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Different Relationship Between Systolic Blood Pressure and Cerebral Perfusion in Subjects With and Without Hypertension

Glodzik, Lidia; Rusinek, Henry; Tsui, Wai; Pirraglia, Elizabeth; Kim, Hee-Jin; Deshpande, Anup; Li, Yi; Storey, Pippa; Randall, Catherine; Chen, Jingyun; Osorio, Ricardo S; Butler, Tracy; Tanzi, Emily; McQuillan, Molly; Harvey, Patrick; Williams, Stephen K; Ogedegbe, Gbenga; Babb, James S; de Leon, Mony J
Although there is an increasing agreement that hypertension is associated with cerebrovascular compromise, relationships between blood pressure (BP) and cerebral blood flow are not fully understood. It is not known what BP level, and consequently what therapeutic goal, is optimal for brain perfusion. Moreover, there is limited data on how BP affects hippocampal perfusion, a structure critically involved in memory. We conducted a cross-sectional (n=445) and longitudinal (n=185) study of adults and elderly without dementia or clinically apparent stroke, who underwent clinical examination and brain perfusion assessment (age 69.2±7.5 years, 62% women, 45% hypertensive). Linear models were used to test baseline BP-blood flow relationship and to examine how changes in BP influence changes in perfusion. In the entire group, systolic BP (SBP) was negatively related to cortical (β=-0.13, P=0.005) and hippocampal blood flow (β=-0.12, P=0.01). Notably, this negative relationship was apparent already in subjects without hypertension. Hypertensive subjects showed a quadratic relationship between SBP and hippocampal blood flow (β=-1.55, P=0.03): Perfusion was the highest in subjects with mid-range SBP around 125 mm Hg. Longitudinally, in hypertensive subjects perfusion increased with increased SBP at low baseline SBP but increased with decreased SBP at high baseline SBP. Cortical and hippocampal perfusion decrease with increasing SBP across the entire BP spectrum. However, in hypertension, there seems to be a window of mid-range SBP which maximizes perfusion.
PMID: 30571554
ISSN: 1524-4563
CID: 3556742

Partnerships to Improve Shared Decision Making for Patients with Hypertension - Health Equity Implications

Langford, Aisha T; Williams, Stephen K; Applegate, Melanie; Ogedegbe, Olugbenga; Braithwaite, Ronald S
Shared decision making (SDM) has increasingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hypertension is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds promise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hypertension. These options include medication and/or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on "the best" plan of action for hypertension management can be challenging because patients have different goals and preferences for treatment. As hypertension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient preferences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.
PMCID:6428173
PMID: 30906156
ISSN: 1945-0826
CID: 3776502

Concordance Between Self-Reported and Physician Diagnosis of Stroke Type in Hypertensive Minority Stroke Survivors: Implications for Population Health Research. [Meeting Abstract]

Ogunlade, Adebayo O.; Joseph, Jennifer; Payano, Leydi; Montesdeoca, Jacqueline; Spruill, Tanya; Williams, Stephen K.; Teresi, Jeanne; Williams, Olajide; Ogedegbe, Gbenga
ISI:000478733401095
ISSN: 0039-2499
CID: 4047942

Frequency of Post-stroke Depression Among Hypertensive Black and Hispanic Stroke Survivors [Meeting Abstract]

Ogunlade, Adebayo O.; Payano, Leydi; Joseph, Jennifer; Williams, Stephen K.; Spruill, Tanya; Teresi, Jeanne; Williams, Olajide; Ogedegbe, Gbenga
ISI:000478733402100
ISSN: 0039-2499
CID: 4047972

Predictors of Delayed Hospital Arrival After Onset of Stroke Symptoms in Black and Hispanic Stroke Survivors [Meeting Abstract]

Chan, Monica; Ogunlade, Adebayo O.; Joseph, Jennifer; Williams, Stephen K.; Spruill, Tanya; Teresi, Jeanne; Williams, Olajide; Ogedegbe, Gbenga
ISI:000478733402125
ISSN: 0039-2499
CID: 4047982

Beliefs about the causes of hypertension and associations with pro-health behaviors

Langford, Aisha T; Solid, Craig A; Gann, Laura C; Rabinowitz, Emily P; Williams, Stephen K; Seixas, Azizi A
OBJECTIVE:To describe behavioral and genetic beliefs about developing hypertension (HTN) by sociodemographic factors and self-reported HTN status, and among those with a history of HTN, evaluate associations between HTN-related causal beliefs and behavior change attempts. METHOD/METHODS:Data from the 2014 Health Information National Trends Survey were evaluated. HTN causal beliefs questions included (a) "How much do you think health behaviors like diet, exercise, and smoking determine whether or not a person will develop high blood pressure/HTN?"; and (b) "How much do you think genetics, that is characteristics passed from one generation to the next, determine whether or not a person will develop high blood pressure/HTN?" Multivariate logistic regressions evaluated associations between HTN causal beliefs and behavior change attempts including diet, exercise, and weight management. RESULTS:Approximately 1,602 out of 3,555 respondents with nonmissing data (33% weighted) reported ever having HTN. In logistic regression models, results show that the more strongly people believed in the impact of behavior on developing HTN, the higher their odds for behavior change attempts. Beliefs about genetic causes of HTN were not associated with behavior change attempts. Women had higher odds of attempts to increase fruit and vegetable intake, reduce soda intake, and lose weight compared to men. Blacks and Hispanics were significantly more likely than Whites to report attempts to lose weight. CONCLUSIONS:Beliefs about behavioral causes of HTN, but not genetic, were associated with behavior change attempts. Health messages that incorporate behavioral beliefs and sociodemographic factors may enhance future prohealth behavior changes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
PMID: 30307273
ISSN: 1930-7810
CID: 3335342

Quality of Cardiovascular Disease Care in Small Urban Practices

Shelley, Donna; Blechter, Batel; Siman, Nina; Jiang, Nan; Cleland, Charles; Ogedegbe, Gbenga; Williams, Stephen; Wu, Winfred; Rogers, Erin; Berry, Carolyn
PURPOSE/OBJECTIVE:We wanted to describe small, independent primary care practices' performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling), as well as on a composite measure that captured the extent to which multiple clinical targets are achieved for patients with a history of arteriosclerotic cardiovascular disease (ASCVD). We also explored relationships between practice characteristics and ABCS measures. METHODS:We conducted a cross-sectional, bivariate analysis using baseline data from 134 practices in New York City. ABCS data were extracted from practices' electronic health records and aggregated to the site level. Practice characteristics were obtained from surveys of clinicians and staff at each practice. RESULTS:= .011) than practices with multiple clinicians. CONCLUSION/CONCLUSIONS:Achieving targets for ABCS measures varied considerably across practices; however, small practices were meeting or exceeding Million Hearts goals (ie, 70% or greater). Practices were less likely to meet consistently clinical targets that apply to patients with a history of ASCVD risk factors. Greater emphasis is needed on providing support for small practices to address the complexity of managing patients with multiple risk factors for primary and secondary ASCVD.
PMCID:5891310
PMID: 29632222
ISSN: 1544-1717
CID: 3036762

The Healthy Hearts and Kidneys (HHK) study: Design of a 2x2 RCT of technology-supported self-monitoring and social cognitive theory-based counseling to engage overweight people with diabetes and chronic kidney disease in multiple lifestyle changes

