2024
Use of electronic health records to characterize patients with uncontrolled hypertension in two large health system networks
Lu Y, Keeley E, Barrette E, Cooper-DeHoff R, Dhruva S, Gaffney J, Gamble G, Handke B, Huang C, Krumholz H, McDonough C, Schulz W, Shaw K, Smith M, Woodard J, Young P, Ervin K, Ross J. Use of electronic health records to characterize patients with uncontrolled hypertension in two large health system networks. BMC Cardiovascular Disorders 2024, 24: 497. PMID: 39289597, PMCID: PMC11409735, DOI: 10.1186/s12872-024-04161-x.Peer-Reviewed Original ResearchConceptsElectronic health recordsHealth recordsHealth systemUncontrolled hypertensionUse of electronic health recordsHypertension managementElectronic health record systemsOneFlorida Clinical Research ConsortiumElectronic health record dataYale New Haven Health SystemBP measurementsICD-10-CM codesHealth system networkPublic health priorityICD-10-CMIncidence rate of deathElevated BP measurementsElevated blood pressure measurementsHealthcare visitsAmbulatory careHealth priorityRetrospective cohort studyEHR dataOneFloridaBlood pressure measurementsLearning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial
Song J, Wang X, Wang B, Ge Y, Bi L, Jing F, Jin H, Li T, Gu B, Wang L, Hao J, Zhao Y, Liu J, Zhang H, Li X, Li J, Ma W, Wang J, Normand S, Herrin J, Armitage J, Krumholz H, Zheng X. Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial. The BMJ 2024, 386: e079143. PMID: 39043397, PMCID: PMC11265211, DOI: 10.1136/bmj-2023-079143.Peer-Reviewed Original ResearchConceptsClinical decision support systemsPrimary care practicesElectronic health recordsIntervention groupSystolic blood pressurePrimary careCare practicesBlood pressure <Health recordsPragmatic cluster randomised controlled trialCluster randomised controlled trialImproving hypertension treatmentPrimary care settingBlood pressure control ratesBlood pressureProportion of visitsProportion of participantsRandomised controlled trialsSystolic blood pressure <Control groupInjurious fallsRelated visitsCare settingsDiastolic blood pressure <Follow-upHypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records
Brush J, Lu Y, Liu Y, Asher J, Li S, Sawano M, Young P, Schulz W, Anderson M, Burrows J, Krumholz H. Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records. Journal Of The American Heart Association 2024, 13: e033253. PMID: 38686864, PMCID: PMC11179912, DOI: 10.1161/jaha.123.033253.Peer-Reviewed Original ResearchConceptsElectronic health recordsRegional health systemImprove hypertension careHealth systemHealth recordsHypertension careDiastolic blood pressureAge-adjusted prevalence ratesNon-Hispanic Black patientsPrevalence ratesLarger health systemCross-sectional analysisTransformation of medical dataLeveraging real-world dataHigh prevalence rateHypertension trendsHypertension prevalenceBlood pressureBlood pressure measurementsHypertension diagnosisPrimary outcomeNational trendsProportion of patientsAntihypertensive medicationsBlack patients
2023
Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study
Lu Y, Linderman G, Mahajan S, Liu Y, Huang C, Khera R, Mortazavi B, Spatz E, Krumholz H. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009258. PMID: 36883456, DOI: 10.1161/circoutcomes.122.009258.Peer-Reviewed Original ResearchConceptsRetrospective cohort studyBlood pressure valuesPatient characteristicsReal-world settingCohort studyPatient subgroupsYale New Haven Health SystemMean body mass indexSystolic blood pressure valuesBlood pressure visitHistory of hypertensionCoronary artery diseaseManagement of patientsMultivariable linear regression modelsBlood pressure readingsBody mass indexPatient-level measuresBlood pressure variationAbsolute standardized differencesNon-Hispanic whitesAntihypertensive medicationsReal-world practiceVisit variabilityArtery diseaseRegression modelsDeveloping an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records
Lu Y, Du C, Khidir H, Caraballo C, Mahajan S, Spatz E, Curry L, Krumholz H. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009453. PMID: 36727515, DOI: 10.1161/circoutcomes.122.009453.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntihypertensive AgentsBlood PressureElectronic Health RecordsFemaleHumansHypertensionMaleMiddle AgedConceptsPersistent hypertensionElectronic health recordsBlood pressureHealth recordsPharmacologic agentsPrescribed treatmentYale New Haven Health SystemTreatment planAdditional pharmacologic agentsAntihypertensive treatment intensificationConsecutive outpatient visitsElevated blood pressurePersistence of hypertensionElectronic health record dataHealth record dataEligible patientsTreatment intensificationChart reviewHispanic patientsOutpatient visitsMean agePharmacological treatmentConventional content analysisHypertensionClinician notes
2022
Revisiting ACCORD: Should Blood Pressure Targets in People With and Without Type 2 Diabetes Be Different?
Du CX, Huang C, Lu Y, Spatz ES, Lipska KJ, Krumholz HM. Revisiting ACCORD: Should Blood Pressure Targets in People With and Without Type 2 Diabetes Be Different? The American Journal Of Medicine 2022, 136: 6-8. PMID: 35981647, DOI: 10.1016/j.amjmed.2022.07.023.Peer-Reviewed Original ResearchHemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography
Caraballo C, Mahajan S, Gu J, Lu Y, Spatz ES, Dreyer RP, Zhang M, Sun N, Ren Y, Zheng X, Zhao H, Lu H, J. Z, Krumholz HM. Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography. PLOS ONE 2022, 17: e0269777. PMID: 35700163, PMCID: PMC9197037, DOI: 10.1371/journal.pone.0269777.Peer-Reviewed Original ResearchConceptsElevated blood pressureSystemic vascular resistance indexVascular resistance indexBlood pressureCardiac indexResistance indexHigh systemic vascular resistance indexLower systemic vascular resistance indexHigher mean systolic blood pressureMean diastolic blood pressureMean systolic blood pressureImpedance cardiographyLow cardiac indexHigher cardiac indexDiastolic blood pressureSystolic blood pressureBody mass indexYear old womanPersonalization of treatmentSame age groupNon-invasive assessmentSex differencesHemodynamic profileMass indexHemodynamic differencesEffectiveness of a clinical decision support system for hypertension management in primary care: study protocol for a pragmatic cluster-randomized controlled trial
Song J, Wang X, Wang B, Gao Y, Liu J, Zhang H, Li X, Li J, Wang JG, Cai J, Herrin J, Armitage J, Krumholz HM, Zheng X. Effectiveness of a clinical decision support system for hypertension management in primary care: study protocol for a pragmatic cluster-randomized controlled trial. Trials 2022, 23: 412. PMID: 35578345, PMCID: PMC9109449, DOI: 10.1186/s13063-022-06374-x.Peer-Reviewed Original ResearchConceptsHypertension managementPrimary carePrimary outcomeDual antihypertensive therapyHypertension Treatment TrialBlood pressure managementGuideline-based treatmentPrimary care sitesCluster-randomized trialUnit of randomizationGuideline-based decision support systemClinical decision support systemAntihypertensive regimensAntihypertensive treatmentUsual careGuideline adherenceBlood pressureMiddle-income countriesTreatment trialsManagement visitsStudy protocolCare sitesPatientsTrialsPressure managementProceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension
Commodore-Mensah Y, Loustalot F, Himmelfarb CD, Desvigne-Nickens P, Sachdev V, Bibbins-Domingo K, Clauser SB, Cohen DJ, Egan BM, Fendrick AM, Ferdinand KC, Goodman C, Graham GN, Jaffe MG, Krumholz HM, Levy PD, Mays GP, McNellis R, Muntner P, Ogedegbe G, Milani RV, Polgreen LA, Reisman L, Sanchez EJ, Sperling LS, Wall HK, Whitten L, Wright JT, Wright JS, Fine LJ. Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension. American Journal Of Hypertension 2022, 35: 232-243. PMID: 35259237, PMCID: PMC8903890, DOI: 10.1093/ajh/hpab182.Peer-Reviewed Original ResearchConceptsHypertension controlBlood pressureHypertension treatmentBlood InstituteNational HeartSelf-measured BP monitoringDisease controlCommunity-clinical linkagesModifiable risk factorsMore cardiovascular eventsAge-adjusted proportionSurgeon General's CallTeam-based careHigh-quality health carePublic health messagingCardiovascular eventsStroke preventionControl hypertensionBP monitoringHeart diseaseRisk factorsUS adultsClinical supportHealth messagingSocial determinants
2021
National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018
Lu Y, Liu Y, Dhingra LS, Massey D, Caraballo C, Mahajan S, Spatz ES, Onuma O, Herrin J, Krumholz HM. National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018. Hypertension 2021, 79: 207-217. PMID: 34775785, DOI: 10.1161/hypertensionaha.121.18381.Peer-Reviewed Original ResearchConceptsAntihypertensive medication usePoor hypertension controlOverall treatment rateLow control rateHypertension controlHypertension awarenessMedication useControl rateHispanic individualsEthnic differencesTreatment ratesBlack individualsGuideline-recommended medicationsBlood pressure controlWhite individualsNutrition Examination SurveyLow awareness rateAntihypertensive medicationsHypertensive peopleExamination SurveyIntensive medicationNational HealthAwareness rateEthnic disparitiesPressure controlPersistent Hypertension: A Broader Framework for Improving Blood Pressure Control
Lu Y, Krumholz HM. Persistent Hypertension: A Broader Framework for Improving Blood Pressure Control. The American Journal Of Medicine 2021, 135: 273-275. PMID: 34656531, DOI: 10.1016/j.amjmed.2021.09.018.Peer-Reviewed Original ResearchEffectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial
Wang L, Lu Y, Wang H, Gu J, J Z, Lian Z, Zhang Z, Krumholz H, Sun N. Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial. Open Heart 2021, 8: e001719. PMID: 34580169, PMCID: PMC8477318, DOI: 10.1136/openhrt-2021-001719.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAntihypertensive AgentsBlood PressureCardiography, ImpedanceChinaClinical Decision-MakingFemaleFollow-Up StudiesHumansHypertensionIncidenceMaleMiddle AgedPractice Guidelines as TopicRetrospective StudiesTherapy, Computer-AssistedTime FactorsTreatment OutcomeYoung AdultConceptsBody mass indexPeking University People's HospitalStandard care groupBlood pressure controlSystolic BPHaemodynamic groupsTreatment strategiesImpedance cardiographyBaseline BPBP goalHypertension clinicHaemodynamic profileBP levelsCare groupPeople's HospitalMean baseline systolic BPPressure controlReal-world clinical practiceBaseline systolic BPMean systolic BPDiastolic BP levelsProportion of patientsPragmatic clinical trialsReal-world populationBaseline DBPComprehensive Comparative Effectiveness and Safety of First-Line β-Blocker Monotherapy in Hypertensive Patients
You S, Krumholz HM, Suchard MA, Schuemie MJ, Hripcsak G, Chen R, Shea S, Duke J, Pratt N, Reich CG, Madigan D, Ryan PB, Park R, Park S. Comprehensive Comparative Effectiveness and Safety of First-Line β-Blocker Monotherapy in Hypertensive Patients. Hypertension 2021, 77: 1528-1538. PMID: 33775125, PMCID: PMC8035236, DOI: 10.1161/hypertensionaha.120.16402.Peer-Reviewed Original Research
2020
Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China
Mahajan S, Feng F, Hu S, Lu Y, Gupta A, Murugiah K, Gao Y, Lu J, Liu J, Zheng X, Spatz ES, Zhang H, Krumholz HM, Li J. Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China. JAMA Network Open 2020, 3: e209743. PMID: 33289843, PMCID: PMC7724558, DOI: 10.1001/jamanetworkopen.2020.9743.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsBlood PressureChinaCross-Sectional StudiesFemaleHumansHypertensionMaleMiddle AgedObesityPrevalenceConceptsMiddle-aged adultsSystolic hypertensionCardiac Events Million Persons ProjectOlder individualsIsolated systolic hypertensionManagement of ISHMillion Persons ProjectPrevalence of ISHPrevious cardiovascular eventsSystolic blood pressureTypes of hypertensionAssessment of prevalenceCross-sectional studyHypertension subtypesCardiovascular eventsBlood pressureChina PatientMean ageHypertensionMAIN OUTCOMEAwareness ratePrevalenceAged adultsYoung adultsAdultsRelationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure
Mahajan S, Gu J, Caraballo C, Lu Y, Spatz ES, Zhao H, Zhang M, Sun N, Zheng X, Lu H, Yuan H, J. Z, Krumholz HM. Relationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure. Journal Of The American Geriatrics Society 2020, 68: 1520-1528. PMID: 32212398, DOI: 10.1111/jgs.16411.Peer-Reviewed Original ResearchMeSH KeywordsAgingBlood PressureCardiography, ImpedanceChinaCross-Sectional StudiesFemaleHemodynamicsHumansHypertensionMaleMiddle AgedConceptsElevated blood pressureBlood pressureCardiac indexHemodynamic profileHemodynamic parametersHealth checkup centerFinal study populationPathophysiology of hypertensionSelection of therapyCross-sectional studyMin/Relationship of ageDifferent age groupsHemodynamic assessmentMean ageStudy populationMAIN OUTCOMEAge strataAge groupsLarger studyImpedance cardiographyAgeSVRIWomenMenLeveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure
Lu Y, Huang C, Mahajan S, Schulz WL, Nasir K, Spatz ES, Krumholz HM. Leveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure. Journal Of The American Heart Association 2020, 9: e015033. PMID: 32200730, PMCID: PMC7428633, DOI: 10.1161/jaha.119.015033.Peer-Reviewed Original ResearchConceptsDiastolic blood pressureSystolic blood pressureElevated blood pressureBlood pressureElectronic health recordsPopulation health surveillanceHealth recordsYale New Haven Health SystemHealth surveillanceHealth systemPatterns of patientsLarge health systemUsual careOutpatient encountersControl ratePatientsCare patternsPopulation healthMonthsHgSurveillancePrevalenceRecordsVisitsCareHeterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study
Lin H, Cui M, Spatz ES, Wang Y, Lu J, Li J, Li S, Huang C, Liu X, Jiang L, Krumholz HM, Xu X. Heterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study. Global Heart 2020, 15: 20. PMID: 32489793, PMCID: PMC7218791, DOI: 10.5334/gh.764.Peer-Reviewed Original ResearchConceptsSystolic blood pressureHigher systolic blood pressureCardiovascular Health StudyBlood pressureYoung adultsHealth StudyEffective blood pressure controlBaseline systolic blood pressureInitial systolic blood pressureGreater body mass indexBlood pressure controlBody mass indexGreater waist circumferenceBaseline health characteristicsSBP trendsWaist circumferenceMass indexSBP trajectoriesAdvanced ageOrdinal logistic regressionRisk factorsCardiovascular diseaseFamily historyHealth characteristicsHigh school education
2019
Population Impact of Generic Valsartan Recall
Jackevicius CA, Krumholz HM, Chong A, Koh M, Ozaki AF, Austin PC, Udell JA, Ko DT. Population Impact of Generic Valsartan Recall. Circulation 2019, 141: 411-413. PMID: 31707798, DOI: 10.1161/circulationaha.119.044494.Peer-Reviewed Original ResearchConceptsNational Ambulatory Care Reporting System databaseEmergency department visitsRegistered Persons DatabaseOntario Registered Persons DatabaseReporting System databaseHealth care systemDrug recallsSegmented regression analysisBaseline comorbiditiesOral medicationsDepartment visitsHospital admissionMedication useClinical outcomesDischarge diagnosisVital statusChronic conditionsHealthcare databasesHealth CanadaCare systemCanadian InstituteHealth informationPopulation impactPatientsRegression analysisPrevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project
Mahajan S, Zhang D, He S, Lu Y, Gupta A, Spatz ES, Lu J, Huang C, Herrin J, Liu S, Yang J, Wu C, Cui J, Zhang Q, Li X, Nasir K, Zheng X, Krumholz HM, Li J, Dong Z, Jiang B, Zhang Y, Liu Y, Meng Y, Xi Y, Tian Y, Fu Y, Liu T, Yan S, Jin L, Wang J, Xu X, Xing X, Zhang L, Fang X, Xu Y, Xu C, Fan L, Qi M, Qi J, Li J, Liu Q, Feng Y, Wang J, Wen H, Xu J, He J, Jiang C, Yang C, Yu Y, Tashi Z, Hu Z, Zhang J, Li X, Ma S, Ma Y, Huang Y, Zhang Y, Shen J. Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project. Journal Of The American Heart Association 2019, 8: e012954. PMID: 31566101, PMCID: PMC6806046, DOI: 10.1161/jaha.119.012954.Peer-Reviewed Original ResearchConceptsMillion Persons ProjectPrior cardiovascular eventsBody mass indexAntihypertensive medicationsDiastolic hypertensionCardiovascular eventsDiabetes mellitusMass indexIsolated diastolic hypertensionDiastolic blood pressureSelf-reported diagnosisTreatment of peoplePersons ProjectBlood pressureTreatment patternsHypertensionLeast collegeHigher likelihoodMellitusMedicationsPrevalenceTreatmentDiagnosisSubstantial numberCurrent useHemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance
Mahajan S, Gu J, Lu Y, Khera R, Spatz ES, Zhang M, Sun N, Zheng X, Zhao H, Lu H, Ma ZJ, Krumholz HM. Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance. The American Journal Of Medicine 2019, 133: e127-e139. PMID: 31525336, DOI: 10.1016/j.amjmed.2019.08.042.Peer-Reviewed Original ResearchConceptsSystemic vascular resistance indexVascular resistance indexSystemic vascular resistanceCardiac indexBlood pressure categoriesResistance index ratioResistance indexVascular resistanceCardiac outputBlood pressureHemodynamic phenotypesPressure categoriesHigh systemic vascular resistance indexNormal systemic vascular resistance indexSystolic blood pressure 140Systolic blood pressure categoriesBlood pressure 140Health checkup centerNormal cardiac indexLow cardiac indexStroke volume indexHigher cardiac indexSystolic blood pressureBody mass indexSubtypes of hypertension