Mayo Clinic proceedings最新文献

Objective: To evaluate the effects of mobile apps with tailored recommendations on changes in blood pressure (BP) and drug adherence.

Patients and methods: This study is a randomized, open-label, multicenter trial to evaluate the efficacy of self-monitoring of BP (SMBP) with a mobile application-based feedback algorithm (SMBP app with feedback) compared with SMBP alone. Patients with uncontrolled hypertension aged 19 years or older were randomly assigned. In the control group, the patients only measured their BP at home using the mobile app combined with a Bluetooth BP monitor and received standard care, whereas in the intervention group, the patients could also receive alerts for BP measurement and additional recommendations from the app using a feedback algorithm in response to the obtained BP value. The primary end point was the change in mean home systolic BP at 24 weeks.

Results: From September 1, 2019, through July 8, 2020, 184 patients were randomized into 2 groups: SMBP app with feedback (n=97) and SMBP alone (n=87). At 24 weeks, the mean ± SD home systolic BP reduction from baseline was significantly greater in the SMBP app with feedback group than in the SMBP alone group (-22.4±13.5 vs -17.2±13.3 mm Hg; P=.02). The SMBP app with feedback group had higher drug adherence and proportion of adherence of 95% or greater than the SMBP alone group.

Conclusion: The SMBP app with feedback is superior to SMBP alone in terms of systolic BP reduction and improved drug adherence in patients with hypertension. Given the high cost of traditional interventions between patients and health care professionals, feedback through mobile apps could potentially be a useful tool in the management of hypertension.

Trial registration: clinicaltrials.gov Identifier: NCT04470284.

Objective: To investigate the most prevalent diagnosed conditions contributing to health care visitations in a defined US population by age and racial group, educational level, and socioeconomic deprivation.

Patients and methods: The Rochester Epidemiology Project is a medical records-linkage system that captures medical care provided to residents of Olmsted County, Minnesota. The Rochester Epidemiology Project was queried for all Olmsted County residents. International Classification of Diseases codes were obtained for individuals included in the project between January 1, 2014, and December 31, 2019, and they were categorized into 46 broad disease groups. Age- and sex-specific prevalences were estimated by dividing the number of individuals within each group by the corresponding population.

Results: In total, 154,254 individuals were included, and 122,627 (65,782 [53.6%] female) had at least one diagnosis of interest. Arthritis/joint disorders and back problems (ie, musculoskeletal disorders) were the most prevalent across all ages (42%), followed by skin (40%) and anxiety/depression/bipolar disorders (24%). Lower education and a higher area deprivation index score were associated with certain modifiable chronic diseases.

Conclusion: Musculoskeletal diseases were the most prevalent diagnosed conditions contributing to health care visitations within a defined US population. Individual level of education and socioeconomic deprivation were associated with modifiable diseases. An emphasis on effective diagnosis and management of musculoskeletal conditions in health care delivery models and more focused preventative efforts in disadvantaged communities are imperative.

Objective: To investigate the association of 24-hour, daytime, and nighttime ambulatory systolic blood pressure (SBP) time in target range (TTR) with the risk of cardiovascular disease (CVD) and mortality in real-world settings.

Patients and methods: Data were obtained from the Kailuan study. Systolic blood pressure TTR was calculated using linear interpolation, with 110 to 140 mm Hg as the target range. Cox regressions were performed to assess the associations of SBP TTR with outcomes.

Results: Among 5099 participants in this analysis, 396 cases of CVD (7.77%) and 490 cases of all-cause mortality (9.61%) occurred during a median follow-up of 6.96 years. After multivariable adjustment, each 1-SD increment in 24-hour SBP TTR was associated with an 11% lower risk of CVD (hazard ratio [HR], 0.89; 95% CI, 0.79 to 0.99; P=.008) and all-cause mortality (HR, 0.89; 95% CI, 0.81 to 0.98; P=.01). Consistently, each 1-SD increment in daytime SBP TTR was associated with 14% lower risk of CVD (HR, 0.86; 95% CI, 0.78 to 0.95; P=.005) and 13% lower risk of all-cause mortality (HR, 0.87; 95% CI, 0.79 to 0.95; P=.003). However, the associations for nighttime SBP TTR did not reach statistically significant levels.

Conclusion: Higher SBP TTR was associated with lower risk of CVD and mortality among Chinese adults in real-world settings. Efforts to attain SBP within 110 to 140 mm Hg over time may be an effective strategy to prevent CVD.