Sevick, Mary Ann; Woolf, Kathleen; Mattoo, Aditya; Katz, Stuart D; Li, Huilin; St-Jules, David E; Jagannathan, Ram; Hu, Lu; Pompeii, Mary Lou; Ganguzza, Lisa; Li, Zhi; Sierra, Alex; Williams, Stephen K; Goldfarb, David S
Patients with complex chronic diseases usually must make multiple lifestyle changes to limit and manage their conditions. Numerous studies have shown that education alone is insufficient for engaging people in lifestyle behavior change, and that theory-based behavioral approaches also are necessary. However, even the most motivated individual may have difficulty with making lifestyle changes because of the information complexity associated with multiple behavior changes. The goal of the current Healthy Hearts and Kidneys study was to evaluate, different mobile health (mHealth)-delivered intervention approaches for engaging individuals with type 2 diabetes (T2D) and concurrent chronic kidney disease (CKD) in behavior changes. Participants were randomized to 1 of 4 groups, receiving: (1) a behavioral counseling, (2) technology-based self-monitoring to reduce information complexity, (3) combined behavioral counseling and technology-based self-monitoring, or (4) baseline advice. We will determine the impact of randomization assignment on weight loss success and 24-hour urinary excretion of sodium and phosphorus. With this report we describe the study design, methods, and approaches used to assure information security for this ongoing clinical trial. Clinical Trials.gov Identifier: NCT02276742.
PMCID:6007843
PMID: 28867396
ISSN: 1559-2030
CID: 2688792

Sleep Duration and Physical Activity Profiles Associated With Self-Reported Stroke in the United States: Application of Bayesian Belief Network Modeling Techniques

Seixas, Azizi A; Henclewood, Dwayne A; Williams, Stephen K; Jagannathan, Ram; Ramos, Alberto; Zizi, Ferdinand; Jean-Louis, Girardin
Introduction: Physical activity (PA) and sleep are associated with cerebrovascular disease and events like stroke. Though the interrelationships between PA, sleep, and other stroke risk factors have been studied, we are unclear about the associations of different types, frequency and duration of PA, sleep behavioral patterns (short, average and long sleep durations), within the context of stroke-related clinical, behavioral, and socio-demographic risk factors. The current study utilized Bayesian Belief Network analysis (BBN), a type of machine learning analysis, to develop profiles of physical activity (duration, intensity, and frequency) and sleep duration associated with or no history of stroke, given the influence of multiple stroke predictors and correlates. Such a model allowed us to develop a predictive classification model of stroke which can be used in post-stroke risk stratification and developing targeted stroke rehabilitation care based on an individual's profile. Method: Analysis was based on the 2004-2013 National Health Interview Survey (n = 288,888). Bayesian BBN was used to model the omnidirectional relationships of sleep duration and physical activity to history of stroke. Demographic, behavioral, health/medical, and psychosocial factors were considered as well as sleep duration [defined as short < 7 h. and long ≥ 9 h, referenced to healthy sleep (7-8 h)], and intensity (moderate and vigorous) and frequency (times/week) of physical activity. Results: Of the sample, 48.1% were ≤ 45 years; 55.7% female; 77.4% were White; 15.9%, Black/African American; and 45.3% reported an annual income < $35 K. Overall, the model had a precision index of 95.84%. We found that adults who reported 31-60 min of vigorous physical activity six times for the week and average sleep duration (7-8 h) had the lowest stroke prevalence. Of the 36 sleep (short, average, and long sleep) and physical activity profiles we tested, 30 profiles had a self-reported stroke prevalence lower than the US national average of approximately 3.07%. Women, compared to men with the same sleep and physical activity profile, appeared to have higher self-reported stroke prevalence. We also report age differences across three groups 18-45, 46-65, and 66+. Conclusion: Our findings indicate that several profiles of sleep duration and physical activity are associated with low prevalence of self-reported stroke and that there may be sex differences. Overall, our findings indicate that more than 10 min of moderate or vigorous physical activity, about 5-6 times per week and 7-8 h of sleep is associated with lower self-reported stroke prevalence. Results from the current study could lead to more tailored and personalized behavioral secondary stroke prevention strategies.
PMCID:6060565
PMID: 30072944
ISSN: 1664-2295
CID: 3216812

Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling

Carroll, Jennifer K; Fiscella, Kevin; Cassells, Andrea; Sanders, Mechelle R; Williams, Stephen K; D'Orazio, Brianna; Holder, Tameir; Farah, Subrina; Khalida, Chamanara; Tobin, Jonathan N
Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.
PMID: 30122677
ISSN: 1548-6869
CID: 3659012