Journal of Clinical Hypertension 

About: Journal of Clinical Hypertension is an academic journal published by Wiley-Blackwell. The journal publishes majorly in the area(s): Blood pressure & Population. It has an ISSN identifier of 1524-6175. It is also open access. Over the lifetime, 4235 publications have been published receiving 71115 citations. The journal is also known as: JCH.

Predictive validity of a medication adherence measure in an outpatient setting

Abstract: This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension We also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care and complexity of the medical regimen A total of 1367 patients participated in the study; mean age was 525 years, 408% were male, 765% were black, 51% graduated from high school, 26% were married, and 541% had income <$5,000 The eight-item medication adherence scale was reliable (α= 083) and significantly associated with blood pressure control (P<005) Using a cutpoint of less than 6, the sensitivity of the measure for identifying low versus higher adherers was estimated to be 93%, and the specificity was 53% The medication adherence measure proved to be reliable with good concurrent and predictive validity in primarily low income, minority patients with hypertension, and might function as a screening tool in outpatient settings with other patient groups

Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT).

Abstract: Context Blood pressure control ( Objective To determine the success and predictors of blood pressure control in a large hypertension trial involving a multiethnic population in diverse practice settings. Design The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial is a randomized, double-blind, active-controlled clinical trial with a mean follow-up of 4.9 years. Participant enrollment began in February 1994 and follow-up was completed in March 2002. Setting A total of 623 centers in the United States, Canada, and the Caribbean. Participants A total of 33,357 participants (aged > or =55 years) with hypertension and at least one other coronary heart disease risk factor. Interventions Participants were randomly assigned to receive (double-blind) chlorthalidone, 12.5-25 mg/d (n=15,255), amlodipine 2.5-10 mg/d (n=9048), or lisinopril 10-40 mg/d (n=9054) after other medication was discontinued. Doses were increased within these ranges and additional drugs from other classes were added as needed to achieve blood pressure control ( Main outcome measures The outcome measures for this report are systolic and diastolic blood pressure, the proportion of participants achieving blood pressure control ( Results Mean age was 67 years, 47% were women, 35% black, 36% diabetic; 90% were on antihypertensive drug treatment at entry. At the first of two pre-randomization visits, blood pressure was or =2 drugs was 63%. Blood pressure control varied by geographic regions, practice settings, and demographic and clinical characteristics of participants. Conclusions These data demonstrate that blood pressure may be controlled in two thirds of a multiethnic hypertensive population in diverse practice settings. Systolic blood pressure is more difficult to control than diastolic blood pressure, and at least two antihypertensive medications are required for most patients to achieve blood pressure control. It is likely that the majority of people with hypertension could achieve a blood pressure

Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension.

Abstract: Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the International society of hypertension

Working Group Report on High Blood Pressure in Pregnancy

Abstract: This report updates the 1990 National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy and focuses on classification, pathophysiology, and management of the hypertensive disorders of pregnancy. Using evidence-based medicine and consensus, this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The recommendations to use K5 for determining diastolic pressure and to eliminate edema as a criterion for diagnosing pre-eclampsia are discussed. In addition, the use of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic as a diagnostic criterion has not been recommended, as available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Management considerations are made between chronic hypertension that is present before pregnancy and those occurring as part of the pregnancy-specific condition preeclampsia, as well as management considerations in women with comorbid conditions. A discussion of the pharmacologic treatment of hypertension in pregnancy includes recommendations for specific agents. The use of low-dose aspirin, calcium, or other dietary supplements in the prevention of pre-eclampsia is described, and expanded sections on counseling women for future pregnancies and recommendations for future research are included. Once again we thank Dr. Ray Gifford, Jr., and his committee for volunteering their time to produce this important report. We hope it helps the busy clinician prevent and manage a very important problem.—Claude Lenfant, MD, Director, National Heart, Lung, and Blood Institute, and Chair, National High Blood Pressure Education Program Coordinating Committee

Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee

Abstract: VOL. 7 NO. 2 FEBRUARY 2005 102 Ten years have passed since the last version of the American Heart Association (AHA) blood pressure (BP) measurement recommendations,1 during which time there have been major changes in the ways in which BP is measured in clinical practice and research; hence this document represents a major revision of previous versions.2 BP determination continues to be one of the most important measurements in clinical medicine, and still one of the most inaccurately performed. The gold standard for clinical BP measurement has always been readings taken by a trained health care provider using a mercury sphygmomanometer and the Korotkoff sound technique. There is increasing evidence, however, that this procedure may lead to the misclassification of large numbers of individuals as hypertensive, and fail to diagnose other individuals whose BP may be normal in the clinic setting but elevated at other times. There are three reasons for this: 1) inaccuracies in the methods, some of which are avoidable; 2) the inherent variability of BP; and 3) the tendency for BP to increase in the presence of a physician (the so-called “white coat effect”). Numerous surveys have shown that physicians and other health care providers rarely follow established guidelines for BP measurement, but when they do, the readings they get correlate more closely with more objective measures of BP than the usual clinic readings. It is generally agreed that conventional clinic readings, when made correctly, are a surrogate marker for a patient’s true BP, which is conceived as the average level over prolonged periods of time, and which is thought to be the most important component of BP in determining its adverse effects. Usual clinic readings give a poor estimate of this, not only because of poor technique, but also because they typically consist only of one or two individual measurements, and the beat-to-beat BP variability is such that a small number of readings may only give a crude estimate of the average level. The recognition of these limitations of traditional clinic readings has led to two parallel developments: first, increasing use of measurements out of the clinic, Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee