Quality of care for patients with hypertension in selected Health Centres in Rwamagana District, Rwanda

Background Hypertension is the main risk factor for cardiovascular diseases and its prevalence is high in Rwanda. Rwanda has integrated the management of hypertension in health centres (HCs). However, little is known about the quality of hypertension care in HCs in Rwanda. Study objective To examine the quality of care for patients with hypertension and associated outcome of hypertension control in Health Centres. Methods A cross-sectional study design was used, and data were collected from a convenience sample of 202 patients. A self-reported questionnaire and blood pressure measurement were taken. Data were analysed using descriptive, bivariate, and hierarchical logistic regression analyses. Results A total of 166 (82.2%) patients participated in the study. Of these, 130 (78.3%) were females. Mean age was 57.8 (SD =14.0). The quality of hypertension care process was high with mean score of 5.86 over 7 (SD = 1.4). However, only 30.1% (n = 50/166) had well-controlled hypertension. Comorbidity (OR = 2.3; 95% CI:1.0- 5.1, p =.039) and the quality of care (OR = 1.6; 95% CI: 1.1- 2.4, p = .024) were associated with higher odds of having hypertension control. Conclusion Tailored patient-centred primary care interventions that consider comorbidity could contribute to hypertension control in primary HCs in Rwanda.

Caracterización de la prevalencia de la hipertensión arterial en Cuba en 2019 / Characterization of Arterial Hypertension Prevalence in Cuba in 2019

Introducción: La hipertensión arterial pudiera ser un elemento clave para la prevención de las enfermedades cardiovasculares, pues constituye su principal denominador común. Es el principal factor de riesgo, para la carga mundial de morbilidad y mortalidad. Objetivo: Caracterizar la prevalencia de hipertensión arterial en Cuba en el año 2019. Métodos: Se realizó un estudio ecológico. Se compararon las prevalencias de hipertensión arterial en las encuestas nacionales de factores de riesgo en los años 1995, 2001 y 2010 respecto a las de la dispensarización de esos años. Se tuvieron en cuenta las prevalencias totales de hipertensión arterial por grupos de edad y sexo, las de cada provincia y del municipio especial Isla de la Juventud. Los datos se procesaron de forma automatizada. Los resultados se expresaron en una tabla y gráficos. Resultados: Las prevalencias de hipertensión arterial encontradas en las encuestas nacionales de factores de riesgo superaron a las de la dispensarización en esos años. La prevalencia de hipertensión arterial se incrementó en la medida que lo hizo la edad. En el grupo de edad de 60 a 64 años, más del 75 por ciento de las personas resultaron hipertensas. En los de 25 a 59, de 65 y más y en el total predominaron las mujeres hipertensas. Conclusiones: Es preciso reducir la brecha entre los pacientes conocidos como hipertensos, dentro del sistema de salud y los que realmente son portadores de la enfermedad, conseguir el manejo adecuado de esta y con eso influir favorablemente en la morbilidad y mortalidad por enfermedades vasculares(AU)

Introduction: Hypertension could be a key element for the prevention of cardiovascular diseases, since it constitutes its main common denominator. It is the main risk factor for the global burden of morbidity and mortality. Objective: To characterize the prevalence of arterial hypertension in Cuba in 2019. Methods: An ecological study was carried out. The prevalence rates of arterial hypertension in the national surveys of risk factors in the years 1995, 2001 and 2010 were compared to those of the dispensarization carried out in those years. The total prevalence rates of arterial hypertension were taken into account by age groups and sex, considering also those of each province and of the special municipality of Isla de la Juventud. The data was processed automatically. The results were expressed in a table and in graphs. Results: The prevalence rates of arterial hypertension found in the national surveys of risk factors exceeded those of dispensarization in those years. The prevalence of hypertension increased with age. In the age group 60-64 years, more than 75 percent of people were hypertensive. In those aged 25-59, 65 and over, as well as in the total, hypertensive women predominated. Conclusions: It is necessary to reduce, within the health system, the gap between patients known as hypertensive and those who really are carriers of the disease, to achieve proper management of this and, thus, to have a favorable influence on morbidity and mortality from vascular diseases(AU)

El control de la hipertensión arterial, aún sin definir / Arterial hypertension control: still without definition

RESUMEN El debate alrededor de las cifras de tensión arterial, y sobre todo las cifras a obtener mediante el tratamiento es en la actualidad un grave problema de salud. Se realizó una revisión sistemática en inglés y español de los principales artículos publicados en PubMed, Scielo y MEDLINE durante el periodo comprendido desde el año 2012 hasta 2018, acerca de la definición, evaluación y manejó de la tensión arterial. Todas las guías están de acuerdo en la toma de múltiples medidas de la tensión arterial para el diagnóstico, pero no para definir el control de la tensión, definir el control de la tensión arterial debe incluir una dimensión en el tiempo en un año por lo menos, y una proporción mínima de medidas donde debe pensar en la mitad de todas las medidas por lo menos, con medidas de tensión arterial tomadas por lo menos cada tres meses, por lo que sugerimos que un perfil anual de las cifras de tensión arterial debe ser considerado como un requisito mínimo para evaluar el control de la hipertensión arterial, este trabajo ha perfilado dos de los factores menos reconocidos: la necesidad de la intensificación del tratamiento después de la primera toma de tensión arterial por encima de las cifras deseadas, y el incremento de una nueva droga en vez de incrementar las dosis de las ya indicadas.

ABSTRACT The debate on the maintained arterial tension measure, and on the measure to obtain through the long term treatment, is currently a problem for the medical practitioner, due to the variation of arterial tension during the day at different hours because of the patients circadian cycle, and due to variations in different days according to the proper patient's situations or the environment around it, and the different seasons of the year. They make it difficult to know when arterial tension is within the parameters accepted as "controlled". The authors carried out a systematic review of documents published in PubMed, Scielo and MEDLINE in the period 2012-2018, both in English and Spanish, on the arterial tension definition, evaluation and management. The guidelines agree in taking arterial tension measures in different moments for the diagnosis, but not in defining tension control. Defining tension control should include a time dimension of at least a year, and a minimal proportion of measures within the parameters recognized as non-pathological or optimal on the basis of measures taken at least every three months. Therefore, the authors suggest that an annual profile of the arterial tension parameters should be considered as a minimal requirement to evaluate arterial hypertension control.

Prevalence of hypertension and hypertension control rates among elderly adults during the cold season in rural Northeast China: a cross-sectional study / Journal of Rural Medicine

Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment.Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50–69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates.Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.

Effects of different modes of hypertension management on blood pressure control in patients with hypertension / 中国卫生政策研究

Objective: To study the effect of different hypertension management modes on the blood pressure control in patients with hypertension. Methods:Three community health service centers in Xinjiang city were includ-ed in the study, which used different modes of hypertension management. Center A carried out the basic public health services,but did not provide medical services; Center B provided both the basic public health services and medical services,Center B also established the responsible doctor system; Center C carried out basic public health services and provided medical services based on the regional medical association. The blood pressure of patients with hypertension from the three centers were investigated in July 2013 and in December 2015. Using Logistic regression to analyze the effect of different management modes on blood pressure control. Results: The average SBP of patients from Center A increased by 0.89mmHg (P >0.05), the average BP increased by 0.67mmHg (P >0.05), the blood pressure control rate decreased by 2.54% (P>0.05); The average SBP of patients from Center B increased by 5.31mmHg (P<0.01), the average BP decreased by 1.70mmHg (P>0.05), the blood pressure control rate increased by 2.70% (P>0.05);The average SBP of patients from Center C decreased by 1.54mmHg(P>0.05), the average BP decreased by 2.97mmHg (P<0.01), the blood pressure control rate increased by 16.24% (P<0.05).According to the results of the random effect model,the likelihood of blood control of Center A is 0.27 times that of Center C (P<0.05),the likelihood of blood control of Center B is 0.41 times that of Center C (P>0.05). Conclusion: the hypertension management mode based on regional medical association can effectively control the blood pressure of patients with hypertension.

A case-control study on influencing factors of community-based hypertension control / 预防医学

Objective To understand the influencing factors of hypertension control,and to provide a theoretical basis for developing intervention measures.Methods A two-stage cluster random sampling method was performed and a total of 1 377 cases and 749 controls in Yuhang District were selected.Univariate and multivariate logistic regression analysis were used.Results The control rate of hypertension was 64. 77%.Hypertension control was related to BMI,course of disease and models of follow-up by univariate logistic regression analysis(P<0. 05 ).The multivariate logistic regression analysis showed that older age (OR =0. 983,95%CI=0. 974 -0. 993 ),male (OR =1. 272,95%CI=1. 053 -1. 535 ), overweight (OR=0. 709,95%CI=0. 576-0. 872),obesity (OR=0. 297,95%CI=0. 210-0. 421)and model of group follow-up (OR=0. 495,95%CI=0. 375 -0. 654)were the major influencing factors.Conclusion The older age,male, overweigt,obesity and model of group follow-up were the major influencing factors.Comprehensive intervention measures should be strengthened so as to improve the control rate of hypertension in community.

Control de la hipertensión arterial en personas con diabetes tipo 2 / Blood hypertension control in type 2 diabetic persons

Objetivo: Evaluar el control de la hipertensión arterial y su relación con algunas variables clínicas y bioquímicas, en personas con diabetes mellitus tipo 2 de Bayamo, provincia Granma. Métodos: estudio descriptivo transversal con 382 pacientes diabéticos tipo 2, además hipertensos, ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre septiembre de 2011 y mayo de 2013. Los pacientes se dividieron en 2 grupos, atendiendo al control de la hipertensión arterial: controlados y no controlados. Resultados: al final del ingreso 345 pacientes con diabetes (90,3 por ciento) obtuvieron un control óptimo de la presión arterial. Para lograr este objetivo fue necesario utilizar 2 o más medicamentos en el 68,4 por ciento de los casos. Los diabéticos que no alcanzaron un buen control de la presión arterial (9,7 por ciento), tenían una edad y un tiempo de evolución de la diabetes significativamente mayor que aquellos que sí lo consiguieron (p= 0,0126 y p= 0,0090, respectivamente). Hubo una asociación notoria entre el descontrol de la glucemia y el de la presión arterial (OR= 6,82, IC= 3,3-13,9, p= 0,0000). Conclusiones: para alcanzar un control óptimo de la presión arterial en la mayoría de los diabéticos tipo 2, en nuestro medio, se necesitan 2 o más medicamentos, y tener en cuenta diferentes factores como: la edad, el tiempo de evolución de la diabetes y el control de la glucemia(AU)

Objective: To evaluate the blood hypertension control and its relationship with some clinical and biochemical variables in type 2 diabetic persons living in Bayamo, Gramma province. Methods: cross-sectional descriptive study of 382 type 2 diabetic and hypertensive patients, who were admitted to the Center of Care for Diabetic Patient in Bayamo, Gramma province in the period of September 2011 through May 2013. The patients were divided into 2 groups according to the blood hypertension control in terms of controlled and uncontrolled hypertensives. Results: on discharge from hospital, 345 diabetic patients (90.3 percent) had reached optimal control of their blood pressure. To attain this goal, it was necessary to use two or more drugs in 68.4 percent of cases. The diabetics that did not succeed in this task were older and had longer time of progression of diabetes than those who did (p= 0.0126 y p= 0.0090, respectively). There was remarkable association of lack of glycemic control and uncontrolled blood pressure (OR= 6.82, IC= 3.3-13.9, p= 0.0000). Conclusions: it was necessary to use two or more drugs to reach optimal control of blood pressure in most of the type 2 diabetic patients and to consider different factors such as age, time of diabetes progression and glycemic control(AU)

Studying arterial hypertension uncontrol among the population of Selenge province / Монголын Анагаах Ухаан

Background During the last ten years cardiovascular disease has became one of the priority cause of death in Selenge province, while 23.9 cases in 10.000 population. Studying cause of increasing cardiovascular disease by year and year, connecting with arterial hypertension control and influenced factors is our research work background.GoalTo determine uncontrolled arterial hypertension and evaluate its influenced factors among the population with arterial hypertension in Selenge province.Objectives:1. Research uncontrolled arterial hypertension among the population2. Determine factors that influence uncontrolled arterial hypertensionMaterials and Metods: Research model: Population based moment model of analitic research is used to survey control of population with arterial hypertension. Research coverage and Sampling: Eruu, Zuunburen, and Khutul soums were chosen from 23 soums including center of Selenge province through the random sampling. And then 480 people with arterial hypertension, aged above 18 years were participated in the research. Data was analysed by SPSS 17 program. Collecting information method: Situation of arterial hypertension control is taken by questionnaire method developed by collaboration with WHO and International Association of Arterial Hypertension, and whether follow the drug treatment instruction of physicians is evaluated by MMAS questionnaire method developed by Association of Control Case Managment of America. Arterial hypertension, weight and height of participants were measured. Although people with arterial hypertension under 140-90 mm.Hy are reported “people who are controlling their arterial pressure in normal rate”.ResultsTotally 480 people with arterial hypertension, aged above 18 years were chosen from of Eruu, Zuunburen, and Khutul soums and center of Selenge province. Approximetly, 29.1 percent were male, 70.8 percent were female and average age was 52.43. About 34 percent were high education, 85.8 percent were married and 34.4 percent were retired people. According to the survey, 68 people or 14.1 percent were controlled their arterial pressure/hypertension in normal rate, 412 people or 85.8 percent were uncontrolled their arterial pressure/hypertension in normal rate. Because of the arterial hypertension 59 percent of the participants were under control of physicians. Also there was difference on age and gender with statistical benefit. (p=0.001) People who can control arterial pressure in normal rate were 12.7 percent of people under control of physicians.Conclusions:About 85.8 percent or 412 people with arterial hypertension were uncontrolled, 90 percent were male and 84.1 percent were female. Because of the arterial hypertension, 59 percent of the participants were under control of physicians. But 87.3 percent of them cannot control their arterial pressure/ypertension in normal rate. Physicians control, employment, body mass index and following drug treatment instruction were the factors influence on arterial hypertension control.

Adherencia a los tratamientos farmacológicos y no farmacológicos en personas con hipertensión arterial. Montería, 2010 / Adherence to pharmacological and non-pharmacological treatments in people with arterial hypertension. Monteria, 2010

El presente estudio tuvo como objetivo describir y analizar la adherencia a tratamientos farmacológicos y no farmacológicos en personas con hipertensión arterial, inscritas en el Programa de Control de una Empresa Social del Estado de baja complejidad en la ciudad de Montería. Se utilizó un diseño descriptivo transversal con abordaje cuantitativo que permitió describir la adherencia al tratamiento en una muestra aleatoria de 177 personas que asistieron al servicio de consulta externa a control de la hipertensión arterial, mediante el empleo del Instrumento Factores que influyen en la adherencia a tratamientos farmacológicos y no farmacológicos en pacientes con factores de riesgo de enfermedad cardiovascular de Bonilla y De Reales. Los resultados del estudio revelan que la mayor proporción de las personas que participaron en el estudio se encontraron en riesgo de no desarrollar comportamientos de adherencia al tratamiento farmacológico y no farmacológico, lo cual guarda relación con los factores socioeconómicos y relacionados con el proveedor. Los factores relacionados con la terapia y con el paciente reflejaron una situación de ventaja para la adherencia. La relación entre los 24 ítems del instrumento utilizado y la situación adherencia encontrada es lineal y en general la relación es fuerte con tendencia positiva. Se recomienda a los profesionales de enfermería continuar realizando investigaciones sobre el fenómeno de la adherencia al tratamiento en personas con riesgo cardiovascular con el propósito de contribuir al desarrollo disciplinar y por ende mejorar las prácticas de cuidado como un aporte a la solución del problema de altos índices de morbimortalidad por enfermedades cardiovasculares.

This study has as an aim to describe and analyze the adherence to nonpharmacological and pharmacological treatment on people with arterial hypertension, registered in the control program of a state social enterprise of low complexity at Monteria city. It was used a cross sectional descriptive design with quantitative approach that allowed to describe the adherence to the treatment in a randomize sample of 117 people that attended the outpatient service to arterial hypertension control, through the using the instrumental factors that has influence in the adherence of nonpharmacolocical and pharmacological treatment on patients with risk factors of cardiovascular illness of Bonilla and De Reales. The outcomes of the study disclose that in an upper proportion of people who participate in the research were found on risk of not developing behaviors of adherence to the nonpharmacological and pharmacological treatment, which keeps relation with socioeconomic factors and related with the supplier. The factors related to the therapy and with the patient, showed a situation of advantage for the adherence. The relationship between the 24 items of the used instrument and the adherence situation founded is lineal and in general the relationship is strong and with positive trend. It is recommended for the nursery professionals to continue doing researches about the phenomenon of treatment adherence on people with cardiovascular risk with the aim of contributing to the disciplinary development and therefore improving the practices of care as a contributing to the solution for the problem of high mortality index due to cardiovascular illness. The present study aimed to describe and analyze adherence to pharmacologic and non pharmacologic treatments in people with hypertension, enrolled in a control program of the State Social Enterprise of low complexity for the city of Montería.

Fatores para não-adesão ao programa de controle da hipertensão arterial em Campo Grande, MS / Factors for nonadherence to the Arterial Hypertension Control Program in Campo Grande, MS, Brazil

A adesão ao tratamento farmacológico em doenças crônicas como a hipertensão arterial, é fundamental para o controle, prevenção de complicações e diminuição da mortalidade. Identificar os fatores que levam a não adesão ao programa de controle de hipertensão arterial, em Unidades Básicas de Saúde de Campo Grande, MS e produzir um modelo de predição desta condição foi o objetivo do presente estudo. Utilizou-se o método de caso-controle, aninhado a coorte de pacientes cadastrados no programa, no período de 2002 a 2005. Foi utilizada regressão logística tendo como variável-resposta ?adesão ao programa?. As associações significativas identificadas na análise univariada foram: características socioeconômicas, da doença, do tratamento e as relacionadas ao programa. Para prever a adesão, mantiveram-se no modelo as seguintes variáveis: dificuldade em ir ao programa, renda familiar, presença de diabetes, escolaridade e viver com companheiro. Com base no modelo, a probabilidade do paciente ser classificado corretamente como aderente, é de aproximadamente, 80% e como não aderente, 67%. O modelo identifica precocemente, pacientes vulneráveis à não adesão ao programa propiciando que este institua medidas voltadas aos prováveis, não aderentes.

Adherence to the pharmacological treatment of chronic diseases such as arterial hypertension is decisive in their control, in preventing complications, and in decreasing mortality rates. To identify factors that led patients to drop out of an arterial hypertension control program available at local district clinics of the government-run National Health Service in Campo Grande, MS, Brazil, and to design a model to predict adherence. A nested case?control study was conducted on subjects selected from within a cohort of patients enrolled in the above program, from 2002 to 2005. Binary logistic regression was used, with ?adherence to program? as the binary response variable. Data were subjected to logistic regression analysis to generate a model capable of predicting adherence. Factors identified: difficulty in going to the venue where the program was available, family income, presence of diabetes, level of education and living with a partner. When the logistic regression model was used, the probability of a patient being correctly classified as adherent and nonadherent was approximately 80% and 67%, respectively. The model enables early identification of patients prone to nonadherence to the control program, thus making it possible to implement measures directed at potentially nonadherent participants.

Factores asociados con la hipertensión no tratada en los adultos mayores: resultados del estudio nacional sobre salud y envejecimiento en México, 2001 / Factors associated with untreated hypertension among older adults: results of the Mexican health and aging study, 2001

OBJETIVO: Determinar los factores asociados con la falta de adhesión al tratamiento de la hipertensión arterial (HTA) diagnosticada en una muestra representativa de adultos mayores mexicanos que viven en la comunidad. MÉTODOS: Estudio transversal con 2 029 personas de 65 años o más con diagnóstico de HTA, participantes en el Estudio Nacional sobre Salud y Envejecimiento en México realizado en el verano de 2001. La encuesta recabó información sobre algunas características sociodemográficas (edad, sexo, escolaridad, si vivía solo y si realizaba algún trabajo remunerado, entre otras), las enfermedades crónicas, los síntomas depresivos, el deterioro cognoscitivo, el índice de masa corporal, el tabaquismo, el consumo de bebidas alcohólicas y las dificultades para realizar actividades básicas (ABVD) e instrumentales (AIVD) de la vida diaria, entre otras. Se evaluó la asociación entre las variables estudiadas y el autoinforme de hipertensión arterial no tratada (HTNT) mediante análisis de regresión logística simple y multifactorial. RESULTADOS: De los 2 029 participantes, 437 (21,5 por ciento) declararon no seguir tratamiento alguno para controlar la HTA, 1 584 (78,1 por ciento) afirmaron seguir un tratamiento y 8 (0,4 por ciento) no respondieron a esa pregunta. El análisis multifactorial ajustado por posibles variables confusoras (edad, sexo, síntomas depresivos y deterioro cognoscitivo) mostró que solo la baja escolaridad (razón de posibilidades [odds ratio, OR] ajustada = 1,70; intervalo de confianza de 95 por ciento [IC95 por ciento]: 1,10 a 2,64; P = 0,02 para la escolaridad de 1 a 6 años y OR ajustada = 3,32; IC95 por ciento: 2,10 a 5,24; P < 0,01 para los no escolarizados), consumir bebidas alcohólicas (OR ajustada = 1,52; IC95 por ciento: 1,14 a 2,03; P = 0,01) y padecer de incontinencia urinaria (OR ajustada = 1,61; IC95 por ciento: 1,15 a 2,26; P < 0,01) resultaron asociadas independientemente con la HTNT. CONCLUSIONES: La HTNT es ...

