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Blood pressure in older americans: The U.S. Health and Nutrition Examination Survey (HANES)
434
ABSTRACTS:
HIGH
BLOOD
PRESSURE
CONTROL
The receptionist’s responsibility is in three broad areas: first, in making appointments. Clinic structure must be flexible enough to allow patients reasonable choices regarding times and dates of appointments. They must be made welcome to call regarding appointments rather than miss, without rescheduling, for a legitimate reason. To the degree possible, clinics must be structured to the convenience of patients. A second area is records handling. Having medical files where and when they are needed is important, particularly when a patient is followed by more than one clinic. The third, and perhaps most important area, is patient contact. It is in this area that much can be accomplished by a receptionist to reinforce advice given patients by their doctor/nurse (D/N). Generally, the receptionist is the first contact the patient has with the clinic, thereby setting the tone for patient/clinic relationship. First impressions are important. A clinic can be judged by the receptionist’s attitude. The first step in building a good patient/clinic relationship is having the trust of the patient. Patients need to know the receptionist is a liaison between the D/N and patient, not a blocker who protects the D/N from the patient. Putting patients at ease in the waiting room makes it easier for them to accept advice and treatment; relaxed people are more receptive. There are times the patient will tell a receptionist things pertaining to their disease they might not think to relay to the D/N. Encouraging patients to talk to D/N is often all that is needed, although sometimes it is wise for the receptionist to personally inform the D/N. Reassurance that the patient will receive the best care available in the clinic will often assuage apprehension. In short, a receptionist can be a vital link in the health care of the hypertensive patient. By working closely with D/N and patient, the receptionist can provide support for both.
A-36 Evaluation of Borderline Hypertension in Young Adults Using Orthosratic and Exercise Stress. PETER G. HANSON, University of Wisconsin Center for Health Sciences, 1552 University Avenue, Madison, Wisconsin 53706; RODOLFO LEAL; GUILLERMO DEVENECIA; MARGRETNEWTON. Borderline essential hypertension (BEH) in young adults presents a difftcult diagnostic and management problem due to lability in resting blood pressure (RBP) values. We have used a combination of orthostatic and exercise stress to evaluate and compare BP responses in 66 male patients (18-33 years) with borderline essential hypertension and 44 age group controls. BEH patients had variable RBP with normal and elevated (140-155/90-105) values and early hypertensive retinal vascular changes detected by stereofundic photographic studies. Controls had normal RBP and retinal vascular studies. Systolic (SBP) and diastolic (DBP) pressures were measured during four standardized conditions: supine rest x 30 mitt, orthostatic rest x 5 min, isometric handgrip (50% max) x 90 set, maximum treadmill exercise (Balke protocol). During supine rest, average BP in both groups was within normal range (120-135/70-85). BEH patients had significant increases (P < 0.05) in orthostatic DBP (XX)); isometric DBP (>125) and maximum treadmill exercise SBP (>210) and DBP (>85). BEH patients also showed a greater early rise in SBP (>180) at submaximum (50%) treadmill effort. There was correlation between a graduated score for stress-induced BP responses and the estimated grade of hypertensive retinal vascular change in BEH patients. These combined BP responses may provide useful criteria for initial evaluation and subsequent management of borderline essential hypertension in young adults.
A-37 Blood Pressure in Older Americans: The U.S. Health and Nutrition Examination Survey (HANES). ALAN L. HULL, University of Michigan, Ann Arbor, Michigan; WILLIAM R. HARLAN; FRANCES THOMPSON.
