Browsing by Subject "hypertension"
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Item Beta Blockers: A Guide for Patients(2009-09-18) Sharpe, EmilyIn patients who are at risk for heart disease, beta blockers started during surgery prevented heart attack but increased the risk of stroke and death. The current guidelines that recommend the initiation of beta-blocker therapy in patients having noncardiac surgery should be reevaluated. However, patients who have been treated with beta blockers for a long time should continue their medication throughout the perioperative period.Item Blood Pressure(2008-04-07) Renner, JodiThis document provides a description of blood pressure, ranges of normal and high blood pressure, and recommendations on how lifestyle modifications can help decrease blood pressure. Finally, it describes some classes of common medications that may be used to help lower blood pressure.Item Dairy- and Soy-Derived Bioactive Peptides and the Renin-Angiotensin-Aldosterone System(2013-05) Munn, MelissaHypertension is a chronic, often asymptomatic, and highly prevalent cardiovascular disorder. Medications prescribed to lower blood pressure in hypertensive individuals are successful but are not without side effects or associated costs that render these agents inconvenient to patients. Furthermore, from a public health standpoint, a proactive approach to preventing or delaying progression into a hypertensive state in at-risk individuals is promising. Researchers have discovered bioactivity in peptides derived from food protein sources and the observed potential for blood pressure lowering effects through ACE inhibition has fueled further interest. This thesis focuses on the potential use of dairy- and soy- derived bioactive peptides in lowering blood pressure through ACE inhibition. Chapter 1 provides an overview of hypertension, including its prevalence, clinical definition, associated risk factors, and potential contributors to its complex pathophysiology, as well as current medications and a brief introduction to the use of bioactive peptides in a functional food. Chapter 2 presents a systematic review of the literature, with a strong emphasis on in vivo animal and human studies regarding the blood pressure lowering potential of dairy- and soy- derived bioactive peptides. Chapter 3 shares the findings of our study on the acute effects of whey- and soy- derived bioactive peptides administered in the form of a cookie to overweight, prehypertensive men and postmenopausal women. Finally, this thesis is concluded with a brief summary provided in Chapter 4.Item A Description of Medication Decision-Making, Dispensing, and Utilization for Hypertensive Patients in Nishtar Hospital Multan, Pakistan(University of Minnesota, College of Pharmacy, 2013) Saeed, Hafiz Muhammad Khawar; Nasar, Naveera; Batool, Sonia; Ghauri, Rabia; Rauf, AquulaHypertension is a worldwide health problem affecting developed and developing countries, and Pakistan is no exception. Nishtar Hospital Multan is categorized as one of the biggest hospitals in South Asia. The objective for this study was to describe medication decision-making, dispensing, and utilization for patients diagnosed with hypertension at this patient care facility. The study was conducted by 5 trained pharmacists working in collaboration with prescribers who met with study participants when they visited the hospital. All interview questions were asked in Urdu during the hospital visit. Data were summarized using descriptive statistics. A total of 301 patients who visited the hospital agreed to participate in the study. The findings showed that prescribers spend little time with patients and rarely follow guidelines for decision-making. Regarding the dispensing of medications for the treatment of hypertension, none of the dispensing was completed by a pharmacist and none of the patients received counseling about medications at the time of dispensing. Most patients reportedly do not take their medication as prescribed. Regarding outcomes, 20% of the patients had pre-hypertension, 47% stage 1 hypertension, and 33% stage 2 hypertension. Great improvements are possible in the treatment of hypertension at the hospital we studied through application of standard treatment guidelines, patient education, and adjustments to work system processes so that alignment of provider’s skills with opportunities in improving the patient care process can be achieved.Item Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities(University of Minnesota, College of Pharmacy, 2014) Doucette, William R.; Lickteig, Cailin; Veach, Stevie; Carter, Barry; Levy, BarceyObjectives: 1) Conduct team building activities for provider-community pharmacist teams in small communities and 2) Determine the impact of the team approach on practitioner-reported consequences and 3) Identify obstacles to the team approach and ways to overcome them. Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisions included patient identification, practitioner roles, and communications. Most pharmacists conducted blood pressure (BP) checks in the pharmacy and assessed the anti-hypertensive medications. If the BP was not at goal, the pharmacist worked with the patient and provider to make improvements. Teams followed their strategies for 3-5 months. Data were collected from pharmacy logs and on-line surveys of team members before and after the team period. Results: Using a multi-case approach, 4 cases were classified as Worked-Well, 5 as Limited-Success, and 2 as No-Team-Care. The Worked-Well teams provided an average of 26.5 BP visits per team, while the Limited-Success teams averaged 6.8 BP visits. The Worked-Well teams established and used a system to support the team approach. The Limited-Success teams either didn’t fully establish their team system, or used it sparingly. The No-Team-Care cases did not provide any team care. Conclusions: Factors supporting success were: positive provider-pharmacist relations, established team system, commitment to team care, and patient willingness to participate. While this program had some success, potential improvements were identified: more follow-up after the team building session, additional patient materials, and guidance for practice changes.Item Examining the Effect of a Medication Synchronization or an Education Program on Health Outcomes of Hypertensive Patients in a Community Pharmacy Setting(University of Minnesota, College of Pharmacy, 2014) DiDonato, Kristen L.; Vetter, Kristin R.; Liu, Yifei; May, Justin R.; Hartwig, D. MatthewObjective: To examine the effect of a medication synchronization or education program on hypertensive health outcomes. Methods: This study used a design of randomized controlled trial lasting four months taking place within a family-owned community pharmacy chain in a U.S. Midwestern state. A total of 302 hypertensive patients were randomized into 3 study groups – control, medication synchronization, and education. Interventions included management of medication refills through a medication synchronization program for the medication synchronization group, and monthly hypertension (HTN) education for the education group. Outcome measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), percentage of patients at blood pressure (BP) goal, self-rated change in medication adherence, and patients’ HTN knowledge. Results: All groups had significant decline of SBP from baseline; however the final analysis showed no significant SBP differences among study groups. The proportion of patients achieving BP goals in both the control (p=0.005) and education (p=0.019) groups increased at Month 4. Changes in self-reported adherence were not significant for any groups. All groups showed positive changes on HTN knowledge questions with the education group showing the greatest change. Conclusion: Compared to the control group, there was no difference in the primary outcomes. However, this study demonstrated that educational materials written at an appropriate level and presented by community pharmacists to patients may have been associated with an increase in HTN knowledge and a significant increase in the proportion of patients achieving their BP goal. These educational interventions had a greater impact on helping patients achieve their blood pressure goals than medication synchronization. This may indicate that further intervention is needed to impact adherence aside from ensuring that patients have their medication on hand. Taking the time to educate patients about hypertension led to self-reported positive change with being more careful about taking medications and with not forgetting to take medications when they felt better.Item Eye Changes and High Blood Pressure: What do they Mean?(2010-07-22) Hayward, DanielHypertensive retinopathy is a term used to describe certain types of changes in the small blood vessels in the eye caused by hypertension. While it is unusual for these changes to be symptomatic, testing for them can provide useful information to your physician about your risk for heart attack, stroke, and other high blood pressure related problems. Testing is usually done by ophthalmologists, or eye doctors.Item Improving Blood Pressure Control in Over-the-Road Truck Drivers: Is Provision of Medication Therapy Management by Pharmacists Feasible?(University of Minnesota, College of Pharmacy, 2015) Hager, Keri D.; Aronson, Benjamin D.; Smith, Reid C.; Parra, David; Swanoski, MichaelPurpose This pilot sought to determine feasibility of studying the impact on hypertension in over-the-road truck drivers who met with pharmacists for Medication Therapy Management (MTM) compared to those who did not. Design/methodology/approach Drivers were randomly assigned to control or treatment (MTM) group for 52 weeks. Drivers assigned to the MTM arm could receive services in person or via secure videoconferencing technology located in a private space at the trucking company. All subjects were provided education and received a blood pressure monitor and log for recording daily blood pressures. Findings Eleven drivers enrolled and seven drivers completed the study. The primary barriers to participation included unpredictable driver schedules and lack of access to MTM provider while on the road. Research limitations/implications This pilot study was limited by small sample size. Pharmacists were not available to meet with truckers “on