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Harlan Krumholz Profile picture
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Feb 3 • 6 tweets • 15 min read
Why do people have persistent hypertension? Turns out there are many reasons; we developed a taxonomy to classify them so they can be addressed, based on #EHR data. @yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology #bloodpressure @AHAScience ahajournals.org/doi/abs/10.116…
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience Several years ago @yuan_lu1 and I introduced the concept of persistent hypertension to describe people with many measures of elevated #bloodpressure; a more encompassing term than resistant hypertension, which was about not responding to drugs. @amjmed sciencedirect.com/science/articl…
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed We wrote that persistent hypertension was a condition of repetitive measures of above-goal elevated blood pressure over a period of time (eg, 6 mos), and drug resistance was just one of many causes. And many causes were related to missed opportunities in the care pathways.
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed This work builds on our observation that so many people in our health systems have many visits w/very elevated #bloodpressure, and little evidence of a strong response in their care. There were many underlying causes. ahajournals.org/doi/full/10.11… @JAHA_AHA
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed @JAHA_AHA So this current contribution seeks to leverage #EHR data to provide actionable insights about the cause of persistent hypertension & identify intervention targets. This precision prevention goes beyond biology to care quality, social determinants, behaviors, etc. @YaleMed
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed @JAHA_AHA Thanks to a great team. Led by @yuan_lu1 and with @HazarKhidir LeslieCurry @CesarCaraballoC @SpatzErica @shiwani_mahajan XinxinDu - We all hope that this is science that can reduce preventable adverse events from hypertension. @CircOutcomes @AHAScience

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More from @hmkyale

Harlan Krumholz Profile picture
Jan 22
Sleep as medicine... On behalf of hospitalized patients, what is we simply stopped ordering routine lab draws before 7am. What is we wrote an order, do not disturb before 7am except for an urgent need. Or an order for 7 hrs of peace and quiet. @FutureDocs nam12.safelinks.protection.outlook.com/?url=https%3A%…
@FutureDocs I strongly believe that rest and sleep are essential to recovery from acute illness...and yet everything we do in the hospital seems to ignore the role of sleep in treatment. We need to put people in a position to help their bodies heal and recovery... not make it more difficult.
@FutureDocs In our study we found it was normal operating procedures to draw bloods from 4-6am on hospitalized patients...the unintended effect, in my view, is to slow recovery and add stress... and impede healing. Shouldn't the hospital be where people can be treated, healed and recover?
Read 6 tweets
Harlan Krumholz Profile picture
May 20, 2022
Is Omicron benign? No. In our @JAMA_current study, led by @jeremyfaust, more all-cause excess mortality occurred in MA during the first 8 wks of Omicron period than during the entire 23-week Delta period. @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH jamanetwork.com/journals/jama/…
@JAMA_current @jeremyfaust @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH We believe excess mortality is the best metric of the burden of the pandemic… how many excess deaths compared with a pre-pandemic steady state period. And so not about labeling deaths… but a broader view of mortality.
@JAMA_current @jeremyfaust @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH And we are showing here that in a highly vaccinated state… omicron exactly a high mortality toll; and make no mistake, would have been worse w/o vaccination. But this crossed all age groups.
Read 5 tweets
Harlan Krumholz Profile picture
Apr 3, 2022
Hey #ACC22 presenters, especially late breaking studies of consequence. If you don't have simultaneous peer-reviewed pub, consider #preprint what you presented so it's archived & accessible. Let’s make it normative. @medrxivpreprint @yaleHFdoc #LBCT @EricTopol @CMichaelGibson
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson For all #ACC22 presenters, preprinting is easy; we accept scientific studies, screen rapidly, post quickly. Non-profit. It is of the community-available throughout the world, understood as pre-peer reviewed, and citable. Almost all reputable journals are fine with it, incl @NEJM.
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson @NEJM In the pandemic @medrxivpreprint stimulated discussions about research in progress, & many examples of advancing research. Cardiology has not yet fully embraced it, yet is this work any less important? All fields should accelerate public scientific communication & #openscience.
Read 6 tweets
Harlan Krumholz Profile picture
Apr 3, 2022
Great piece @FrancesSSellers ...'How #LongCovid is accelerating a revolution in medical research...Patients, who have typically been only subjects in the research process, are becoming partners in it.’ @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI “The people who had the wisdom [about #LongCovid were the people experiencing it.” And that Krumholz, said “opened a lot of people’s eyes to a different way of doing research.” [and this approach should become normative…not more subjects in studies, just authentic partners]
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI People participating in research as partners, and w/agency over their data, & w/an approach of 'nothing about me, without me’ has great promise, yet threatens a status quo… but about time. Will enable better, faster, more efficient, more relevant, and less burdensome research.
Read 7 tweets
Harlan Krumholz Profile picture
Apr 2, 2022
Perhaps the most important and most actionable trial #ACC22 is Chronic Hypertension and Pregnancy (CHAP) Trial. Blood pressure control matters in pregnancy. This needs to be put into action. Next in line of great recent BP trials. nejm.org/doi/pdf/10.105… @ACCinTouch @NEJM
@ACCinTouch @NEJM In this study @atitapatterns and colleagues randomized 2408 women w/chronic htn to target <140/90 or usual care (unless BP ≥160/105). Outcomes improved substantially with strategy of targeting <140/90. 18% reduction in risk for primary outcome. @nih_nhlbi @NICHD_NIH
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Here is the blood pressure in the trial…at baseline SBP was ~134 mm Hg. About 56% diagnosed and receiving medication. SBP randomization to delivery lower in active-Rx group (129.5 vs 132.6 and 81.5 vs 81.5). That’s not much, but yet, yielded benefit.
Read 7 tweets
Harlan Krumholz Profile picture
Apr 2, 2022
Should we put patients w/chronic heart failure on low sodium diets. This international trial indicates it doesn’t decrease risk of CV events or all-cause death. Little reason to promote the approach.
Nice study @JustinEzekowitz and colleagues. #ACC22 thelancet.com/journals/lance…
@JustinEzekowitz The #SODIUMHF study had an interesting finding…secondary endpoints of health status modestly improved w/low salt diet. People can try it if they want & see if they feel better. If not, they can stop w/o fear they're increasing their risk. We docs should not push it on them.
@JustinEzekowitz Another interesting feature of the study is that while people reported modest improvement in health status w/low salt diet, they did not walk farther in 6 minute walk test. So a split in what you might expect.
Read 8 tweets

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