Data from the Health and Nutrition Examination Survey (HANES) were analyzed to provide data on blood pressure and related demographic, anthropometric, and dietary variables. This survey was conducted from 1971 to 1974 on a sample of 23,808 persons selected to be representative of the U.S. population aged l-74 years. For the present analysis, systolic and diastolic pressures were considered separately for each race-sex group in the age ranges of 45-54,55-64, and 65-74 years. Throughout these ages, systolic and diastolic pressures were higher for black men and women than comparable
ABSTRACTS:
HIGH
BLOOD
PRESSURE
CONTROL
435
white groups. Systolic pressures for women (white and black) were higher above age 54 than for men. However, diastolic pressures were similar for men and women because there was a trend downward for males and a slight increase and subsequent plateau for females of the same age. Socioeconomic variables were inversely related to blood pressure. Degree of adiposity was directly related to systolic and diastolic pressures. Other nutritional variables, including dietary sodium intake, are being examined. Other aspects of the survey permit linking of the needs for antihypertensive therapy to seeking and receiving of care. Data from HANES provide a representative and useful portrayal in older Americans of blood pressure, and its correlates, and the seeking of medical care. A-38
of Exercise Training on Subjects with Initially Elevated Blood Pressure. G. HARLEY HARTUNG, The Methodist Hospital and Baylor College of Medicine, Houston, Texas 77030; IMOGENE VLASEK.
Effect
Observations were made that blood pressure was reduced after an I-week exercise training program in a substantial number of cases. The purpose of this study was to determine the effect of training on resting blood pressure in men and women with elevated levels of systolic and/or diastolic pressure. Of 115 participants enrolled in an adult exercise program, 18 (group HBP) were initially identified as having eievated systolic and diastolic pressure, 22 (group DP) had elevated diastolic pressure (XXI mm Hg), and 8 (group SP) had elevated systolic pressure (>140 mm Hg) only. After 8 weeks of aerobic training consisting mainly of walking, jogging, and cycling, blood pressure measurements were made under identical conditions. A correlated f test was used to determine the significance of mean changes. Group HBP had significant (P < 0.001) decreases in both systolic (152.8-136.6 mm Hg) and diastolic (99.7-89.2 mm Hg) pressure. Group SP had a significant (P < 0.001) decrease in SBP (147.6-128.7 mm Hg) and group DP had a significant decrease in DBP (94.6-86.6 mm Hg, P < 0.001). All groups also had significant (P < 0.01) decreases in weight and percentage fat and an increase in estimated aerobic capacity, except for group DP which did not have significant weight loss. Our conclusion is that regular exercise of the aerobic type results in decreases in both systolic and diastolic blood pressure in subjects in whom the pressure is initially elevated. Exercise training could and should be considered as an adjunct or alternative to the drug treatment of hypertension or borderline hypertension A-39 Determinants of Blood Pressure Lowering in the Management of Hypertension. R. B. HAYNES, McMaster University Faculty of Medicine, Hamilton, Ontario, Canada; D. L. SACKETT; D. W. TAYLOR; E. S. GIBSON; J. S. SICURELLA; C. BERNHOLZ.
Clinical
Previous investigators of the quality of hypertensive care have failed to demonstrate a relationship between the blood pressure response and large number of elements of the process of care. These attempts were hampered by three important shortcomings. First, the process measures placed heavy emphasis on diagnostic tests that would have scant impact on outcomes because of the rarity of disorders they detect; comparatively little attention was directed toward the process of follow-up. Second, a major process item, the clinical decision, to treat or not to treat, was ignored by including only treated patients. Finally, the measurements of medication compliance used in these early studies were relatively insensitive. We have assessed the relationship between process and outcome in an inception cohort of 230 men referred to primary care physicians after being found hypertensive (diastolic 295 mm Hg on two occasions over 3 months). The men were reassessed, at 6 and 12 months after referral, for treatment (if any), compliance (by pill count at home), and BP response. One-third of patients were left untreated and their BP response was highly significantly less (P < 0.001) than those who were treated. For treated men, the vigor of treatment (derived from analysis of pharmacologic trials) was highly significantly related to BP drop (P < 0.005). The best determinant of BP response, however, was the product of prescribed vigor and medication compliance (P < 0.0001): 64% of men prescribed a “high vigor” antihypertensive regimen achieved goal blood pressure whereas 7% of men who actually consumed a high vigor regimen achieved this goal (P < 0.01). The process of hypertensive care is, indeed, related to blood pressure lowering.
