starting treatment of blood pressure with two medicines rather than the one produces better and faster results and fewer side effects -- findings that could change clinical practice world-wide.

The study, published in the Lancet, challenges popular medical practice for the treatment of high blood pressure. The research was led by Cambridge in collaboration with the Universities of Dundee, Glasgow and the British Hypertension Society.

Doctors usually start treatment with one medicine and then add others over a period of months, if needed, to control blood pressure. This study shows that it is best to start treatment with two medicines together at the same time -- resulting in much faster and better control of blood pressure and surprisingly fewer side effects than with one medicine alone.

The two medicines can be incorporated into a single pill, simplifying things for patients who will still only have to take one pill. But by including two medicines in the same pill, they are taking a much more effective medicine with fewer side effects.

Professor Morris Brown, of the University of Cambridge and Addenbrooke's Hospital, said, "The ACCELERATE study breaks the mould for treating hypertension. Most patients can now be prescribed a single combination pill and know that they are optimally protected from strokes and heart attacks."

Prof Bryan Williams, of the British Hypertension Society, said, "This study is important and the findings could change the way we approach the treatment of high blood pressure."

Currently there are almost 10 million people in the UK with high blood pressure and effective treatment is known to substantially reduce the risk of stroke and heart disease.

The investigators believe these important findings could change clinical practice and affect the future treatment of blood pressure for millions of people in the UK.

Professor Tom MacDonald, of the University of Dundee, said: "The research is a great result for patients with high blood pressure. Starting with two medicines is clearly better than starting with one and amazingly there were fewer side effects and not more."

Gordon McInnes, Professor of Clinical Pharmacology at the University of Glasgow, said: "The results of this trial are of huge importance to doctors and people treated for high blood pressure. Future treatment will be more effective and, since fewer side effects will lead to better acceptance of therapy, many fewer heart attacks and strokes are likely."

The 'ACCELERATE' study of 1250 patients with hypertension shows that a new accelerated treatment programme lowers blood pressure faster, more effectively, and with fewer side effects than conventional treatment.

ACCELERATE shows that patients who start treatment with a single tablet containing a combination of drugs will have a 25% better response during the first six months of treatment than patients receiving conventional treatment, and -- remarkably -- are less likely to stop treatment because of side effects. Still more remarkably, the blood pressure in the conventional treatment arm never caught up with the new treatment arm, even when all the patients in the study were being treated with the same combination of drugs.

The authors suspected that conventional treatment allows the body to partially neutralise each drug, and ACCELERATE was designed to show that the new treatment programme prevents this neutralisation from happening.

ACCELERATE was designed by The British Hypertension Society, who entered a unique partnership with Novartis in order for the treatment programme to be simultaneously tested in ten countries on four continents.

Currently, patients with hypertension take many months to have their blood pressure lowered, following guidance to start with a low-dose of one tablet, and gradually increase the dose and number of drugs. This traditional 'start low, go-slow' policy is encouraged in order to avoid side effects, but has been shown to delay the protection from strokes which is the main reason for treating hypertension. In the longer-term, patients are also less likely to take their medication if multiple tablets are required.

Funded by the British Heart Foundation, the British Hypertension Society Research Network is now doing a similar study with different medicines to be sure these results are generalisable.

Reference: "Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial" will be published in the Lancet on 13 January.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cambridge, via EurekAlert!, a service of AAAS.

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Medication adherence improves blood pressure control in chronic kidney disease

ScienceDaily (Nov. 3, 2010) — Researchers at the University of Cincinnati (UC) and the Cincinnati Veterans Affairs (VA) Medical Center have found that about one-third of chronic kidney disease patients who are prescribed therapies for high blood pressure do not often adhere to treatments.

This report was published in the Nov. 2 online edition of the American Journal of Nephrology.

The study, led by researchers at UC and the Cincinnati VA, showed that treatment of hypertension in patients with chronic kidney disease continues to be a challenge in their care and that by simply improving medication adherence, outcomes would improve greatly.

Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body. Ongoing hypertension is often associated with kidney disease.

"Hypertension, or high blood pressure, is probably the most important modifiable risk factor in chronic kidney disease -- a precursor to end-stage renal disease that is associated with increased risk of morbidity and mortality," says Charuhas Thakar, MD, associate professor in the division of nephrology and hypertension at UC and chief of the renal section at the Cincinnati VA. "In chronic conditions, such as hypertension, whether or not a patient takes the correct dosage and amount of their hypertension medication is critical in reaching treatment goals.

"Patterns of medication adherence for these agents and their impact on blood pressure in practice settings were not previously well studied. We wanted to find out if medication adherence could make a difference on outcomes in kidney disease patients."

Using two years worth of data from patients seeking ambulatory care at the VA, researchers examined 7,227 chronic kidney disease patients who received at least one blood pressure medication prescription. Outpatient blood pressure measurements were averaged as high (more than 130/80 mm of Hg) versus normal, based on the national guidelines for hypertension management in kidney disease.

Medication adherence was calculated using medication possession ratio, meaning the actual treatment days divided by the total possible treatment days.

"Good versus poor medication adherence groups were compared for differences in demographic, co-morbid and laboratory variables," says Kristen Schmitt, chief of pharmacy at the Cincinnati VA and the lead author of the study. "Results showed that while 67 percent of patients took their medication properly, a total of 33 percent of patients had poor medication adherence. More importantly, those with poor adherence were 23 percent more likely to have sub-optimal blood pressure control during the entire two-year study period."

