Hypertension: does “pay-for-performance” deliver quality care?

Nowadays, health care practitioners are reimbursed on a “pay-for-performance” basis also called P4P which rewards physicians financially for achieving targets and treatment goals. The financial rewards can vary from increase in percentage of reimbursements, bonuses, and grants. Even though the P4P program aims to promote better health care delivery, it can backfire when doctors may avoid patients with complex disorders (and therefore more difficult goals to achieve) and opt more for patients with simple, straightforward ailments (e.g. easy targets). As an example, patients with diabetes are also likely to present with concomitant illnesses such as high blood pressure, heart disease, and other cardiovascular disorders.

Researchers looked followed up 141,609 patients with high blood pressure from at eight Veterans Affairs (VA) hospitals in three states. They compared quality of care and patient satisfaction between patients with simple hypertension and those who are “sicker” hypertensive patients, e.g. with other co-existing conditions, from diabetes to chronic lung diseases.

According to lead author Dr. Laura A. Petersen of the VA Health Services Research and Development Center of Excellence and affiliated with the Baylor College of Medicine, in Houston, Texas

“Many clinicians are concerned that when they care for patients with multiple medical conditions, their performance on measures of health care quality is going to suffer due to that complexity. The concern is that the time spent treating other unrelated conditions would take away time from treating high blood pressure, causing performance on measures of quality to suffer.”

The results of the study show that:

• “Sicker patients” are more likely to receive high quality health care.
• Patients with multiple diseases have to take many types of medications but expressed an overall high satisfaction with the medical care they receive.
• Patient satisfaction is generally positive regardless whether patients are treated for high blood pressure only or for other conditions as well.

“Overall good quality care” was defined as:

• When doctors managed to keep blood pressure under 140/90 millimeters of mercury (mm Hg) at first visit and within the six-month follow-up period.
• When doctors are actively trying to control blood pressure (even if the patient fell short of the treatment goal) as shown by intensified follow-up care that would include change in medication, nutrition and lifestyle change counselling, etc.

The study results indicate that P4P measures do not necessarily “penalize physicians who treat patients with more complicated medical conditions”, at least in the case of hypertensive patients.

One weak point of the study is the fact that it looked only at patients under the VA system which essentially differs in a lot of ways from the civilian health care system.

However, the results of the study should be a reassurance to both health care practitioners and patients alike that indeed the P4P program seems to be also achieving its goal - quality health care.

               

Watch your salt intake!

Do you know how much salt you should take each day? The amount of daily recommended level of sodium is not more than 1,500 mg (equivalent to about 5 to 6 g of table salt). And it seems that most Americans consume more than double of that, according to a Centers for Disease Control and Prevention (CDC) press release.

But why should we pay attention to our daily salt intake?

A diet rich in sodium is not favourable for our cardiovascular health. It increases the risk of high blood pressure, a major risk factor for heart disease and stroke. These diseases are the first and third leading causes of mortality in the United States, respectively.

Researchers at the University of California, San Francisco report that even a small reduction in dietary salt can have far-reaching consequences. They estimate that ” cutting just 1 g of salt a day would prevent a quarter of a million new heart-disease cases and 200 000 deaths from any cause over a decade.”

We may not be aware of it, but most of the salt we consume does not come from our very own kitchen. 80% of salt in Western country’s diet comes from processed and prepared food. It is therefore difficult for people to keep track of their salt consumption.

According to the CDC.

Nationwide, 16 million men and women have heart disease and 5.8 million are estimated to have had a stroke.  People who reduce their sodium consumption benefit from improved blood pressure and reduce their risk for developing other serious health problems. Choosing foods like fresh fruits and vegetables, when eating out, asking that foods be prepared without added salt, and reading the nutrition label of foods before purchasing can improve health for all adults.

However, not all food labels reflect the real salt content and some labels are too complicated for consumers to understand.

The USCSF researchers recommend that public-health types of intervention such as

• regulatory efforts to restrict salt
• force labeling of foods based on their salt content
• encouragement of food manufacturers to reduce salt.

“The experience in other countries suggests that with these very small changes we are describing, we will not change the taste of foods or the profit margins of the food industry, but it would be a great benefit for public health.”

Some major players in the food industry have answered the public health issue of salt consumption. The food company Campbell’s has set a good example and came up with a special line of heart-friendly products that contains 50% less sodium. Let us hope that more food companies will follow suit.

Photo credit: stock. xchng

               

The STITCH study: hypertension management made simple

“Less is better” might be the new strategy in treating high blood pressure, according a study by Canadian researchers. The study called “Simplified Treatment Intervention to Control Hypertension” (STITCH) was conducted by researchers at the Robarts Research Institute of the University of Western Ontario. The study followed up 2,104 participants with high hypertension, basically patients from 45 family practices in southwestern Ontario, Canada.

There are many different guidelines of the management of hypertension depending on the country and the medical group you are talking to. They can be complicated and confusing and can be challenging to both patients and doctors alike. Furthermore, they are frequently updated and amended.

The objective of the STITCH study is “to see if there are simpler ways to help patients (and their doctors) reduce their blood pressure to goal levels than by following national guidelines which can be complicated.”

The STITCH study came up with the following simplified treatment regime:

(1) initial therapy with a low-dose angiotensin-converting enzyme (ACE) inhibitor/diuretic or angiotensin receptor blocker/diuretic combination;

(2) up-titration of combination therapy to the highest dose;

(3) addition of a calcium channel blocker and up-titration; and

(4) addition of a non-first-line antihypertensive agent.

The results of the study suggest that starting with low doses of combination drug, then gradually increasing may actually be better for recently diagnosed hypertensive patients. “A half tablet of a single pill combination drug (e.g. an ACE-inhibitor/diuretic or angiotensin receptor blocker/diuretic combination) than the regular starting dose of a single drug” may actually be more effective. The results of the study will be published in the April edition of the journal Hypertension.

High blood pressure is a risk factor for heart disease and stroke. According to the most recent estimates (source: American Heart Association), one in three Americans have high blood pressure.

Aside from pharmacological therapy, lifestyle changes are necessary to prevent, manage and control high blood pressure. Some of these lifestyle changes are (Source: American Heart Association Scientiific Advisory):

• Weight Loss
• Dietary Salt Restriction
• Moderation of Alcohol Intake
• Increased Physical Activity
• Ingestion of a High-Fiber, Low-Fat Diet

Honestly, even the “simplified” treatment regime of the STITCH study doesn’t look that simple to me. I’d rather go for the lifestyle changes and got for prevention.

Photo credit: stock.xchng

               

What is bad for the heart is bad for the eyes

We all know that high blood pressure and high cholesterol levels are bad for our heart. A study by Irish and Canadian researchers shows that these health conditions can damage our eyes as well.

According to a recent report in the Archives of Ophthalmology

“The two conditions appear to increase one’s risk for retinal vein occlusion, a condition that leads to vision loss. It results from one or more veins carrying blood from the eye to the heart becoming blocked and causing bleeding or fluid build-up.”

The study found that high blood pressure increases the risk of developing retinal vein occlusion by more than 3.5 times while high cholesterol levels increases it 2.5-fold.

What is retinal vein occlusion?

Retinal vein occlusion is a blockage in the blood supply from the retina — the light-sensitive tissue in the back of the eye. Veins of the retina can become blocked by a blood clot. Retinal vein occlusion also can occur when the retinal arteries put pressure on the retinal vein.

according to the Medline Health Encyclopedia.

The pressure on the retina is linked to several disorders, including diabetes, glaucoma, hardening of the arteries (atherosclerosis), high blood pressure, and blood clot. Symptoms of retinal vein occlusion are blurring or vision loss in all or part of one eye.

The study analysed results of 21 studies previously published involving a total of 28,646 patients. The findings show that 63.6% of those with retinal vein occlusion also had concurrent conditions of hypertension. In addition, 35.1% of these patients have high cholesterol levels.

It is therefore important that

“…those who treat patients with hypertension, diabetes and high cholesterol should be as concerned with the health of the person’s eyes as they are with the health of the person’s cardiovascular system.”

Remember, when we do something that is detrimental to our health, it’s not only our heart that is at stake, it’s our eyes as well. Our sense of sight is very important and loss of vision is a major disability that can drastically affect our quality of life.

Want to know more about cholesterol and blood pressure? The American Heart Association can give you a sample of the brochure Understanding and Controlling Cholesterol for free. The Hypertension Primer is also available for free. A resource post from last month gives some tips on blood pressure awareness.

Original Article Source:

O’Mahoney P et al. Retinal Vein Occlusion and Traditional Risk Factors for Atherosclerosis. Arch Ophthalmol. 2008;126(5):692-699.

Photo credit

               

Heavy drinking: bad for both male and female hearts

Heavy drinking is bad for the heart and for the arteries. Furthermore, heavy alcohol consumption affects men and women differently - although in the long run, the effects are never beneficial. This is according to a report presented at American Society of Hypertension 2008 Annual Meeting in New Orleans, LA in May.

Men: Heavy drinking among men leads to elevated blood pressure. Chronic high blood pressure then leads to stiffening of the arteries.

