Annals of Family Medicine 6:0- (2008)
© 2008 Annals of Family Medicine, Inc.
doi: 10.1370/afm.894
Annals Journal Club: Mortality from White Coat vs Sustained Hypertension
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1
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HOW IT WORKS
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In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials, and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.
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CURRENT SELECTION
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Article for Discussion
Dawes MG, Bartlett G, Coats AJ, Juszczak E. Comparing the effects of white coat hypertension and sustained hypertension on mortality in a UK primary care setting. Ann Fam Med. 2008;6(5):390–396.
Discussion Tips
This article describes a practice-based cohort study comparing outcomes among patients with white coat hypertension or sustained hypertension. It is amenable to a usual journal club discussion using the questions below as a starting point.
Discussion Questions
- What question is addressed by the article? Why does it matter? How does the question fit with what already is known on this topic?
- How strong is the study design for answering the question?
- To what degree can the findings be accounted for by:
- How participants were selected? The exclusion criteria and drop outs? Are any biases likely to be important?
- How blood pressures and outcomes were measured?
- Confounding (false attribution of causality because two variables discovered to be associated actually are associated with a 3rd factor)?
- How information was interpreted? 5. Chance?2
- What are the main findings?
- How transportable are the findings to your clinical setting?
- How might you interpret these findings in light of a recent "call to action" to incorporate routine home blood pressure monitoring into clinical care?3
- What might patients think of these findings? How does this study affect what you recommend to patients?
- What are some next steps for applying the findings or answering other questions that this study raises?
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REFERENCES
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- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: it’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. http://annfammed.org/cgi/content/full/4/3/196.[Free Full Text]
- Zyzanski SJ, Flocke SA, Dickinson LM. On the nature and analysis of clustered data. Ann Fam Med. 2004;2(3):199–200.[Free Full Text]
- Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. 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. J Cardiovasc Nurs. 2008;23(4):299–323.[Medline]
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HOW IT WORKS
CURRENT SELECTION
