Obesity and pre-hypertension in family medicine: Implications for quality improvement
Tóm tắt
Prevention of pre-hypertension is an important goal for primary care patients. Obesity is a risk factor for hypertension, but has not been addressed for pre-hypertension in primary care populations. The objective of this study was to assess the degree to which obesity independently is associated with risk for pre-hypertension in family medicine patients. This study was a retrospective analysis of information abstracted from medical records of 707 adult patients. Multivariable logistic regression was used to test the relationship between body mass index (BMI) and pre-hypertension, after adjustment for comorbidity and demographic characteristics. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg. In our sample, 42.9% of patients were pre-hypertensive. Logistic regression analysis revealed that, in comparison to patients with normal body mass, patients with BMI > 35 had higher adjusted odds of being pre-hypertensive (OR = 4.5, CI 2.55–8.11, p < .01). BMI between 30 and 35 also was significant (OR = 2.7, CI 1.61–4.63, p < 0.01) as was overweight (OR = 1.8, CI 1.14–2.92, p = 0.01). In our sample of family medicine patients, elevated BMI is a risk factor for pre-hypertension, especially BMI > 35. This relationship appears to be independent of age, gender, marital status and comorbidity. Weight loss intervention for obese patients, including patient education or referral to weight loss programs, might be effective for prevention of pre-hypertension and thus should be considered as a potential quality indicator.
Tài liệu tham khảo
Patterson RE, Frank LL, Kristal AR, White E: A comprehensive examination of health conditions associated with obesity in older adults. Am J Prev Med. 2004, 27 (5): 385 -3890. 10.1016/j.amepre.2004.08.001.
Andersen RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR: Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obes Res. 2003, 11 (10): 1159 -11562.
Bigal ME, Lipton RB: Modifiable risk factors for migraine progression. Headache. 2006, 46 (9): 1334 -13343.
Okoro CA, Hootman JM, Strine TW, Balluz LS, Mokdad AH: Disability, arthritis, and body weight among adults 45 years and older. Obes Res. 2004, 12 (5): 854 -8561.
Garrett N, Martini EM: The boomers are coming: a total cost of care model of the impact of population aging on the cost of chronic conditions in the United States. Dis Manag. 2007, 10 (2): 51 -560. 10.1089/dis.2006.630.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40 (5): 373 -3783. 10.1016/0021-9681(87)90171-8.
Greenlund KJ, Zheng ZJ, Keenan NL, Giles WH, Casper ML, Mensah GA, Croft JB: Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991-1999. Archives of Internal Medicine. 2004, 164 (2): 181-188. 10.1001/archinte.164.2.181.
Greenlund KJ, Croft JB, Mensah GA: Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000.[see comment]. Archives of Internal Medicine. 2004, 164 (19): 2113-2118. 10.1001/archinte.164.19.2113.
Mulrow CD, Chiquette E, Angel L, Cornell J, Summerbell C, Anagnostelis B, Grimm R, Brand MB: Dieting to reduce body weight for controlling hypertension in adults. Cochrane Database Syst Rev. 2000, CD000484-2
Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA: Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. Journal of Hypertension. 2006, 24 (2): 215-233. 10.1097/01.hjh.0000199800.72563.26.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, Joint National Committee on Prevention DETHBPNHLBI, National High Blood Pressure Education Program Coordinating C: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003, 42 (6): 1206 -12052. 10.1161/01.HYP.0000107251.49515.c2.
USPSTF: Screening and Interventions to Prevent Obesity in Adults, Topic Page. Guide to Clinical Preventive Services 2006: Recommendations of the US Preventive Services Task Force. 2006, Agency for Healthcare Research and Quality
Stevens VJ, Corrigan SA, Obarzanek E, Bernauer E, Cook NR, Hebert P, Mattfeldt-Beman M, Oberman A, Sugars C, Dalcin AT: Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group. Arch Intern Med. 1993, 153 (7): 849 -8458. 10.1001/archinte.153.7.849.
Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR, Writing Group of the PREMIER Collaborative Research Group: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003, 289 (16): 2083 -20893. 10.1001/jama.289.16.2083.
Rohrer JE, Merry SP, Lopez-Jimenez F, Adamson SA, Wilshusen LA: Patient-Centered Decision Rule for Referral of Patients to Weight- Loss Programs. Quality Management in Health Care. 2007, 16 (3).
Lavin JH, Avery A, Whitehead SM, Rees E, Parsons J, Bagnall T, Barth JH, Ruxton CH: Feasibility and benefits of implementing a Slimming on Referral service in primary care using a commercial weight management partner. Public Health. 2006, 120 (9): 872 -8781. 10.1016/j.puhe.2006.05.008.
Fontaine KR, Haaz S, Bartlett SJ: Are overweight and obese adults with arthritis being advised to lose weight?. J Clin Rheumatol. 2007, 13 (1): 12 -125. 10.1097/01.rhu.0000256168.74277.15.
Wee CC, Davis RB, Phillips RS: Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Intern Med. 2005, 20 (5): 410 -4105. 10.1111/j.1525-1497.2005.0074.x.
Rollnick S, Mason P, Butler CC: Health behavior change: a guide for practitioners. 1999, Edinburgh , Churchill Livingston
West DS, DiLillo V, Bursac Z, Gore SA, Greene PG: Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007, 30 (5): 1081 -10817. 10.2337/dc06-1966.
Viera AJ: The new "normal" blood pressure: what are the implications for family medicine?. J Am Board Fam Med. 2007, 20 (1): 45 -451. 10.3122/jabfm.2007.01.060088.
Viera AJ: Will diagnosing prehypertension help?. J Am Board Fam Med. 2007, 20 (3): 322 -3223. 10.3122/jabfm.2007.03.070052.
Wexler RK: Treatment of hypertension critical in reducing morbidity and mortality. J Am Board Fam Med. 2007, 20 (3): 322-10.3122/jabfm.2007.03.070002.
Viera AJ, Jamieson B, Dealleaume L: How effective are hypertension self-care interventions?. J Fam Pract. 2007, 56 (3): 229 -2231.
Truby H, Baic S, deLooy A, Fox KR, Livingstone MB, Logan CM, Macdonald IA, Morgan LM, Taylor MA, Millward DJ: Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC "diet trials". BMJ. 2006, 332 (7553): 1309 -13014. 10.1136/bmj.38833.411204.80.
Bordowitz R, Morland K, Reich D: The use of an electronic medical record to improve documentation and treatment of obesity. Fam Med. 2007, 39 (4): 274 -2749.
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