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"Background: Heart disease and stroke have become the leading causes of mortality among ANAI people, who experience CVD disparities in incidence, risk factors, and mortality, particularly in stroke, relative to the general population. " In ANAIs, the mortality from 1994-2003 was at least 25% higher than that of Whites in Alaska. A notable rise in recorded prevalence in ANAI people over the past three decades has been documented, as well as a significantly higher incidence in ANAI adults than in reference groups, usually White. Aggregated results from the Behavioral Risk Factor Surveillance System reveal a higher risk of self-reported hypertension in ANAIs than in non-Hispanic Whites. Following a computer-generated alert, more than half of physicians with hypertension had poorly managed systolic BP, according to another study using electronic health record data on military veterans, but only half of clinicians made medication changes after a computer-generated alert. Minorities, who may get more benefit from HBPM than Whites, should therefore have tailored HBPM solutions. It will be the first comprehensive, population-based study on BP control for prevention of CVD and stroke in ANs, and one of very few multilevel interventions in any minority group. The investigators will perform a group-randomized trial for improving BP control among ANAI adults with diagnosed hypertension. Randomizing all SCF primary care panels to the BP-ICAN or standard care control arms will occur; adults with uncontrolled hypertension will be nested within groups outlined by panel; adults with uncontrolled hypertension will be nested within groups defined by panel, which corresponds to one provider. " "For each panel, investigators will recruit up to ten ANAI adults who have previously experienced hypertension and systolic BP u2265 130 mmHg determined at a clinic visit or home screening visit. " Participants in the BP-ICAN arm will be sent information about the importance of timely response to uncontrolled hypertension, CVD, and stroke. Participants in the BP-ICAN arm will also be provided with HBPM equipment and instruction in its use, analysis of results, and assistance in delivering high BP values to healthcare practitioners. Investigators intend to use a cloud-based technology platform to act as a data repository and collecting data from tribal governments, institutional privacy officers, compliance officers, and other health care providers on how information will be displayed and stored within the health care system, according to investigators. The aim is to make aggregate BP measurement results available to providers in either a personal health record and/or health information exchange that allows for the exchange of selected measurements into the electronic health or population health database. The primary result is change in systolic BP for all adults with hypertension whose providers are randomized to the BP-ICAN arm vs. the care as usual arm, regardless of whether the adults were enrolled directly into the study.
Source link: https://clinicaltrials.gov/ct2/show/NCT03872856
"Any patients with eligibility requirements and are seen in a clinic assigned to the control group will be given a Control-Encounter Decision Intervention about kidney disease in general by their primary care provider. " Patients who are seen in a clinic assigned to the intervention group will be given a personalized Intervention-EDI by their primary care provider. Following this, eligible patients who consent to enroll and give permission will complete the enrollment process and have a baseline call with a health coach. These patients will also have approximately 4-6 phone calls with the health coach between the baseline visit and 11 months after enrollment in addition to the 1, 6, 12 month follow-up visits.
Source link: https://clinicaltrials.gov/ct2/show/NCT04087798
"The research group will get a smartphone app for postpartum education and a Wi-Fi connected blood pressure cuff for at-home monitoring for 16 days postpartum. " If necessary, the home BP monitoring will be conducted twice a day, and the research team will check the BPs twice a day and intervene by phone or text if necessary. ".
Source link: https://clinicaltrials.gov/ct2/show/NCT04823949
"Noncirrhotic Portal Hypertension is a chronic liver disease disorder characterized by elevated pressure within the portal circulation in the absence of cirrhosis. " The challenges with NCPH are similar to those experienced by cirrhosis-induced portal hypertension, portal hypertensive gastropathy, splenomegaly, sepsis, and ascites. It is clear that the exact mechanism and the natural history of noncirrhotic portal hypertensive liver disease have yet to be elucid and described. To name a few, multiple cohorts of patients have been found to be at risk for the onset of noncirrhotic portal hypertensive liver disease in noncirrhotic portal hypertensive liver diseases such as Cystic Fibrosis, common variable immunodeficiency, Turner s Syndrome, and congenital hepatic fibrosis. Within these and other cohorts of patients known to be at risk for NCPH for an indefinite period of time, we would like to determine individuals with NCPH and those at risk of developing NCPH. Patients 12 years of age and older who are likely to be at risk for the development of NCPH will be subjected to preliminary testing, which includes history and physical examination, blood, urine, and stool samples, radiologic imaging, echocardiogram, and fibroscan. Adults and minors with NCPH who are likely to have NCPH will also be screened for transjugular or percutaneous liver biopsy with transjugular hepatic gradient measurements and endoscopy. All patients with NCPH will have preventative screening tests for signs of NCPH.