Women: Among women, heavy drinking does not necessarily cause high blood pressure but they are more at risk of developing enlarged hearts with structural abnormalities.

“Women … are at greater risk of developing increased left ventricular mass and septal thickness, whereas men experience more arterial and ventricular stiffness.“

The study investigated 200 men and women in Dublin, Ireland who were patients in a hypertension clinic. The drinking habits of the patients were classified as follows:

• nondrinkers
• moderate drinkers (males: 1 to 21 units of alcohol per week; females: 1 to 14 units per week)
• heavy drinkers (males: >21 units per week; females: >14 units per week)

The patients were then followed up by blood pressure measurements, conventional ECG and tissue Doppler imaging. Pulse-wave velocity and augmentation index were used to measure arterial stiffness.

“Investigators observed in men a dose-response relationship between alcohol intake and aortic systolic and diastolic blood pressure, the augmentation index, pulse-wave velocity, and indices of diastolic function. Even among those who drank moderately, there were significant increases in aortic blood pressures and the augmentation index. These findings, however, differed from the females in the study. In women, there was a dose-response relationship between alcohol and left ventricular septal and posterior wall thickness and left ventricular mass index. Even among heavy female drinkers, there was no relationship between drinking and arterial stiffness and high blood pressures.“

The results, especially those for women, were especially surprising. For one thing, heavy drinker females do not necessarily develop hypertension. It is a common belief that it is chronic hypertension that leads to the deleterious cardiovascular effects. Women, however, are more likely to develop liver disease than men. This difference is due to the fact that women are smaller and have relatively lesser liver enzymes to metabolize alcohol.

The study, however, shows that women are not only at risk for liver disease, but for heart disease as well. In fact, for women, the bad effects are not evident in the arteries but directly in the heart itself.

The heart enlargement among heavy drinking women can eventually lead to heart failure. With this condition, the heart muscles become weaker and weaker and will eventually lose the capacity to contract.

A rise in the rate of alcohol consumption among females has been the trend in Ireland. The researchers speculate that this might be due to the country’s booming economy as well as the belief that alcohol is actually beneficial to your health.

Indeed, several recent studies have reported that light to moderate alcohol consumption may actually be good for the heart. However, it seems that we need to draw a line between moderate drinking and drinking that is harmful to our health.

Photo credit

               

Resource for May: National Blood Pressure Awareness Month

When was the last time you had your blood pressure (BP) checked? Do you know the difference between systole BP and diastole BP and what BP measurements mean for your health? Do you know your risk factors for hypertension and other cardiovascular disorders?

May is the month to start answering these questions. Since 1984, May has been proclaimed as the National Blood Pressure Awareness Month in the United States. The Centers for Disease Prevention and Control (CDC) also calls it the National High Blood Pressure Education Month.

Why is hypertension dangerous? High blood pressure is a major risk for serious cardiovascular disorders such as myocardial infarction (heart attack), stroke, heart failure, and kidney failure. Heart diseases and stroke are the leading causes of death in the US.

According to the CDC, approximately 73 million Americans have high blood pressure. The direct and indirect health care costs of high blood pressure were estimated to cost more than 69 billion dollars in 2008.

According to the American Heart Association (AHA), you have high blood pressure or hypertension when:

Systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher; or

Taking medicine to lower blood pressure; or

Being told twice by a doctor or other healthcare professional that you have hypertension

The CDC also gives this definition:

“High blood pressure or hypertension is defined as having a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher measured on two or more occasions, or taking anti-hypertensive medication. Normal blood pressure levels are considered to be a systolic blood pressure less than 120 mm Hg and a diastolic blood pressure less than 80 mm Hg. Persons with above normal levels (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg) but are not hypertensive are considered to have “prehypertension.” These people are at a greater risk of developing hypertension than are persons with normal blood pressure levels.”

As part of its High Blood Pressure Awareness Month program, the AHA is inviting you to check, manage, and monitor your blood pressure with their free and easy-to use suite of online tools.

Blood Pressure Management Center.

This is a web-based tool which allows you to manage your high blood pressure while also keeping track of your body weight, physical activity and more. The tool is a product of a successful AHA alliance with Microsoft and their new consumer health platform, Microsoft HealthVault which “helps us implement our vision around health information technology.”

Blood Pressure Tracking Chart

With this downloadable and printable blood pressure tracking chart, you can track your blood pressure measurements and how they correspond to your weight and overall feeling of well-being. This is an important part of your Home Monitoring Plan after consultation with your doctor.

High Blood Pressure Risk Calculator.