demand.” Therefore, researchers are encouraged to test alternate opportunities to increase enrollment of drivers in studies and access to MTM services while drivers are on the road. Practical implications Hypertension is the second highest health-related cost burden, and over-the-road truck drivers have unique challenges that can make it difficult to attain blood pressure control. Pharmacist-provided MTM has been shown to improve blood pressure control. Improving access to MTM, perhaps using a national network of pharmacists or technology from the road, may decrease morbidity and mortality in drivers. Originality/value This paper fulfills an identified need to study how to improve driver access to care to reduce cardiovascular-related morbidity and mortality.Item Interaction Of Afferent Renal Nerve Activity And Il-1R Signaling In Hypertension(2024-04) Baumann, DanielRenal denervation was recently approved by the FDA for the treatment of hypertension, but the mechanism by which it reduces blood pressure is unclear. Studies of patients who have received the treatment have shown a variety of off-target improvements in conditions associated with sympathetic overactivity. One explanation is that these effects are due to ablation of sympathoexcitatory afferent renal nerves, which are overactive under conditions of renal inflammation. Renal interleukin 1-beta (IL-1β) is elevated in many cases of hypertension, as well as the DOCA-salt model of hypertension, and its activity may be responsible for the elevation in afferent renal nerve activity and arterial pressure. IL-1R activation increases the activity of afferent sensory nerves in other contexts. In these studies, I sought to determine if IL-1R activity was responsible for the increased afferent renal nerve activity characteristic of DOCA-salt hypertension. First, I characterized a mouse model of DOCA-salt hypertension and found that ablation of the afferent renal nerves attenuates hypertension in this model. Next, I used this model in combination with two methods of IL-1R disruption: genetic IL-1R knockout and pharmacological IL-1R antagonism. These methods attenuated hypertension in this model system. Further, combining either method with afferent renal denervation produced no additional attenuation of hypertension, and an acute depressor response to delivery of the IL-1R antagonist was observed only in animals with intact renal afferent nerves, indicating a common mechanism of action. In combination, these findings suggest that IL-1R activation is partially responsible for the elevated afferent renal nerve activity which stimulates central sympathetic outflow to renal and non-renal targets to drive DOCA-salt hypertension.Item Project ImPACT: Hypertension Outcomes of a Pharmacist-Provided Hypertension Service(University of Minnesota, College of Pharmacy, 2014) Nemerovski, Carrie Wentz; Young, Maria; Mariani, Nicholas; Bugdalski-Stutrud, Carol; Moser, Lynette R.Objective: To evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Methods: Self-declared hypertensive patients met with the pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on four occasions over a 6–month period. Practice innovation: A community pharmacy partnered with an employer wellness plan to provide education and monitoring for patients with hypertension based on home blood pressure readings obtained using monitors that wirelessly transmit information to the pharmacist. Main outcome measure(s): Percentage of patients at blood pressure goal, mean blood pressure, percentage of patients with lifestyle goals, medication adherence, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Results: Patients not at their goal blood pressure at baseline had a significant decrease in blood pressure and a significant increase in achievement of their blood pressure goals. Across the population, no significant changes were seen in the primary outcome, lifestyle goals, medication adherence or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high. Conclusion: Blood pressure control improved in patients not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting.Item The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors(University of Minnesota, College of Pharmacy, 2014) Bagwell, Autumn; Skelley, Jessica W.; Saad, Lana; Woolley, Thomas; Dugan, DeeAnnObjective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD. Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors. Setting: The Jefferson County Public Health Department (JCHD) Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7. Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association). Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified. Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease.Item Selecting appropriate initial pharmacotherapy for African Americans with severe, isolated hypertension.(2009-05-06) Saith, Sunil E.African American patients with isolated Stage II hypertension (e.g. no diabetes, previous heart disease) were started on amlodipine and valsartan combination therapy, or amlodipine alone, in a double-blind randomized controlled study. Blood pressure reduction was greater in the amlodipine/valsartan group than amlodipine alone, eight weeks after beginning treatment.