"With this data, we hope to develop a multidisciplinary approach to help kidney disease patients adhere to their prescribed blood pressure medications. This will not only improve their clinical outcomes but will also help in reducing costs of care," she continues.

"Although the results represent a large sample of patients, they are derived from a single center," adds Thakar. "Further investigations are needed to accurately assess the impact of medication adherence on cardiovascular and renal outcomes in practice."

This study was funded by a Federal Services Research Grant from the American Society of Health System Pharmacists (ASHP) Foundation.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cincinnati Academic Health Center.

Journal Reference:

Kristen E. Schmitt, Christine F. Edie, Paul Laflam, Loretta A. Simbartl, Charuhas V. Thakar. Adherence to Antihypertensive Agents and Blood Pressure Control in Chronic Kidney Disease. American Journal of Nephrology, 2010; 32 (6): 541 DOI: 10.1159/000321688

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Blood Pressure Control Is Health Control

If you have been told that your blood pressure is too high (that is, that you have hypertension), then what you were actually being told was that your lifestyle is not particularly healthy. This is because, unless your hypertension has come about because of ethnicity, age, sleeplessness or medication, you are doing something wrong in your daily life.

Blood pressure control for most people means initiating lifestyle alterations for the better or taking tablets for life. If you have hypertension but you cannot go to see your medical doctor as often as you would like, you could always buy a home blood pressure monitor and keep an eye on your blood pressure yourself.

The best sort to buy is an automatic digital monitor with a self-inflating cuff. It should also have a pulse monitor and several memories, although you can always use good old-fashioned pen and paper. They are not expensive any more and should cost between $30 and $100.

Some have a lifetime warranty and are as accurate as your GP's sphygmomanometer, which is the gold standard of blood pressure monitors. You should take your readings at the same time every day (or two or three times a day at the same times) and make a record of it or them. In this fashion you can compare your progress (or lack of it).

The first thing to do is quit smoking (if you smoke, obviously) and then cut down on heavy drinking sessions, if you do that). Doing that will improve your general health whether you have high arterial pressures or not.

The next thing to do is to reduce your weight, if you are overweight by dieting and exercise. If you are not overweight, you will still have to increase your degree of exercise and change your diet for the following reasons. Exercise decreases your arterial pressures and an excessive amount of salt (also called sodium) will raise your blood pressure.

So, whichever way you look at it, you will need to exercise more and take on a low-sodium diet. One of the ways of reducing sodium in your diet is by eating fresh fruit and vegetables and give up eating canned and other fast foods, which are stuffed with salt.

These lifestyle changes are not easy, so if you have to take some of them on board, consider getting help. For instance, you could use patches to help you quit smoking. You could visit the pub less frequently or simply go there later in the evening. You could ask your spouse to go on the diet as well or you could join a support group on or off line.

There really are plenty of resources out there to help you circumvent hypertension, but if you really cannot be bothered, then pop along to your physician's and get your first batch or high blood pressure tablets and be certain to make a repeat appointment, because you will be going back and forth for the remainder of your life.

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To Control High Blood Pressure, Look Really Close at What You Are Eating

Here's the good news first - the average blood pressure level in people around the world has fallen. As good as it is to hear that, there still are some holdouts who find it hard to take control of their blood pressure problems. One of the most important things you can do to control high blood pressure that seems impervious to all your well-intentioned attempts would be to deal with the salt in your food. For a healthy blood pressure count, you need to make sure that there are no more than 1.5 teaspoons of salt in your diet a day. In America, we end up taking in almost 2 teaspoons of salt a day. If you're hastily mentally totaling up all the salt that you sprinkle over your food and spoon into the bubbling pot on the stove everyday, you would be surprised to know that that isn't where you make your mistake. Three-quarters of the salt we eat every day comes from other places. What other places? They're pretty well hidden.

Let's start with a product that really is innocuous as far as its effects on your blood pressure go - it's Kellogg's raisin bran. They advertise on the box that a serving of Raisin Bran gives you no more than 15% of your daily dietary allowance. While that sounds pretty modest, that's twice as much as almost every other cereal- Cheerios, Special K Protein Plus or anything else. How about that nutritious snack that you would prefer your child chose over junk food - beef jerky? Even the mild variety has a full 500mg to a serving - probably not the healthiest snack ever at twice the salt content of even a serving of potato chips. You eat a little bit of this, and you'll get a fifth of your daily recommended 1.5 teaspoon allowance of salt.

Certainly, your efforts trying to control high blood pressure can't have anything to do with your hankering for pancakes, now could it? Take a package of Kellogg's Eggo pancakes (perhaps they wouldn't sell as well if they called them Ego pancakes). Delicious as these are, would you believe that you get a whopping 500mg of sodium to the package? It's a full quarter of your daily allowance of salt. The syrup that comes with the package is even more salty goodness. But that is nothing compared to what looks like an otherwise very healthy snack - a vegetarian burger by MorningStar Farms. Here, you are buying one of these in the hope that you're doing the right thing for your health staying away from beef patties in your burgers. That would be a reasonable assumption - except for the fact that some of these have whopping amounts of salt - a full third per burger of your allowance. If you go low-salt, you aren't safe comforting yourself with gobs of ketchup either. Most major brands of ketchup are so heavily laced with salt that you would get about 100mg off just 1 tablespoon of the stuff.

Any attempt to control high blood pressure starts with the processed foods you buy. That's where most of the salty action is.

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Zapping nerves helps control high blood pressure

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