With the latest readings of your blood pressure, you can actually calculate your risks of dying from cardiovascular events such as a heart attack or a stroke, as well as your risks of developing heart failure and kidney disease.

Heart Profilers

With this tool, you can find out more about your condition and about treatments and strategies to help you manage your blood pressure. The tool gives you a confidential personalized report about your treatment options for your condition.

High Blood Pressure e-newsletter

Through this free, monthly e-newsletter, AHA brings you news, tips and even heart-friendly recipes not only on hypertension but also on related diseases such as heart disorders, diabetes, and obesity.

The AHA tools aim to help us understand our health risks, get some quick answers to basic questions about our blood pressure.

In addition, you can also take the high blood pressure quizzes of MayoClinic to find out whether you have your high blood pressure under control and whether you are doing everything you can to manage your hypertension.

The CDC has also been stepping up its efforts for high blood pressure through the

The CDC has also been stepping up its efforts for high blood pressure through the CDC’s State Heart Disease and Stroke Prevention Program.

“CDC currently funds health departments in 33 states and the District of Columbia to develop effective strategies to reduce the burden of heart disease, stroke, and related risk factors. This program emphasizes the need for policy, environmental, and systems changes that promote heart-healthy and stroke-free living and working conditions.”

I’ve personally tried the High Blood Pressure Risk Calculator and I’m happy with my results. However, getting good results doesn’t mean we should become complacent and forget about our blood pressure. Constant awareness and vigilance is necessary.

If your risk results are not optimal, then it’s probably time to talk to your doctor and discuss your options, including lifestyle changes that can help lower blood pressure and your health risks.

I must admit I am a bit disappointed with my performance on the blood pressure quizzes. It only goes to show again that complacency is something we cannot afford when it comes to our health. And that learning is a continuous process.

Yes, May is high blood pressure awareness month but we should not stop being on guard even when this month is over. Remember, blood pressure can change rather abruptly and with it your health status and your risks.

Photo credit

               

May is High Blood Pressure Awareness Month

May is High Blood Pressure Awareness Month, as initiated by the American Heart Association (AHA). More details soon!

               

Diabetic Heart Health

Tell me something I didn’t know, please.

This morning I read an article on the elevated risk of cardiovascular disease in women with diabetes. I would hate to have to point out to the scientists that discovered this that diabetic women already knew this. My mother has had two heart catheter procedures in the past few years, I do not know about her cholesterol, but I would guess it is not a pretty number.

Lower the pressure.

Blood pressure is always an issue with diabetics. Before being diagnosed with diabetes, my mother lived with low blood pressure, much like my own. In the years following the progression of the disease, her blood pressure steadily rose. Today she is on medication to control it and aspirin therapy. I have been incorporating better whole foods into her diet, which seems to have helped bring her sugar levels to a more controlled plateau.

At least the vampires will go away.

How do you control your cholesterol, though? Many people endorse garlic as a cure-all, the best thing for cholesterol ever. I have seen the effects of fresh garlic work on cholesterol in the past. My oldest daughter’s father took garlic supplements and ate roasted garlic spread on toast with every evening meal for a month. His cholesterol levels dropped 80 points in a month. Will that work for everyone? I cannot say that it will. Unless you have an allergy to garlic, it certainly will not hurt you to add a bit to your diet.

Caring for your heart is easy, all you need to do is exercise more and eat a diet with whole grains, plenty of fiber, and cut the junk out of your life. Ok, maybe it sounds easier than it actually is. I can guarantee you will feel much better if you talk to your doctor about the proper way to care for your heart, then follow his or her advice.

Want a heart healthy quick breakfast? With these muffins, you can prepare them the night before and grab one on the way out the door in the morning!

Blue Berry Muffins

Ingredients:
* 2 eggs
* ½ cup soymilk
* ¼ cup vegetable oil
* 1 cup flour
* ½ cup wheat flour
* ½ cup soy flour
* ½ cup Sucralose( splenda)
* 1 tablespoon baking powder
* 1 ½ cup blue berries (frozen is fine)

Mix all ingredients except blueberries. Shake the blueberries in a zip top bag with a bit of flour. Flour helps the blue berries be suspended in the muffins instead of sinking. Add to batter, mix.

Pour into a greased or papered muffing tin. Bake at 350 degrees F for 30 minutes. Begin checking for doneness at 20 minutes. (12 muffins)

               

Genetic Risk Factors for Diabetes

The causes of diabetes are complex and only partly understood. Complicating the picture even further is the fact that there are multiple types, each with its own risk factors. Type 1 and Type 2 diabetes are the most common, encompassing about 97% or more of cases in the U.S. Each results from a combination of environmental and genetic influences.