Source link: https://clinicaltrials.gov/ct2/show/NCT02417740
"Patients will be ambulatory BP testing at baseline and at the end of each treatment cycle" says the narrator. The other program will consist of 16 weeks of placebo, followed by a 3 week wash out period, 16 weeks of minocycline, 16 weeks of wash out, and finally a final 16 weeks of placebo. For each group, the 16 weeks, 19 weeks, 35 weeks, 38 weeks, and 54 weeks will be observed.
Source link: https://clinicaltrials.gov/ct2/show/NCT02133885
"Peripheral blood mononuclear cells will be isolated and used to produce human-induced pluripotent stem cells, which will be used for further mechanism research. " Patients were on active therapy following enrollment of the first two patients and seeing a dramatic drop in blood pressure. If the primary outcome measure of ambulatory blood pressure monitor =/> to 5 mm Hg, a decrease in mean daytime SBP was not achieved because these patients had CVD, but the procedure was changed to an open-label approach to dose titration for each participant beginning at 50 mg/day and 200 mg/day, increasing to 100 mg/day and 200 mg/day. Patients will be mailed the ABPM for 24 hours, at which time the monitor will be sent back to research staff. After completing the 24-hour ABPM monitoring period, the study drug will be disregarded at this visit, and patients will be encouraged to start the study drugs. When the cuff is completed, the subject will mail it to research workers. Patients who respond to medication, by protocol defined drop in daytime ABPM and/or the need for down titration of hypertensive therapy, they will be designated as a responder, complete the final visit, and full study participation if patients respond. Patients who complete the six months of therapy or are considered a responder at a lower dose will be seen in for their last visit and return the ABPM monitor, and their participation in the trial will be considered complete. ".
Source link: https://clinicaltrials.gov/ct2/show/NCT02133872
"This report includes the development and evaluation of a culturally and contextually appropriate intervention program for hypertension diagnosis and therapy at primary health centers in Abuja, N. . . . ia, based on Kaiser Permanente Northern California and World Health Organization HEARTS programs for hypertension diagnosis and treatment. " 1 patient registration and empanelment health system level, 2 national policy level, 3 support for a single-dose combination therapy health system level, 4 team-based care health worker level, and 5 home blood pressure monitoring and health coaching patient-level are among the multi-level implementation options that include: 1 patient registration and empanelment health system level, 3 standard treatment protocol national policy level, 3 improvement of fixed-dose combination therapy health system level, 3 recommendation of prescribed therapy protocol national policy level, 2 patient registration and health care health system level, 2 patient registration and empanelization health system level, 3 year-level, 3 standardized treatment protocol national policy level, 3000-level, 4 team-based care health worker level of health worker level, and health coaching patient-levels.
Source link: https://clinicaltrials.gov/ct2/show/NCT04158154
"Black Americans with CKD have a high incidence of cardiovascular disease mortality, which is indicative of a significant national health inequalities. " Blacks develop CKD earlier in life and Blacks with CKD are 3 times more likely to die of CVD and kidney transplantation, and are 1. 5 times more likely to die prematurely from CVD than white counterparts. In patients with hypertension and CVD, the DASH diet lowers BP and reduces CVD risk in patients with hypertension, and has a larger effect on blacks than on Whites. However, the effect of the DASH diet on BP in Blacks with CKD has yet to be established. Participants were divided into four groups of 6-8 people and were asked semi-structured questions to determine whether self-perceived socioeconomic barriers and promoters of DASH diet adherence and disease-specific factors that could influence their ability and willingness to follow a DASH-style diet.
Source link: https://clinicaltrials.gov/ct2/show/NCT04084574
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