ABSTRACTS:
HIGH
BLOOD
PRESSURE
CONTROL
The receptionist’s responsibility is in three broad areas: first, in making appointments. Clinic structure must be flexible enough to allow patients reasonable choices regarding times and dates of appointments. They must be made welcome to call regarding appointments rather than miss, without rescheduling, for a legitimate reason. To the degree possible, clinics must be structured to the convenience of patients. A second area is records handling. Having medical files where and when they are needed is important, particularly when a patient is followed by more than one clinic. The third, and perhaps most important area, is patient contact. It is in this area that much can be accomplished by a receptionist to reinforce advice given patients by their doctor/nurse (D/N). Generally, the receptionist is the first contact the patient has with the clinic, thereby setting the tone for patient/clinic relationship. First impressions are important. A clinic can be judged by the receptionist’s attitude. The first step in building a good patient/clinic relationship is having the trust of the patient. Patients need to know the receptionist is a liaison between the D/N and patient, not a blocker who protects the D/N from the patient. Putting patients at ease in the waiting room makes it easier for them to accept advice and treatment; relaxed people are more receptive. There are times the patient will tell a receptionist things pertaining to their disease they might not think to relay to the D/N. Encouraging patients to talk to D/N is often all that is needed, although sometimes it is wise for the receptionist to personally inform the D/N. Reassurance that the patient will receive the best care available in the clinic will often assuage apprehension. In short, a receptionist can be a vital link in the health care of the hypertensive patient. By working closely with D/N and patient, the receptionist can provide support for both.
A-36 Evaluation of Borderline Hypertension in Young Adults Using Orthosratic and Exercise Stress. PETER G. HANSON, University of Wisconsin Center for Health Sciences, 1552 University Avenue, Madison, Wisconsin 53706; RODOLFO LEAL; GUILLERMO DEVENECIA; MARGRETNEWTON. Borderline essential hypertension (BEH) in young adults presents a difftcult diagnostic and management problem due to lability in resting blood pressure (RBP) values. We have used a combination of orthostatic and exercise stress to evaluate and compare BP responses in 66 male patients (18-33 years) with borderline essential hypertension and 44 age group controls. BEH patients had variable RBP with normal and elevated (140-155/90-105) values and early hypertensive retinal vascular changes detected by stereofundic photographic studies. Controls had normal RBP and retinal vascular studies. Systolic (SBP) and diastolic (DBP) pressures were measured during four standardized conditions: supine rest x 30 mitt, orthostatic rest x 5 min, isometric handgrip (50% max) x 90 set, maximum treadmill exercise (Balke protocol). During supine rest, average BP in both groups was within normal range (120-135/70-85). BEH patients had significant increases (P < 0.05) in orthostatic DBP (XX)); isometric DBP (>125) and maximum treadmill exercise SBP (>210) and DBP (>85). BEH patients also showed a greater early rise in SBP (>180) at submaximum (50%) treadmill effort. There was correlation between a graduated score for stress-induced BP responses and the estimated grade of hypertensive retinal vascular change in BEH patients. These combined BP responses may provide useful criteria for initial evaluation and subsequent management of borderline essential hypertension in young adults.
A-37 Blood Pressure in Older Americans: The U.S. Health and Nutrition Examination Survey (HANES). ALAN L. HULL, University of Michigan, Ann Arbor, Michigan; WILLIAM R. HARLAN; FRANCES THOMPSON.
Data from the Health and Nutrition Examination Survey (HANES) were analyzed to provide data on blood pressure and related demographic, anthropometric, and dietary variables. This survey was conducted from 1971 to 1974 on a sample of 23,808 persons selected to be representative of the U.S. population aged l-74 years. For the present analysis, systolic and diastolic pressures were considered separately for each race-sex group in the age ranges of 45-54,55-64, and 65-74 years. Throughout these ages, systolic and diastolic pressures were higher for black men and women than comparable
ABSTRACTS:
HIGH
BLOOD
PRESSURE
CONTROL
435
white groups. Systolic pressures for women (white and black) were higher above age 54 than for men. However, diastolic pressures were similar for men and women because there was a trend downward for males and a slight increase and subsequent plateau for females of the same age. Socioeconomic variables were inversely related to blood pressure. Degree of adiposity was directly related to systolic and diastolic pressures. Other nutritional variables, including dietary sodium intake, are being examined. Other aspects of the survey permit linking of the needs for antihypertensive therapy to seeking and receiving of care. Data from HANES provide a representative and useful portrayal in older Americans of blood pressure, and its correlates, and the seeking of medical care. A-38
of Exercise Training on Subjects with Initially Elevated Blood Pressure. G. HARLEY HARTUNG, The Methodist Hospital and Baylor College of Medicine, Houston, Texas 77030; IMOGENE VLASEK.
Effect
Observations were made that blood pressure was reduced after an I-week exercise training program in a substantial number of cases. The purpose of this study was to determine the effect of training on resting blood pressure in men and women with elevated levels of systolic and/or diastolic pressure. Of 115 participants enrolled in an adult exercise program, 18 (group HBP) were initially identified as having eievated systolic and diastolic pressure, 22 (group DP) had elevated diastolic pressure (XXI mm Hg), and 8 (group SP) had elevated systolic pressure (>140 mm Hg) only. After 8 weeks of aerobic training consisting mainly of walking, jogging, and cycling, blood pressure measurements were made under identical conditions. A correlated f test was used to determine the significance of mean changes. Group HBP had significant (P < 0.001) decreases in both systolic (152.8-136.6 mm Hg) and diastolic (99.7-89.2 mm Hg) pressure. Group SP had a significant (P < 0.001) decrease in SBP (147.6-128.7 mm Hg) and group DP had a significant decrease in DBP (94.6-86.6 mm Hg, P < 0.001). All groups also had significant (P < 0.01) decreases in weight and percentage fat and an increase in estimated aerobic capacity, except for group DP which did not have significant weight loss. Our conclusion is that regular exercise of the aerobic type results in decreases in both systolic and diastolic blood pressure in subjects in whom the pressure is initially elevated. Exercise training could and should be considered as an adjunct or alternative to the drug treatment of hypertension or borderline hypertension A-39 Determinants of Blood Pressure Lowering in the Management of Hypertension. R. B. HAYNES, McMaster University Faculty of Medicine, Hamilton, Ontario, Canada; D. L. SACKETT; D. W. TAYLOR; E. S. GIBSON; J. S. SICURELLA; C. BERNHOLZ.
Clinical
Previous investigators of the quality of hypertensive care have failed to demonstrate a relationship between the blood pressure response and large number of elements of the process of care. These attempts were hampered by three important shortcomings. First, the process measures placed heavy emphasis on diagnostic tests that would have scant impact on outcomes because of the rarity of disorders they detect; comparatively little attention was directed toward the process of follow-up. Second, a major process item, the clinical decision, to treat or not to treat, was ignored by including only treated patients. Finally, the measurements of medication compliance used in these early studies were relatively insensitive. We have assessed the relationship between process and outcome in an inception cohort of 230 men referred to primary care physicians after being found hypertensive (diastolic 295 mm Hg on two occasions over 3 months). The men were reassessed, at 6 and 12 months after referral, for treatment (if any), compliance (by pill count at home), and BP response. One-third of patients were left untreated and their BP response was highly significantly less (P < 0.001) than those who were treated. For treated men, the vigor of treatment (derived from analysis of pharmacologic trials) was highly significantly related to BP drop (P < 0.005). The best determinant of BP response, however, was the product of prescribed vigor and medication compliance (P < 0.0001): 64% of men prescribed a “high vigor” antihypertensive regimen achieved goal blood pressure whereas 7% of men who actually consumed a high vigor regimen achieved this goal (P < 0.01). The process of hypertensive care is, indeed, related to blood pressure lowering.