Of those, Type 2 is far and away the most common, about 90% of cases.

Obesity is thought to be a major contributor to Type 2 diabetes. Being overweight is a good prototype for a cause since it is itself a combination of genetic background and lifestyle choices. Though the diet opted for and the amount of exercise one chooses to undertake are lifestyle choices, it’s still true that some individuals gain or shed weight more easily than others.

But there are many other factors, as well.

A history of diabetes during pregnancy contributes to part of the total risk. Just shy of 40% of women who develop diabetes during pregnancy (a type known as gestational diabetes) will later develop Type 2 diabetes. That typically occurs within 5-10 years after giving birth. Those who give birth to larger babies have a greater risk.

Glucose intolerance is another genetically influenced factor. Since Type 2 diabetes results not from underproduction of insulin (as in Type 1) but from inadequate use of it, it shouldn’t be surprising that glucose intolerance is a contributing circumstance. That glucose intolerance should exist is puzzling enough, since it’s a major source of the body’s energy. But genetic anomalies produce some unusual situations.

Ethnicity plays a role in whether or not an individual will develop Type 2 diabetes, though the reasons are not fully understood. Even after adjusting for lifestyle, Aboriginals, Africans, Latin Americans and some Asian groups are at higher risk. The profile varies between 1.5-2 times the incidence among Caucasians, according to one broad Canadian study. Oddly, though, the risk of Type 1 diabetes is much higher among Caucasians than any other race.

Having high blood pressure raises the odds, too. That again is partly a lifestyle (chiefly, diet and exercise) choice but it has a strong genetic aspect as well. There’s a strong correlation between those with high blood pressure and those who will develop diabetes. Similarly, high cholesterol levels increase the risk. Over 40% of those with diabetes have higher than average levels of cholesterol in the blood.

But simple family medical circumstance is probably the largest genetic risk factor.

An individual with a parent or sibling who has Type 1 diabetes has him or herself a risk 10-20 times higher than average. For a newborn baby with a parent who has Type 1 diabetes the odds are 1 in 25, or 4% if the mother gives birth before age 25. Over age 25, the risk is 1%, about the same as the general population. The odds rise again to about 10% if either parent contracted diabetes before age 11.

The genetic risk factors of contracting diabetes are still an active area of research. Fortunately, while in generations past there was nothing one could do to influence them, modern genetic treatments hold out promise of altering even these odds.

               

High Blood Pressure & The Damage It Can Cause

By Thomas Parker

High blood pressure is a very serious disease. It can cause damage to your vital organs and in the worst cases can be fatal. Sufferers of high blood pressure often do not show any symptoms and when the symptoms do show, the damage has often already occurred. Therefore, the best way to determine whether you have high blood pressure or not is to go and see a trained doctor and get it checked out.

Blood pressure is said to be normal if it is 140 over 85. However, it can differ between different races and geographic locations. Generally speaking blood pressure above 140 over 85 is said to be high. A few degrees above normal may not cause any significant problems but a significant increase can be dangerous.

As I mentioned above high blood pressure does not always display symptoms. However, there are a number of signs you can look out for. Severe headaches can indicate high blood pressure, especially if they occur more regularly than usual. If you find yourself breathless after a little exertion this is another sign that you may have high blood pressure, particularly if this didn’t seem to happen previously. A third sign is increased nose bleeds or increased bleeding from any other area of the body. Other signs of high blood pressure may include hyperventilation or tension. If you notice any of these signs, particularly an increased occurrence of any particular sign e.g. increased nosebleeds, you should seek further advice from your doctor immediately.

If left untreated high blood pressure can cause unwanted damage to a number of areas across your body. Your eyes receive blood through the optic arteries and if these are damaged by high blood pressure then your vision may be impaired. High blood pressure can also cause damage to the brain. The brain requires oxygen and nutrition which is supplied in the blood stream. If this supply is impaired by high blood pressure it can lead to a mini-stroke, a full stroke and even dementia in old age. High blood pressure can also cause serious damage to the heart including heart attacks and heart failure.

As you can see high blood pressure can easily go unnoticed and potentially cause a lot of damage to your body. However, if it is identified early enough then you are likely to never experience any of the consequences mentioned in this article. It’s a good idea to go and see your doctor right away and get tested for high blood pressure. As long as it is diagnosed early enough it can be managed using a combination of medication, diet and exercise.

————————

You can find more great information on High Blood Pressure and how to treat it by heading over to blog.freefitnesstips.co.uk/

Article Source: EzineArticles.com/?expert=Thomas_Parker

               

Next Page »