Olugbenga Ogedegbe
Olugbenga Ogedegbe
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Professor of Social and Behavioral Sciences
Professor for the Department of Population Health at NYU Grossman School of Medicine
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Professional overview
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Gbenga Ogedegbe, a physician, is Professor of Population Health & Medicine, Chief Division of Health & Behavior and Director Center for Healthful Behavior Change in the Department of Population Health at the School of Medicine. Gbenga is a leading expert on health disparities research; his work focuses on the implementation of evidence-based interventions for cardiovascular risk reduction in minority populations. He is Principal Investigator on numerous NIH projects, and has expanded his work globally to Sub-Saharan Africa where he is funded by the NIH to strengthen research capacity and reduce the burden of noncommunicable diseases. He has co-authored over 250 publications and his work has been recognized by receipt of several research and mentoring awards including the prestigious John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality, and the Daniel Savage Science Award. He has served on numerous scientific panels including the NIH, CDC, World Health Organization, and the European Union Research Council. Prior to joining NYU, he was faculty at Cornell Weill Medical School and Columbia University College of Physicians and Surgeons.
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Education
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MPH from Columbia University, 1999Residency, Montefiore Medical Center, Internal Medicine, 1998MD from Donetsk University, 1988
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Areas of research and study
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Access to HealthcareGlobal HealthHealth of Marginalized PopulationImplementation and Impact of Public Health RegulationsImplementation scienceStroke and Cardiovascular Disease
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Publications
Publications
Measurement of psychiatric treatment adherence
AbstractSajatovic, M., Velligan, D. I., Weiden, P. J., Valenstein, M. A., & Ogedegbe, G. (n.d.).Publication year
2010Journal title
Journal of Psychosomatic ResearchVolume
69Issue
6Page(s)
591-599AbstractObjective: Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research but also in clinical trials in which medications are being evaluated and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on "Methodological Challenges in Psychiatric Treatment Adherence Research" held on September 27-28, 2007, in Bethesda, MD, and organized by the National Institute of Mental Health (NIMH). Methods: This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed. Results: Each of the adherence measures described are imperfect estimates of actual medication ingestion, but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures. Conclusion: While adherence assessment has become increasingly sophisticated in recent years, there remains a need for refinement and expansion on currently available methods and measures.Methodological challenges in psychiatric treatment adherence research
AbstractVelligan, D. I., Sajatovic, M., Valenstein, M., Riley, W. T., Safren, S., Lewis-Fernandez, R., Weiden, P., Ogedegbe, G., & Jamison, J. (n.d.).Publication year
2010Journal title
Clinical Schizophrenia and Related PsychosesVolume
4Issue
1Page(s)
74-91AbstractReflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.New Recommendations for Treating Hypertension in Black Patients: Evidence and/or Consensus?
Wright, J. T., Agodoa, L. Y., Appel, L., Cushman, W. C., Taylor, A. L., Osei, K., Reed, J., & Ogedegbe, O. (n.d.).Publication year
2010Journal title
HypertensionVolume
56Issue
5Page(s)
801-803Principles and Techniques of Blood Pressure Measurement
AbstractOgedegbe, G., & Pickering, T. (n.d.).Publication year
2010Journal title
Cardiology ClinicsVolume
28Issue
4Page(s)
571-586AbstractAlthough the mercury sphygmomanometer is widely regarded as the gold standard for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings. To date, mercury devices have largely been phased out in United States hospitals. This situation has led to the proliferation of nonmercury devices and has changed (probably forever) the preferable modality of blood pressure measurement in clinic and hospital settings. In this article, the basic techniques of blood pressure measurement and the technical issues associated with measurements in clinical practice are discussed. The devices currently available for hospital and clinic measurements and their important sources of error are presented. Practical advice is given on how the different devices and measurement techniques should be used. Blood pressure measurements in different circumstances and in special populations such as infants, children, pregnant women, elderly persons, and obese subjects are discussed.Sleep duration and the risk of diabetes mellitus: Epidemiologic evidence and pathophysiologic insights
AbstractZizi, F., Jean-Louis, G., Brown, C. D., Ogedegbe, G., Boutin-Foster, C., & McFarlane, S. I. (n.d.).Publication year
2010Journal title
Current Diabetes ReportsVolume
10Issue
1Page(s)
43-47AbstractEvidence from well-defined cohort studies has shown that short sleep, through sleep fragmentation caused by obstructive sleep apnea (OSA) or behavioral sleep curtailment because of lifestyle choices, is associated with increased incidence of diabetes. In this report, we review epidemiologic and clinical data suggesting that OSA is involved in the pathogenesis of altered glucose metabolism. Evidence suggesting increased risk of developing diabetes resulting from curtailed sleep duration is also considered. Proposed mechanisms explaining associations between short sleep and diabetes are examined and clinical management of OSA among patients with diabetes is discussed.The Epidemiology of Hypertension
Ogedegbe, O., & Pickering, T. G. (n.d.). In Hurt’s the Heart (13th eds., 1–).Publication year
2010Adherence to psychiatric treatments
Riley, W. T., Velligan, D. I., Sajatovic, M., Valenstein, M., Safren, S., Lewis-Fernaídez, R., Weiden, P., & Ogedegbe, O. (n.d.).Publication year
2009Journal title
PsychiatryVolume
20Issue
4Page(s)
89 - 96An overview of cardiovascular risk factor burden in sub-Saharan African countries: A socio-cultural perspective
AbstractBeLue, R., Okoror, T. A., Iwelunmor, J., Taylor, K. D., Degboe, A. N., Agyemang, C., & Ogedegbe, G. (n.d.).Publication year
2009Journal title
Globalization and HealthVolume
5AbstractBackground: Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems.Purpose: The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors.Methodology: We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included.Results: The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts.Conclusion: Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.Applying qualitative methods in developing a culturally tailored workbook for black patients with hypertension
AbstractBoutin-Foster, C., Ravenell, J. E., Greenfield, V. W., Medmim, B., & Ogedegbe, G. (n.d.).Publication year
2009Journal title
Patient Education and CounselingVolume
77Issue
1Page(s)
144-147AbstractObjective: To apply qualitative research methods in developing a culturally tailored, educational workbook for hypertensive black patients. Methods: The workbook was developed using formative qualitative data from 60 black primary care patients with hypertension. Participants were interviewed using qualitative methods and data were analyzed through sequential steps of open coding, axial coding, and selective coding. From these analyses, themes describing patients' cultural beliefs about hypertension were derived and used to develop the workbook. Results: The workbook, "Living With Hypertension: Taking Control" is a 37-page illustrated workbook with 11 chapters based on patients' perceptions of hypertension. These chapters focus on strengthening participants' ability to take control and manage hypertension and on providing knowledge and health behavior techniques. Conclusion: Qualitative research methods were used to inform the development of a culturally tailored educational workbook. Practice implications: The workbook developed in this study may offer a practical and effective means of educating patients about blood pressure control in primary care settings.Counseling African Americans to control hypertension (CAATCH) trial: A multi-level intervention to improve blood pressure control in hypertensive blacks
AbstractOgedegbe, G., Tobin, J. N., Fernandez, S., Gerin, W., Diaz-Gloster, M., Cassells, A., Khalida, C., Pickering, T., Schoenthaler, A., & Ravenell, J. (n.d.).Publication year
2009Journal title
Circulation: Cardiovascular Quality and OutcomesVolume
2Issue
3Page(s)
249-256AbstractDespite strong evidence of effective interventions targeted at blood pressure (BP) control, there is little evidence on the translation of these approaches to routine clinical practice in care of hypertensive blacks. The goal of this study is to evaluate the effectiveness of a multilevel, multicomponent, evidence-based intervention compared with usual care in improving BP control among hypertensive blacks who receive care in community health centers. The primary outcomes are BP control rate at 12 months and maintenance of intervention 1 year after the trial. The secondary outcomes are within-patient change in BP from baseline to 12 months and cost-effectiveness of the intervention. Counseling African Americans to Control Hypertension (CAATCH) is a group randomized clinical trial with 2 conditions: intervention condition and usual care. Thirty community health centers were randomly assigned equally to the intervention condition group (n=15) or the usual care group (n=15). The intervention comprises 3 components targeted at patients (interactive computerized hypertension education, home BP monitoring, and monthly behavioral counseling on lifestyle modification) and 2 components targeted at physicians (monthly case rounds based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, chart audit and provision of feedback on clinical performance and patients' home BP readings). All outcomes are assessed at quarterly study visits for 1 year. Chart review is conducted at 24 months to evaluate maintenance of intervention effects and sustainability of the intervention. Poor BP control is one of the major reasons for the mortality gap between blacks and whites. Findings from this study, if successful, will provide salient information needed for translation and dissemination of evidence-based interventions targeted at BP control into clinical practice for this high-risk population. (Circ Cardiovasc Qual Outcomes. 2009;2:249-256.)Group visits in the management of diabetes and hypertension: Effect on glycemic and blood pressure control
AbstractLoney-Hutchinson, L. M., Provilus, A. D., Jean-Louis, G., Zizi, F., Ogedegbe, O., & McFarlane, S. I. (n.d.).Publication year
2009Journal title
Current Diabetes ReportsVolume
9Issue
3Page(s)
238-242AbstractDiabetes is a major public health problem that is reaching epidemic proportions in the United States and worldwide. Over 22 million Americans currently have diabetes and it is forecast that over 350 million people worldwide will be affected by 2030. Furthermore, the economic cost of diabetes care is enormous. Despite current efforts on the part of health care providers and their patients, outcomes of care remain largely suboptimal, with only 3% to 7% of the entire diabetes population meeting recommended treatment goals for glycemic, blood pressure, and lipid control. Therefore, alternative approaches to diabetes care are desperately needed. Group visits may provide a viable option for patients and health care providers, with the potential to improve outcomes and cost effectiveness. In this review, we highlight the magnitude of the diabetes epidemic, the barriers to optimal diabetes care, and the utility of the concept of group visits as a chronic disease management strategy for diabetes care.Lifestyle changes and blood pressure control: A community-based cross-sectional survey (2006 Ontario survey on the prevalence and control of hypertension)
Schoenthaler, A., Ravenell, J., Fernandez, S., & Ogedegbe, G. (n.d.). In Journal of Clinical Hypertension (1–).Publication year
2009Volume
11Issue
7Page(s)
391-392Obstructive sleep apnea and cardiovascular disease: Evidence and underlying mechanisms
AbstractJean-Louis, G., Zizi, F., Brown, C. D., Ogedegbe, G., Borer, J. S., & McFarlane, S. I. (n.d.).Publication year
2009Journal title
Minerva PneumologicaVolume
48Issue
4Page(s)
277-293AbstractA body of epidemiologic and clinical evidence dating back to the early 1960s establishes the relationships between sleep apnea and cardiovascular disease (CVD). Individuals with obstructive sleep apnea, the most common type of sleep-disordered breathing, are at increased risk for coronary artery disease, congestive heart failure, and stroke. Evidence that treatment of sleep apnea with continuous positive airway pressure reduces blood pressure, improves left ventricular systolic function, and diminishes platelet activation further supports linkage between obstructive sleep apnea and CVD. Notwithstanding, complex associations between these two conditions remain largely unexplained due to a dearth of systematic experimental studies. Arguably, several intermediary mechanisms including sustained sympathetic activation, intrathoracic pressure changes, and oxidative stress might be involved. Other abnormalities such as dysfunctions in coagulation factors, endothelial damage, platelet activation, and increased systemic inflammation might also play a fundamental role. This review examines evidence for the associations between obstructive sleep apnea and CVD and suggests underlying anatomical and physiological mechanisms. Specific issues pertaining to definition, prevalence, diagnosis, and treatment of sleep apnea are also discussed. Consistent with rising interest in the potential role of the metabolic syndrome, this review explores the hypothesized mediating effects of each of the components of the metabolic syndrome.Overweight and obesity among Ghanaian residents in the Netherlands: How do they weigh against their urban and rural counterparts in Ghana?
AbstractAgyemang, C., Owusu-Dabo, E., De Jonge, A., Martins, D., Ogedegbe, G., & Stronks, K. (n.d.).Publication year
2009Journal title
Public Health NutritionVolume
12Issue
7Page(s)
909-916AbstractObjective: To investigate differences in overweight and obesity between first-generation Dutch-Ghanaian migrants in The Netherlands and their rural and urban counterparts in Ghana. Design: Cross-sectional study. Subjects: A total of 1471 Ghanaians (rural Ghanaians, n 532; urban Ghanaians, n 787; Dutch-Ghanaians, n 152) aged ≥17 years. Main outcome measures: Overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2). Results: Dutch-Ghanaians had a significantly higher prevalence of overweight and obesity (men 69.1 %, women 79.5 %) than urban Ghanaians (men 22.0 %, women 50.0 %) and rural Ghanaians (men 10.3 %, women 19.0 %). Urban Ghanaian men and women also had a significantly higher prevalence of overweight and obesity than their rural Ghanaian counterparts. In a logistic regression analysis adjusting for age and education, the odds ratios for being overweight or obese were 3.10 (95 % CI 1.75, 5.48) for urban Ghanaian men and 19.06 (95 % CI 8.98, 40.43) for Dutch-Ghanaian men compared with rural Ghanaian men. Among women, the odds ratios for being overweight and obese were 3.84 (95 % CI 2.66, 5.53) for urban Ghanaians and 11.4 (95 % CI 5.97, 22.07) for Dutch-Ghanaians compared with their rural Ghanaian counterparts. Conclusion: Our current findings give credence to earlier reports of an increase in the prevalence of overweight/obesity with urbanization within Africa and migration to industrialized countries. These findings indicate an urgent need to further assess migration-related factors that lead to these increases in overweight and obesity among migrants with non-Western background, and their impact on overweight- and obesity-related illnesses such as diabetes among these populations.Predictors of first-fill adherence for patients with hypertension
AbstractShah, N. R., Hirsch, A. G., Zacker, C., Wood, G. C., Schoenthaler, A., Ogedegbe, G., & Stewart, W. F. (n.d.).Publication year
2009Journal title
American Journal of HypertensionVolume
22Issue
4Page(s)
392-396AbstractBackground: Between the promise of evidence-based medicine and the reality of inadequate patient outcomes lies patient adherence. Studies of prescription adherence have been hampered by methodologic problems. Most rely on patient self-report of adherence or cross-sectional data of plan-wide prescription fills to estimate patient-level adherence. Methods: We conducted a retrospective cohort study and linked individual patient data for incident prescriptions for antihypertensive medications from electronic health records (EHRs) to claims data obtained from the patient's insurance plan. Clinical data were obtained from the Geisinger Clinic, a 41 site group practice serving central and northeastern Pennsylvania with an EHR in use since 2001. Adherence was defined as a prescription claim generated for the first-fill prescription within 30 days of the prescribing date. Results: Of the 3,240 patients written a new, first-time prescription for an antihypertensive medication, 2,685 (83%) generated a corresponding claim within 30 days. Sex, age, therapeutic class, number of other medications prescribed within 10 days of the antihypertensive prescription, number of refills, co-pay, comorbidity score, baseline blood pressure (BP), and change in BP were significantly associated with first-fill rates (P < 0.05). Conclusions: Patients who are older, female, have multiple comorbidities, and/or have relatively lower BPs may be less likely to fill a first prescription for antihypertensive medications and may be potential candidates for interventions to improve adherence to first-fill prescriptions.Provider communication effects medication adherence in hypertensive African Americans
AbstractSchoenthaler, A., Chaplin, W. F., Allegrante, J. P., Fernandez, S., Diaz-Gloster, M., Tobin, J. N., & Ogedegbe, G. (n.d.).Publication year
2009Journal title
Patient Education and CounselingVolume
75Issue
2Page(s)
185-191AbstractObjective: To evaluate the effect of patients' perceptions of providers' communication on medication adherence in hypertensive African Americans. Methods: Cross-sectional study of 439 patients with poorly controlled hypertension followed in community-based healthcare practices in the New York metropolitan area. Patients' rating of their providers' communication was assessed with a perceived communication style questionnaire,while medication adherence was assessed with the Morisky self-report measure. Results: Majority of participants were female, low-income, and had high school level educations, with mean age of 58 years. Fifty-five percent reported being nonadherent with their medications; and 51% rated their provider's communication to be non-collaborative. In multivariate analysis adjusted for patient demographics and covariates (depressive symptoms, provider degree), communication rated as collaborative was associated with better medication adherence (β = -.11, p = .03). Other significant correlates of medication adherence independent of perceived communication were age (β = .13, p = .02) and depressive symptoms (β = -.18, p = .001). Conclusion: Provider communication rated as more collaborative was associated with better adherence to antihypertensive medications in a sample of low-income hypertensive African-American patients. Practice implications: The quality of patient-provider communication is a potentially modifiable element of the medical relationship that may affect health outcomes in this high-risk patient population.Self-efficacy mediates the relationship between depressive symptoms and medication adherence among hypertensive African Americans
AbstractSchoenthaler, A., Ogedegbe, G., & Allegrante, J. P. (n.d.).Publication year
2009Journal title
Health Education and BehaviorVolume
36Issue
1Page(s)
127-137AbstractMany studies have documented the negative effects of depression on adherence to recommended treatment; however, little is known about the mechanism underlying this relationship. Using the Kenny and Baron analytic framework of mediation, the authors assessed whether self-efficacy mediated the relationship between depression and medication adherence in 167 hypertensive African Americans followed in a primary care practice. Depressive symptoms are associated with poor medication adherence (β =.013, p =.036) and low self-efficacy (β = -.008, p =.023). Self-efficacy is negatively associated with medication adherence at follow-up (β = -.612, p <.001). The relationship between depressive symptoms and medication adherence becomes nonsignificant when controlling for self-efficacy (β =.010, p =.087). Implications for further examination into the mediating role of self-efficacy and the deleterious effect of depression on medication adherence are discussed.Socioeconomic and psychosocial factors mediate race differences in nocturnal blood pressure dipping
AbstractSpruill, T. M., Gerin, W., Ogedegbe, G., Burg, M., Schwartz, J. E., & Pickering, T. G. (n.d.).Publication year
2009Journal title
American Journal of HypertensionVolume
22Issue
6Page(s)
637-642AbstractBackground: Reduced nocturnal blood pressure (BP) dipping is more prevalent among blacks living in the United States than whites and is associated with increased target organ damage and cardiovascular risk. The primary aim of this study was to determine whether socioeconomic and psychosocial factors help to explain racial differences in dipping. In order to address the limited reproducibility of dipping measures, we investigated this question in a sample of participants who underwent multiple ambulatory BP monitoring (ABPM) sessions. Methods: The study sample included 171 black and white normotensive and mildly hypertensive participants who underwent three ABPM sessions, each 1 month apart, and completed a battery of questionnaires to assess socioeconomic and psychosocial factors. Results: As expected, blacks showed less dipping than whites, after adjusting for age, sex, body mass index (BMI), and mean 24-h BP level (mean difference = 3.3%, P = 0.002). Dipping was related to several of the socioeconomic and psychosocial factors examined, with higher education and income, being married, and higher perceived social support, each associated with a larger dipping percentage. Of these, marital status and education were independently associated with dipping and together accounted for 36% of the effect of race on dipping. Conclusions: We identified a number of socioeconomic and psychosocial correlates of BP dipping and found that reduced dipping among blacks vs. whites is partially explained by marital status (being unmarried) and lower education among blacks. We also present results suggesting that repeated ABPM may facilitate the detection of associations between dipping and other variables.Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans
AbstractScisney-Matlock, M., Bosworth, H. B., Giger, J. N., Strickland, O. L., Van Harrison, R., Coverson, D., Shah, N. R., Dennison, C. R., Dunbar-Jacob, J. M., Jones, L., Ogedegbe, G., Batts-Turner, M. L., & Jamerson, K. A. (n.d.).Publication year
2009Journal title
Postgraduate MedicineVolume
121Issue
3Page(s)
147-159AbstractAfrican Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.What is the optimal interval between successive home blood pressure readings using an automated oscillometric device?
AbstractEguchi, K., Kuruvilla, S., Ogedegbe, G., Gerin, W., Schwartz, J. E., & Pickering, T. G. (n.d.).Publication year
2009Journal title
Journal of HypertensionVolume
27Issue
6Page(s)
1172-1177AbstractObjectives To clarify whether a shorter interval between three successive home blood pressure (HBP) readings (10 s vs. 1min) taken twice a day gives a better prediction of the average 24-h BP and better patient compliance. Design We enrolled 56 patients from a hypertension clinic (mean age: 60 ± 14 years; 54% female patients). The study consisted of three clinic visits, with two 4-week periods of self-monitoring of HBP between them, and a 24-h ambulatory BP monitoring at the second visit. Using a crossover design, with order randomized, the oscillometric HBP device (HEM-5001) could be programmed to take three consecutive readings at either 10-s or 1-min intervals, each of which was done for 4 weeks. Patients were asked to measure three HBP readings in the morning and evening. All the readings were stored in the memory of the monitors. Results The analyses were performed using the second -third HBP readings. The average systolic BP/diastolic BPfor the 10-s and 1-min intervals at home were 136.1± 15.8/77.5 ± 9.5 and 133.2 ± 15.5/76.9 ± 9.3 mmHg (P = 0.001/0.19 for the differences in systolic BP and diastolic BP), respectively. The 1-min BP readings were significantly closer to the average of awake ambulatory BP (131 ± 14/79 ± 10 mmHg) than the 10-s interval readings. There was no significant difference in patients' compliance in taking adequate numbers of readings at the different time intervals. Conclusion The 1-min interval between HBP readings gave a closer agreement with the daytime average BP than the 10-s interval.A practice-based trial of motivational interviewing and adherence in hypertensive African Americans
AbstractOgedegbe, G., Chaplin, W., Schoenthaler, A., Statman, D., Berger, D., Richardson, T., Phillips, E., Spencer, J., & Allegrante, J. P. (n.d.).Publication year
2008Journal title
American Journal of HypertensionVolume
21Issue
10Page(s)
1137-1143AbstractBackground: Poor medication adherence is a significant problem in hypertensive African Americans. Although motivational interviewing (MINT) is effective for adoption and maintenance of health behaviors in patients with chronic diseases, its effect on medication adherence remains untested in this population. Methods: This randomized controlled trial tested the effect of a practice-based MINT counseling vs. usual care (UC) on medication adherence and blood pressure (BP) in 190 hypertensive African Americans (88% women; mean age 54 years). Patients were recruited from two community-based primary care practices in New York City. The primary outcome was adherence measured by electronic pill monitors; the secondary outcome was within-patient change in office BP from baseline to 12 months. Results: Baseline adherence was similar in both groups (56.2 and 56.6% for MINT and UC, respectively, P = 0.94). Based on intent-to-treat analysis using mixed-effects regression, a significant time x group interaction with model-predicted posttreatment adherence rates of 43 and 57% were found in the UC and MINT groups, respectively (P = 0.027), with a between-group difference of 14% (95% confidence interval, -0.2 to -27%). The between-group difference in systolic and diastolic BP was -6.1 mm Hg (P = 0.065) and -1.4 mm Hg (P = 0.465), respectively, in favor of the MINT group. Conclusions: A practice-based MINT counseling led to steady maintenance of medication adherence over time, compared to significant decline in adherence for UC patients. This effect was associated with a modest, nonsignificant trend toward a net reduction in systolic BP in favor of the MINT group.A senior center-based pilot trial of the effect of lifestyle intervention on blood pressure in minority elderly people with hypertension
AbstractFernandez, S., Scales, K. L., Pineiro, J. M., Schoenthaler, A. M., & Ogedegbe, G. (n.d.).Publication year
2008Journal title
Journal of the American Geriatrics SocietyVolume
56Issue
10Page(s)
1860-1866AbstractOBJECTIVES: To test the feasibility, acceptability, and effect of a senior center-based behavioral counseling lifestyle intervention on systolic blood pressure (BP). DESIGN: A pre-post design pilot trial of behavioral counseling for therapeutic lifestyle changes in minority elderly people with hypertension. Participants completed baseline visit, Visit 1 (approximately 6 weeks postbaseline), and a final study Visit 2 (approximately 14 weeks postbaseline) within 4 months. SETTING: The study took place in six community-based senior centers in New York City with 65 seniors (mean age 72.29±6.92; 53.8% female; 84.6% African American). PARTICIPANTS: Sixty-five minority elderly people. INTERVENTION: Six weekly and two monthly "booster" group sessions on lifestyle changes to improve BP (e.g., diet, exercise, adherence to prescribed antihypertensive medications). MEASUREMENTS: Primary outcome was systolic BP (SBP) measured using an automated BP monitor. Secondary outcomes were diastolic BP (DBP), physical activity, diet, and adherence to prescribed antihypertensive medications. RESULTS: There was a significant reduction in average SBP of 13.0±21.1 mmHg for the intervention group (t(25)=3.14, P=.004) and a nonsignificant reduction in mean SBP of 10.6±30.0 mmHg for the waitlist control group (t(29)=1.95, P=.06). For the intervention group, adherence improved 26% (t(23)=2.31, P=.03), and vegetable intake improved 23% (t(25)=2.29, P=.03). CONCLUSION: This senior center-based lifestyle intervention was associated with a significant reduction in SBP and adherence to prescribed antihypertensive medications and diet in the intervention group. Participant retention and group attendance rates suggest that implementing a group-counseling intervention in senior centers is feasible.Barriers to optimal hypertension control
AbstractOgedegbe, G. (n.d.).Publication year
2008Journal title
Journal of Clinical HypertensionVolume
10Issue
8Page(s)
644-646AbstractThere is an obvious gap in the translation of clinical trial evidence into practice with regards to optimal hypertension control. The three major categories of barriers to BP control are patient-related, physician-related, and medical environment/health care system factors. Patient-related barriers include poor medication adherence, beliefs about hypertension and its treatment, depression, health literacy, comorbidity, and patient motivation. The most pertinent is medication adherence, given its centrality to the other factors. The most salient physician-related barrier is clinical inertia - defined, as the failure of health care providers to initiate or intensify drug therapy in a patient with uncontrolled BP. The major reasons for clinical inertia are: 1) overestimation of the amount of care that physicians provide; 2) lack of training on how to attain target BP levels; and 3) clinicians' use of soft reasons to avoid treatment intensification by adopting a "wait until next visit" approach in response to patients' excuses.Call to action on use and reimbursement for home blood pressure monitoring: A joint scientific statement from the american heart association, american society of hypertension, and preventive cardiovascular nurses association
AbstractPickering, T. G., Miller, N. H., Ogedegbe, G., Krakoff, L. R., Artinian, N. T., & Goff, D. (n.d.).Publication year
2008Journal title
HypertensionVolume
52Issue
1Page(s)
10-29AbstractHome blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of ≥12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.Call to action on use and reimbursement for home blood pressure monitoring: A joint scientific statement from the American heart association, american society of hypertension, and preventive cardiovascular nurses association
AbstractPickering, T. G., Miller, N. H., Ogedegbe, G., Krakoff, L. R., Artinian, N. T., & Goff, D. (n.d.).Publication year
2008Journal title
Journal of Cardiovascular NursingVolume
23Issue
4Page(s)
299-323AbstractHome blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure.