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OBJECTIVE@#Current clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus, we performed this randomized controlled trial to evaluate whether HBPT plus support (patient education and clinician remote hypertension management) improves blood pressure control more than usual care (UC) in the Chinese population.@*METHODS@#This single-center, randomized controlled study was conducted in Beijing, China. Patients aged 30-75 years were eligible for enrolment if they had blood pressure [systolic (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg; or SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg with diabetes]. We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks. The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.@*RESULTS@#Totally, 172 patients completed the study, the HBPT plus support group ( n = 84), and the UC group ( n = 88). Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group. The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the 12th week of follow-up. Additionally, the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.@*CONCLUSION@#HBPT plus additional support results in greater blood pressure reduction, better blood pressure control, a higher proportion of dipper blood pressure patterns, lower blood pressure variability, and higher drug adherence than UC. The development of telemedicine may be the cornerstone of hypertension management in primary care.
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Humans , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Hypertension/therapy , Telemedicine/methods , HypotensionABSTRACT
Objective@#To investigate the prevalence and influencing factors of comorbidity of chronic diseases among hypertensive patients with uncontrolled blood pressure in Huzhou City, so as to provide insights into community hypertension control. @*Methods@#Hypertensive patients with uncontrolled blood pressure at ages of 35 to 74 years were sampled using a cluster random sampling method from 5 districts (counties) of Huzhou City. Participants' demographics, living behaviors, and development of chronic diseases were collected using questionnaires, and the height, body weight, waist circumference and blood pressure were measured. Blood glucose, blood lipid and other biochemical parameters were detected, and the number and combination of comorbidity of chronic diseases were descriptively analyzed. Factors affecting the comorbidity of chronic diseases were identified using a multivariable ordinal logistic regression model.@*Results@# A total of 1 215 respondents were included, with a mean age of (60.83±7.76) years, and including 652 men (53.66%) and 563 women (46.34%). The prevalence of dyslipidemia, diabetes, hyperuricemia and cardiac encephalopathy was 45.10%, 30.95%, 23.05% and 5.10%, respectively. The prevalence of comorbidity of chronic diseases was 69.22% among respondents, and there were 497 respondents with one comorbidity (40.91%), 272 with two comorbidities (22.39%) and 72 with three and more comorbidities (5.93%). Hypertension+dyslipidemia (20.74%), hypertension+diabetes+dyslipidemia (9.96%) and hypertension+diabetes+dyslipidemia+hyperuricemia (4.36%) were predominant comorbid combinations. Multivariable ordinal logistic regression analysis showed that participants with overweight (OR=1.782, 95%CI: 1.390-2.286), obesity (OR=2.411, 95%CI: 1.802-3.222), grade 2 hypertension (OR=1.438, 95%CI: 1.077-1.919) had a higher risk of multiple comorbidities than those with normal body mass index and controlled blood pressure, and women (OR=0.563, 95%CI: 0.456-0.696) had a lower risk of multiple comorbidities than men. @*Conclusions@#The prevalence of comorbidity of chronic diseases was 69.22% among community hypertensive patients with uncontrolled blood pressure in Huzhou City, and the comorbidity of chronic diseases mainly included dyslipidemia and diabetes. Men, overweight, obesity and hypertension resulted in a high risk of comorbidity of chronic diseases.
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Resumo Fundamento Sabe-se que em torno de 30% dos pacientes apresentam valores de pressão arterial (PA) mais elevados quando examinados no consultório do que em suas residências. No mundo, admite-se que apenas 35% dos hipertensos já tratados tenham alcançado meta pressórica. Objetivo Fornecer dados epidemiológicos sobre o controle da PA nos consultórios, em uma amostra de cardiologistas brasileiros, avaliado pela medida de consultório e monitorização residencial da pressão arterial (MRPA). Métodos Análise transversal. Observou-se pacientes com diagnóstico de hipertensão arterial, em tratamento anti-hipertensivo, podendo ou não estar com a PA controlada. A PA foi verificada no consultório por profissional médico, e no domicílio através da MRPA. A associação entre variáveis categóricas se deu por meio do teste do qui-quadrado (p < 0,05). Resultados Foram incluídos 2.540 pacientes, com idade média 59,7 ± 15,2 anos. A maioria dos pacientes eram mulheres (62%; n = 1.575). O estudo mostrou uma prevalência de 15% (n = 382) de hipertensão do avental branco não controlada, e 10% (n = 253) de hipertensão mascarada não controlada. A taxa de controle da PA no consultório foi 56,3%, e no domicílio, de 61%; 46,4% dos pacientes tiveram PA controlada no consultório e fora dele. Observou-se maior controle no sexo feminino e na faixa etária 49-61 anos. Observando o controle domiciliar com o novo ponto de corte das Diretrizes Brasileiras de Hipertensão Arterial de 2020, a taxa de controle foi de 42,4%. Conclusão O controle pressórico nos consultórios em uma amostra de cardiologistas brasileiros foi de 56,3%; 61% quando a PA foi obtida no domicílio, e 46,4% quando o controle foi observado tanto no consultório como no domicílio.
Abstract Background It is known that around 30% of patients have higher blood pressure (BP) values when examined at the office than at home. Worldwide, only 35% of patients with hypertension undergoing treatment have reached their BP targets. Objective To provide epidemiological data on BP control in the offices of a sample of Brazilian cardiologists, considering office and home BP measurement. Methods This is a cross-sectional analysis of patients with a hypertension diagnosis and undergoing antihypertensive treatment, with controlled BP or not. BP was assayed in the office by a medical professional and at home using home BP monitoring (HBPM). The association between categorical variables was verified using the chi-square test (p<0.05). Results The study included 2540 patients, with a mean age of 59.7 ± 15.2 years. Most patients were women (62%; n=1575). Prevalence rates of 15% (n=382) for uncontrolled white coat hypertension and 10% (n=253) for uncontrolled masked hypertension were observed. The rate of BP control in the office was 56.3% and at home, 61%. Meanwhile, 46.4% of the patients had controlled BP in and outside of the office. Greater control was observed in women and in the 49-61 years age group. Considering the new DBHA 2020 threshold for home BP control, the control rate was 42.4%. Conclusion BP control in the offices of a sample of Brazilian cardiologists was 56.3%; this rate was 61% when BP was measured at home and 46.4% when considering both the office and home.
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Objective:To estimate and summarize the evidence for the blood pressure in patients with ruptured intracranial aneurysm bleeding, to provide valuable reference for clinical care and improve the prognosis of patients.Methods:BMJ Best Practice, UpToDate, Chinese Guideline Website, Cochrane Library, PubMed, American Stroke Association, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database were utilized for screening out evidences of blood pressure management strategies for patients with ruptured intracranial aneurysm bleeding from database establishment to December 8, 2020. The source of evidences included guidelines, evidence summarization, information brochure of optimal clinical practice, recommended practice, systematic review and original research. Upon the assessment of the included literature, the evidences meeting the enrollment criterion would be identified and extracted.Results:There were 9 articles involved in this research and 20 evidences possessing clinical applicability were extracted. The evidences involved in clinical assessment, regulation tenets, intervention protocol, and nursing to prevent complications in patients with ruptured intracranial aneurysm bleeding.Conclusions:To summarize, we suggested strongly to evaluate the individual differences in age, underlying diseases and pharmacological tolerance, and to effectivelly control blood pressure in patients with ruptured intracranial aneurysm bleeding through scientific nursing methods, which could improve the nursing qualification.
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Objective:To analyze the control status of ambulatory blood (BP) pressure and influencing factors among hypertensive patients in Shanghai Fengpu community.Methods:From April 2020 to February 2022, 318 hypertensive patients in Shanghai Fengpu community were enrolled in the study. The basic information and thropometric indicators of patients, course of hypertension, the medication, complications, life habits, and biochemical indicators as well as the ambulatory BP monitoring (ABPM) data were collected. Multivariate analysis was used to evaluate the risk factors for lack of 24-hour BP control.Results:Among 318 patients, 63 cases (19.8%) had an average 24-hour BP controlled; the control rate of daytime BP and nighttime BP was 23.3% (74 cases) and 15.7% (50 cases), respectively. The proportion of combined medication in the control group and non-control group was 46.0% (29/63) and 51.8% (132/255), respectively (χ 2=0.66, P=0.415). There were significant differences in gender, proportion of patients with hypertension>10 years, the office blood pressure control rate, the abnormal diastolic circadian rhythm, abdominal obesity, the level of fasting blood glucose, diabetes, physical activity levels, and smoking and drinking (all P<0.05) between the control group and non-control group. Multivariate analyses showed that male gender ( OR=2.00, 95 %CI:1.07-3.76) and abdominal obesity ( OR=2.04, 95 %CI:1.10-3.76) were risk factors for uncontrolled ambulatory BP. Conclusions:The control rate of ambulatory BP in patients with hypertension is relatively low in Shanghai Fengpu community. The ABPM should be enhanced and the management for hypertensive patients with abdominal obesity and lack of physical activity should be strengthened in the community.
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Hypertension (HTN) is the commonest cardiovascular risk factor in sub-Saharan Africa. It is a global public health threat, often associated with significant morbidities and mortality with rising prevalence both in rural and semi-urban areas of economically disadvantaged countries. Aim: This study aimed to assess the determinants of blood pressure control among patients with hypertension receiving care at the Irrua Specialist Teaching Hospital in Southern Nigeria. Patients and Methods: A cross-sectional study of 502 consenting hypertensive adults receiving care at the Irrua Specialist Teaching Hospital, Irrua in Edo State, South-south Nigeria. A pre-tested semi-structured interviewer-administered questionnaire was used to collect data which was analyzed using SPSS version 21 and the level of significance was set at P < 0.05. Results: Five hundred and two participants (226 males, 276 females) completed the study with a mean age of 52.98 ± 12.82 years. Optimal blood pressure control was found in 15.5% of the study participants. Blood pressure control was significantly associated with being married (OR 1.549, CI: 1.0402.309), having a monthly household income of over N50,000 (OR 1.691, CI: 0.999-2.863), engaging in physical activity (OR = 1.537, CI: 0.989-2.388), and not being obese evidenced by a normal Waist Hip Ratio (OR = 2.276, CI: 1.555-3.332). Conclusion: Blood pressure control to target goal was low in the study population and achieved only in less than onefifth of respondents on antihypertensive therapy. Numerous socio-demographic and lifestyle variables were shown to be associated with blood pressure control. Physicians should emphasize medication adherence and lifestyle modification approaches in hypertensive adults.
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Humans , Blood Pressure , Rural Health , Cross-Sectional Studies , Hypertension , EpitopesABSTRACT
Objective@#To understand the situation of blood pressure control and its influencing factors in elderly patients with hypertension in Hangzhou, and to provide basis for the management of elderly patients with hypertension in community. @*Methods@#The subjects of this study were hypertension patients aged 60 years and over in Hangzhou community health management of basic public health services. Demographic data and life behaviors were collected by a questionnaire survey, physical examination and laboratory tests were carried out. The multivariate logistic regression model was used to analyze the influencing factors for blood pressure control in elderly patients with hypertension.@*Results@#A total of 109 583 people were investigated, with 50 500（46.08%） males and 59 083（53.92%） females. The control rate was 47.70% ( 52 273/109 583 ). After adjusted for age and gender, regular medication ( OR=0.874, 95%CI: 0.838-0.912 ) was the protective factor, obesity ( OR=1.291, 95%CI: 1.260-1.324 ), abnormal fasting plasma glucose ( OR=1.218-1.344, 95%CI: 1.178-1.410 ), the number of unhealthy lifestyles ( OR=1.271-1.292, 95%CI: 1.231-1.344 ), the items of dyslipidemia ( OR=1.047-1.253, 95%CI: 1.017-1.311 ), and the number of cardiovascular risk factors above ( OR=1.254-2.109, 95%CI：1.175-2.281 ) were the risk factors for blood pressure control in elderly patients with hypertension.@*Conclusions@#The control rate of elderly patients with hypertension in Hangzhou is 47.70%, which is associated with irregular medication, unhealthy lifestyle, obesity, dyslipidemia, abnormal fasting plasma glucose and clustering of these factors.
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Resumen Objetivo Determinar la prevalencia y el comportamiento epidemiológico de la hipertensión arterial en el Policlínico Julio Antonio Mella entre el 2016-2017. Materiales y métodos Se realizó un estudio descriptivo transversal en mayores de 35 años de ambos sexos que incluyó a 2,297 individuos, de ellos 976 eran hipertensos, a los que se les aplicó encuesta. Las variables cualitativas se expresaron en frecuencia absoluta y relativa, mientras que las asociaciones se realizaron mediante la prueba de Chi cuadrada. Resultados La prevalencia global de hipertensión en la población analizada fue de 42,5 %. En ambos sexos el grupo etario que predominó fue los menores de 65 años. El 62,4 % de los pacientes hipertensos son del sexo femenino, las cuales a su vez tienen mayor porciento de ser diabéticas y tener niveles de colesterol referido elevado. El 71, 5 % de los pacientes al menos ha tenido una consulta de seguimiento en el último año. El 86,1 % de los pacientes hipertensos adheridos al tratamiento están controlados, estando asociado estadísticamente dichas variables. Conclusiones Las mujeres y los menores de 65 años fueron los grupos más representados. Los medicamentos más utilizados para la hipertensión arterial fueron los del grupo farmacológico inhibidores de la enzima convertidora de angiotensina (IECA) y diuréticos.
Abstract Objective To determine the prevalence and epidemiological behavior of hypertension at the Julio Antonio Mella Polyclinic between 2016- 2017. Materials and methods A cross-sectional descriptive study was carried out with people older than 35 years of both sexes, which included 2 297 individuals, from this population 976 were hypertensive, to whom a survey was applied. The qualitative variables were expressed in absolute and relative frequency, while the associations were made using the chi-squared test. Results The overall prevalence of hypertension in the analyzed population was 42.5 %. In both sexes, the predominant age group was in those under 65 years of age. 62.4 % of hypertensive patients are female, which in turn have a higher percentage of being diabetic and have high cholesterol levels. 71, 5 % of patients have had at least one follow-up consultation in the last year and 64.7% of them have indicated angiotensin-converting enzyme inhibitors in the family. 86.1 % of patients adhered to the treatment are controlled and statistically associated. Conclusions Women and younger under 65 were the most represented groups. The drugs most commonly used for arterial hypertension were those of the pharmacological group, the angiotensin-converting enzyme inhibitors (ACEI) and diuretics.
Sumário Objetivo Determinar a prevalência e o comportamento epidemiológico da hipertensão arterial na Policlínica Julio Antonio Mella entre 2016-2017. Materiais e métodos Um estudo transversal descritivo foi realizado em pessoas acima de 35 anos de ambos os sexos, que incluíram 2.297 indivíduos, dos quais 976 eram hipertensos, aos quais foi aplicada uma pesquisa. As variáveis qualitativas foram expressas em frequência absoluta e relativa, enquanto as associações foram realizadas pelo teste do qui-quadrado. Resultados A prevalência geral de hipertensão na população analisada foi de 42,5%. Nos dois sexos, a faixa etária predominante foi a de menores de 65 anos. 62,4% dos hipertensos são do sexo feminino, os quais, por sua vez, apresentam uma porcentagem maior de diabéticos e altos níveis de colesterol referido. Pelo menos 71,5% dos pacientes tiveram uma consulta de acompanhamento no último ano. 86,1% dos hipertensos aderidos ao tratamento são controlados, estando essas variáveis estatisticamente associadas. Conclusões Mulheres e menores de 65 anos foram os grupos mais representados. Os medicamentos mais utilizados para pressão alta foram os do grupo farmacológico para inibidores da enzima conversora da angiotensina (IECA) e diuréticos.
Résumé Objectif Déterminer la prévalence et le comportement épidémiologique de l'hypertension artérielle dans la Polyclinique Julio Antonio Mella (Cuba) entre 2016 et 2017. Matériel et méthodes Une étude descriptive et transversale a été menée auprès d'un échantillon de 2297 personnes de plus de 35 ans, des deux sexes. Un questionnaire a été appliqué á 976 d'entre elles qui étaient hypertendues. Les variables qualitatives ont été exprimées en fréquence absolue et relative, tandis que les associations ont été évaluées á l'aide du test du chi-carré. Résultats Chez les deux sexes, le groupe d'âge prédominant était celui des moins de 65 ans. La prévalence globale de l'hypertension dans la population analysée était de 42,5%. Les femmes représentaient 62,4 % des patients hypertendus; dans leur groupe, il y avait aussi un plus grand pourcentage de diabète et de taux de cholestérol élevé. 71,5% des patients hypertendus avaient eu au moins une consultation de suivi au cours de l'année précédente et 64,7 % avaient reçu une prescription de médicaments de la famille des inhibiteurs de l'enzyme de conversion de l'angiotensine. 86,1 % des patients ayant adhéré au traitement étaient contrôlés, ces variables étant statistiquement associées. Conclusions Les femmes et les personnes de moins de 65 ans étaient les groupes les plus représentés. Les médicaments les plus couramment utilisés pour traiter l'hypertension artérielle étaient ceux du groupe des inhibiteurs de l'enzyme de conversion de l'angiotensine (IECA) et les diurétiques.
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Objective@#To survey on the home blood pressure measurement and blood pressure control rate among patients with hypertension in Beijing Yuetan community.@*Methods@#A questionnaire survey was conducted among 504 hypertensive patients, who were visiting Beijing Yuetan Community Health Service Center and selected by convenience-sampling method during June 2018 to January 2019. The status of home blood pressure measurement, the awareness of hypertension, the blood pressure control rate and factors related to not regularly measuring were surveyed.@*Results@#Of the 504 patients, 93.7% (472/504) took regular medication, but only 61.5% (310/504) had regular blood pressure measurements; 92.5% (466/504) had sphygmomanometers at home with electronic type mainly; 89.9% (453/504) patients knew the method of blood pressure measurement, but only 11.5% (52/453) had their sphygmomanometer calibrated. Among those who measured blood pressure, 77.4% (240/310) measured per week. The main reason for not measuring blood pressure regularly was that there was no need to measure blood pressure without any discomfort, accounting for 50.0% (97/194). The office blood pressure control rate (with desktop mercury sphygmomanometer) was 62.3% (314/504); the blood pressure control rate both in the morning and at bed time was 61.3% (73/119), that in the morning was 68.1% (81/119) and at bed time was 75.6% (90/119). The control rates of systolic blood pressure and heart rate by home measurement at morning and bedtime were significantly higher than those by office measurement (χ2=5.02, 9.97, 15.51, 13.72; all P<0.05).@*Conclusions@#The home blood pressure monitoring rate and knowledge level of hypertension among patients with hypertension in Yuetan community are relatively low. There are some differences in blood pressure control rate between office measurement and home measurement. Comprehensive evaluation is needed in the management process, and the treatment plan should be adjusted according to the specific condition of patients.
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Objective@#To evaluate the effects of the intervention based on WeChat on blood pressure control in patients with essential hypertension. @*Methods@#The databases of CNKI，Wanfang，VIP，PubMed and the Cochrane Library were researched for the literatures about effects of the intervention based on WeChat on blood pressure control in patients with essential hypertension published from 2011 to 2018. These papers were retrieved and evaluated according to inclusion and exclusion criteria. Stata 12.0 software was used for meta analysis.@*Results@#Eleven out of 880 papers were included into meta analysis. There were 1 174 cases，with 587 cases in the experimental group and 587 cases in the control group. The results of the meta analysis showed that compared with traditional health intervention method，the intervention based on WeChat significantly reduced the level of systolic blood pressure（WMD=14.77，95%CI：11.76-17.77）and diastolic blood pressure（WMD=8.17，95%CI：5.67-10.67）of hypertensive patients. Subgroup analysis showed that the longer the intervention，the better the effects（P<0.05）. @*Conclusion@#The intervention based on WeChat is more helpful than traditional health intervention for blood pressure control of patients with essential hypertension.
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Objective To learn the implementation and effects of standardized management of hypertension in Xiangshan. Methods A total of 1500 patients who were over 35 years and admitted to community hypertension management were enrolled in the research. The patients were given standardized management of hypertension, and acceptance questionnaire survey and physical examination. Multivariate logistic regression model was used to analyze the influencing factors of blood pressure control. Results Totally 597 patients were managed according to the standardized management requirements, and the standardized management rate was 39.80％ . All patients were received blood pressure ≥1 times /year, 84.00％ , 84.47％ , 78.27％ and 77.67％ of the patients were received dietary guidance, physical activity guidance, guidance and control tobacco smoking cessation / drinking / alcohol limit guidance respectively. The standardized blood pressure control rate was 42.20％ , which was higher than that of the non standardized management patients (31.01％), and the difference was statistically significant (P<0.05) . Logistic regression showed that high education background (ORjunior middle scho l=0.86, 95％ CI: 0.78-0.95;ORhighscho landabove= 0.76, 95％ CI: 0.68-0.85), excessive waist circumference (OR=0.93, 95％ CI: 0.89-0.97), obesity (OR=0.66, 95％ CI: 0.47-0.93) , receiving dietary guidance, (OR=0.73, 95％ CI: 0.56-0.95 ) , receiving physical activity guidance (OR=0.89, 95％CI: 0.81-0.98), acceptance of standardized management (OR=0.74, 95％CI: 0.62-0.88) were promote factors of blood pressure control. Elder (OR=1.29, 95％CI: 1.08-1.54), male (OR=1.12, 95％ CI: 1.02-1.23), living in rural areas (OR=1.09, 95％ CI: 1.03-1.15) and high income (OR=2.01, 95％ CI: 1.31-3.08) were barriers of blood pressure control. Conclusion Providing standardized management services for patients with hypertension can effectively control the blood pressure level.
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Objective To explore the influence of complications simulated experience education on self-management behavior(medication adherence and blood pressure control and treatment attitudes and beliefs)in young patients with hypertension.Thus,tocontrol the risk factors,improve the quality of life and prevent the complication of the heart, brain and kidneys. Methods A total of 200 young patients aged 18 to 44 old with hypertension were selected according to the diagnostic criteria of Chinese guidelines for the management of hypertension from June 2016 to May 2017.Participants were randomly divided into intervention group and control group (100 cases in each group).In the control group conventional education was used one-to-one education mode.And the complication simulated experience model was used in the intervention group one-to-one education mode. The differences in medication adherences, blood pressure, treatment attitude and beliefs between the two groups of patients were compared before and one month after intervention. Results The were no differences of general situation, blood pressure and medication adherence and treatment attitudes and the score of beliefs between two groups before intervention (P>0.05). After intervention, the systolic and diastolic blood pressure were (132.67 ± 12.95) mmHg (1mmHg=0.133 kPa) and (83.21 ± 5.97) mmHg in the intervention group, which were lower than(137.87±13.97)mmHg and(89.68 ±6.12)mmHg in the control group(t=2.730,7.568,P<0.05).Medication adherence score was 7.15±0.75 in the intervention group,which was higher than 5.10± 1.89 in the control group (t=10.081, P<0.05). In the intervention group, after the intervention treatment, attitudes and beliefs score was 82.15±13.13,which was higher than 71.11±15.89 in the control group.(t=5.337, P<0.05). Conclusions The complications simulated experience education is superior to conventional health education, which can improve medication compliance, blood pressure control, and treatment attitude and belief level in young patients with hypertension.
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background: blood pressure (bP) control among Malaysian is poor and doctor’s adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients’ bP control, doctors’ adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined. Methods: A cross-sectional study was conducted in Kuala Muda district’s health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables. results: A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients’ age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor’s good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians’ treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence. conclusion: Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.
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Various risk factors have been implicated in causation of stroke but hypertension remains the single most important treatable risk factor in all age groups, and it is the one which seems to have a direct relation to incidence. Furthermore antihypertensive therapy has been observed to be effective in reducing the incidence of CVD (cerebrovascular disease). The interaction between hypertension, antihypertensive treatment and stroke is a complex one. Nevertheless the conclusion is that antihypertensive treatment has definite beneficial effects on stroke. Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intra cerebral hemorrhage. In this study, a total of 55 patients who presented with CVD and with hypertension (stage 1 and 2 of JNC 7) were included in this study. Out of 55, 37 (67%) cases are ischemic and 18 (33%) cases were due to cerebral hemorrhage. In ischemic stroke 35 (63.5%) cases are thrombotic, 2 (3.5%) are embolic strokes. All patients were given treatment with oral Nifedipine retard preparation 10-20mg q 8th hourly or Angiotensin converting enzyme inhibitors (which also stabilizes endothelium of the vasculature), along with other conservative treatment and physiotherapy. Patients with intra cerebral haemorrhage were treated with Nimodipine 60 mg q 8th hourly along with antihypertensive treatment. In our study, the reduction of blood pressure improved the outcome, and their Blood Pressure normalized without any complications. Blood pressure reduction in acute stroke, irrespective of the etiology improved the outcome. In our study, we reduced the BP in all acute CVA patients with E. A. Ashok Kumar, P. Jijiya Bai. Role of blood pressure control in all acute cerebrovascular accidents with hypertension. IAIM, 2016; 3(8): 111-125. Page 112 hypertension to normal within 24-48 hours. This study suggested BP control improves the outcome, when compared to fatalities in other studies, where BP is not reduced acutely.
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Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project.The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project.By face-to-face questionnaire survey and health examination,the information of the subjects' demographic characteristics,risk factors,complications,involvement in community-based management of hypertension,anti-hypertension treatment,blood pressure,body height,waistline and body weight were collected.In this study,Rao-Scott x2 test was used to compare the variations among sub-groups.Taylor series linearization method was used to estimate the prevalence rate.The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.Results A total of 5 120 subjects were recruited in the analysis.The proportion of those receiving management for more than two years was 36.57％,and it was higher in urban area (44.56％) than in nural area (31.79％,P＜0.05);In the past 12 months,6.17％ and 14.46％ of the patients received no blood pressure measurement and drug therapy advice respectively,but there were no significant differences between urban group and rural group (P＞0.05);In the past 12 months,the proportions of the patients receiving diet and physical activity advice were 84.25％ and 84.90％ respectively,and the proportions were higher in urban group than in rural group (P＜0.05);In the past 12 months,the proportions of the subjects receiving tobacco and alcohol use advice were 78.41％ and 77.80％ respectively,and the proportions were higher in rural group than in urban group (P＜0.05).In urban area,the subjects receiving standardized management had lower SBP (142.79 ± 17.39) mmHg,lower DBP (84.26 ± 9.49) mmHg and higher blood pressure control rate (49.77％) than those receiving no standardized management (P＜0.05);while in rural area,no difference was found in BP control between the patients receiving and receiving no standardized management (P＞0.05).In urban area,the influencing factors for BP control among the subjects receiving community based management were educational level,annual income,body weight,hypertension management mode,times of receiving BP measurement,times of receiving antihypertensive medicine advice and receiving physical activity advice;while in rural area,the influencing factors for BP control among the subjects receiving community based management were annual income,body weight,family history of hypertension,antihypertensive medicine awareness,times of receiving antihypertensive medicine advice and receiving diet advice.Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area,and the quality of the services of community-based hypertension management was lower in rural area than in urban area.
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Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project.The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project.By face-to-face questionnaire survey and health examination,the information of the subjects' demographic characteristics,risk factors,complications,involvement in community-based management of hypertension,anti-hypertension treatment,blood pressure,body height,waistline and body weight were collected.In this study,Rao-Scott x2 test was used to compare the variations among sub-groups.Taylor series linearization method was used to estimate the prevalence rate.The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.Results A total of 5 120 subjects were recruited in the analysis.The proportion of those receiving management for more than two years was 36.57％,and it was higher in urban area (44.56％) than in nural area (31.79％,P＜0.05);In the past 12 months,6.17％ and 14.46％ of the patients received no blood pressure measurement and drug therapy advice respectively,but there were no significant differences between urban group and rural group (P＞0.05);In the past 12 months,the proportions of the patients receiving diet and physical activity advice were 84.25％ and 84.90％ respectively,and the proportions were higher in urban group than in rural group (P＜0.05);In the past 12 months,the proportions of the subjects receiving tobacco and alcohol use advice were 78.41％ and 77.80％ respectively,and the proportions were higher in rural group than in urban group (P＜0.05).In urban area,the subjects receiving standardized management had lower SBP (142.79 ± 17.39) mmHg,lower DBP (84.26 ± 9.49) mmHg and higher blood pressure control rate (49.77％) than those receiving no standardized management (P＜0.05);while in rural area,no difference was found in BP control between the patients receiving and receiving no standardized management (P＞0.05).In urban area,the influencing factors for BP control among the subjects receiving community based management were educational level,annual income,body weight,hypertension management mode,times of receiving BP measurement,times of receiving antihypertensive medicine advice and receiving physical activity advice;while in rural area,the influencing factors for BP control among the subjects receiving community based management were annual income,body weight,family history of hypertension,antihypertensive medicine awareness,times of receiving antihypertensive medicine advice and receiving diet advice.Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area,and the quality of the services of community-based hypertension management was lower in rural area than in urban area.
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Antecedentes: Inadecuado control de presión arterial (PA) y baja adherencia a tratamiento farmacológico (Rx) en hipertensos son problemas persistentes globales y en Chile. Factores socioeconómicos y psicosociales han sido frecuentemente mencionados, pero escasamente en Chile. Objetivo: Evaluar control de la PA y adherencia a Rx en hipertensos seguidos en el Programa de Salud Cardiovascular (PSCV) y su asociación con factores clínicos, socioeconómicos y psicosociales. Métodos: Muestra randomizada de 1.794 hipertensos seguidos por 1 año en PSCV en Región Metropolitana. Se evaluó la asociación de edad, sexo, educación, ingreso familiar, Rx, diabetes, obesidad, tabaquismo, consumo problemático de alcohol y actividad física con el control de la PA (<140/90 mmHg) y adherencia. Además, en 600 pacientes, se evaluó la asociación con estrés emocional/depre-sión, relación médico-paciente y apoyo social. Se obtuvieron Odds Ratio (OR) mediante análisis de regresión logística multivariante. Resultados: PA controlada se comprobó en 56,5% y adherencia en 37,3% sin documentarse asociación entre ambas (OR 1,01 [IC 95% 0,78 - 1,32]). Factores asociados a PA no controlada y no adherencia fueron: edad, bajo ingreso familiar, inadecuada relación medico-paciente y alto nivel de estrés emocio-nal/depresión. Rx múltiple y obesidad se asociaron a PA no controlada; sexo masculino y baja educación a no adherencia. Conclusiones: El control de la PA (56,5%) fue similar a resultados de países desarrollados y supera ampliamente cifras de la Encuesta Nacional de Salud 2010 (16,9%). Estos resultados y la falta de asociación entre el control de la PA y la adherencia, sugieren la favorable influencia de otros factores posiblemente relacionados al PSCV.
Background: Unsatisfactory blood pressure (BP) control and low adherence to antihypertensive pharmacotherapy (Rx) in hypertensive populations are persistent problems worldwide and also in Chile. Socioeconomic and psychosocial factors have been frequently mentioned, but with limited contributions from Chile. Objective: The assessment of BP control and adherence to Rx in hypertensive patients followed in the Cardiovascular Health Program (CVHP) and to determine their association with clinical, socioeconomic and psychosocial characteristics. Methods: A randomized sample of 1,794 hypertensive patients followed for 1 year under the CVHP in Metropolitan Region. Association of BP control (<140/90 mmHg) and adherence with age, gender, education, income, Rx, diabetes, obesity, smoking, alcohol use problem and physical activity were analyzed. In a subgroup of 600 patients additional analysis included the association with emotional stress and depression, patient-physician relation and social support. Odds Ratio (OR) were obtained by multivariate logistic regression. Results: BP control was achieved in 56.5% and adherence in 37.3%. No association was found between them (OR 1.01 [CI 95% 0.78-1.32]). Uncontrolled BP and no adherence were associated to advanced age, low income, poor patient-physician relation and high stress-depression. Obesity and multiple Rx were associated to uncontrolled BP. Male gender and low education, were associated to no adherence. Conclusions: BP control (56.5%) was similar to results obtained in developed countries and is strikingly higher than the results reported in the 2010 Chilean National Health Survey (16.9%). These results and the lack of association between BP control and adherence suggest the favorable influence of unaccounted factors, possibly related to the CVHP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Primary Health Care , Patient Compliance , Arterial Pressure/drug effects , Hypertension/drug therapy , Physician-Patient Relations , Socioeconomic Factors , Logistic Models , Multivariate Analysis , Surveys and Questionnaires , Medication Adherence , Life Style , Antihypertensive Agents/therapeutic useABSTRACT
A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de pressão arterial (PA). 1 O paciente é considerado hipertenso quando a pressão sistólica é ≥ 140 mmHg e a diastólica é ≥ 90 mmHg em três aferições 1-5.Embora o tratamento adequado seja importante para o controle da HAS, a prevenção se destaca, especialmente nos pacientes de risco 5-9...
Subject(s)
Humans , Health Behavior , Hypertension/therapy , Brazil/epidemiologyABSTRACT
Hypertension is poorly managed in Egypt due to low rates of awareness about the disease. The aim of this study was to describe the role of the pharmacist as a health care provider and the implementation of a pharmaceutical care model to improve medications adherence, BP control, knowledge and quality of life (QOL) in a sample of Egyptian patients suffering from hypertension. A total of 280 hypertensive adults, whether their BP was controlled or not, were enrolled in the study and randomly classified into either control group (CG) or intervention group (IG); both received the usual hospital care and kept on their antihypertensive. Patients in the IG, beside the usual hospital care, received a pharmaceutical care program described in the methods. All patients visited the clinic monthly up to three months for check and evaluation. Significant improvements were observed in the studied parameters for the IG compared with the CG, at the end of the study, although there was no significant difference (P > 0.05) between them in demographics and characteristics at the baseline. At the end of the study, a significant lower SBP (-8.2 mmHg, P = 0.003) and DBP (-5.4 mmHg, P = 0.001) levels were observed in the IG with significantly higher BP control (P=0.018). Also, medication adherence was significantly higher (P = 0.002) in the IG (27.2%, 52.8%, 20.0% vs 48.6%, 33.6%, 17.8% for low, intermediate and high adherence, respectively). Similarly, patients’ knowledge, attitude and practice were significantly improved (P = 0.001) in IG ((20.5+1.8), (4.7+1.0), (4.7+1.0), respectively) vs ((13.7+7.2), (3.8+1.8), (2.9+2.0), respectively) for the CG. While end of study QOL for the IG, increased significantly compared with the CG (P = 0.001, 0.001, 0.020, 0.010 and 0.016 for patients’ rate of QOL, enjoy, energy, sleep and access to health system, respectively), most of QOL dimensions were decreased significantly from their baseline in the CG. Conclusion: Pharmacist intervention can significantly improve BP control, medication adherence, patients’ knowledge, attitude, practice and QOL in hypertensive Egyptian patients treated with antihypertensive agents.
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Type 2 diabetes mellitus (DM) doubles the risk of major cardiovascular complications in both patients with and those without established cardiovascular disease (CVD), and the majority of patients with DM die of CVD. Therefore, prevention and early diagnosis for CVD are important for the improvement of quality of life and prognosis of patients with DM. Exercise stress tests, such as a treadmill test, are needed to detect myocardial ischemia, but such stress testing should be done by cardiologists. On the other hand, measurement of ankle brachial index (ABI) is quick and easy and has been used successfully to diagnose peripheral artery disease. Since ABI is known to be a good predictor of the risk of recurrent CV events and death, I strongly recommend that ABI be measured in all DM patients. Dipeptidyl peptidase 4 (DPP-4) inhibitors are oral agents with little risk of hypoglycemia and thus used widely. In 2013, two clinical studies (EXAMINE and SAVOR-TIMI53) showed that DPP-4 inhibitors were generally safe and well-tolerated but did not decrease or increase the rate of CV events in patients with high risk for CV. Although the study periods were short (1.5-2.0 years), it was shown that a reduction of CV events in DM patients with CV risk is difficult with glycemic control alone. Results of the Steno-2 study showed that optimal treatment of hypertension and dyslipidemia in addition to glycemic control are needed to reduce CV events.