OBJECTIVE: To determine factors associated with failure to adhere to treatment for diagnosed hypertension among a representative sample of older Mexican adults living in the community. METHODS: A cross-sectional study of 2 029 individuals 65 years of age or older with diagnosed hypertension who participated in the Mexican Health and Aging Study, carried out during the summer of 2001. The survey collected information on several demographics (age, sex, schooling, whether living alone, and employment status, among others), any chronic illnesses, symptoms of depression, cognitive deterioration, body mass index, smoking, alcohol consumption, and difficulty performing basic and instrumental activities of daily living. Simple and multifactorial logistical regression analyses were used to evaluate the association among the study variables and self-reported untreated high blood pressure. RESULTS: Of the 2 029 participants, 437 (21.5 percent) reported not following any treatment whatsoever for controlling their hypertension; 1 584 (78.1 percent) affirmed they were complying with treatment; and 8 (0.4 percent) did not respond to this question. The multifactorial analysis adjusted for confounding variables (age, sex, symptoms of depression, and cognitive deterioration) showed that only a low number of years of schooling (adjusted odds ratio [OR] = 1.70; 95 percent confidence interval [95 percentCI]: 1.10-2.64; P = 0.02 for 1-6 years of schooling and adjusted OR = 3.32; 95 percentCI: 2.10-5.24; P < 0.01 for no schooling), alcohol consumption (adjusted OR = 1.52; 95 percentCI: 1.14-2.03; P = 0.01), and urinary incontinence (adjusted OR = 1.61; 95 percentCI: 1.15-2.26; P < 0.01) were independently associated with hypertension. CONCLUSIONS: Hypertension is a common and important issue among older adults in Mexico. To obtain better medication compliance, doctors prescribing or modifying hypertension treatment should taken into account whether or not the ...

Status of Blood Pressure Controlling in 1574 Community Outpatient with Hypertension / 中国康复理论与实践

@#Objective To investigate the reasons of blood pressure not reached standard in community outpatients with hypertension.Methods During January 2001 to December 2006,2798 patients fitting the China hypertension guide standard providing prevention and curing were involved in this study.From them,1574 cases were treated repeatedly,and the blood pressure did not continuously reach the controlled standard.The reasons were analyzed by regular visiting and correspondence with patients.Results The reasons of blood pressure not reached controlled standard related with chiefly the following factors:patient had bad compliance,and not positively intervened the way of life,and not took medicine according to the doctor's advice;doctors were not familiar with the methods of preventing hypertension and the treatment was nonstandrad.Conclusion The reasons of blood pressure not reaching standard in community outpatients with hypertension mainly are that the patients have poor knowledge about hypertension and compliance,and the treatment is nonstandrad.

Physician Factors Associated with the Blood Pressure Control among Hypertensive Patients / 예방의학회지

OBJECTIVES: Little is known about the physician-related factors that are associated with the management of hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. METHODS: We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do. Forty-one physicians completed the survey (response rates: 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the selfreported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center's information system. We compared the physicians' perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians' antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physicianrelated factors. RESULTS: The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients' control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensinconverting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI: 1.17-1.48). CONCLUSIONS: Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians' overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician' awareness regarding the management of patients with hypertension are needed.

Effectiveness and Factors Associated with the Control of Hypertension in Apartment Management Workers : Provided with Occupational Health Services / 대한산업의학회지

OBJECTIVES: This study was conducted to investigate the effectiveness of the visiting occupational health services(OHS)and the factors associated with the proper control of blood pressure in hypertensive apartment management workers. METHODS: The study group included 60 workers,who were visited and followed up regularly by a nurse for a period of more than 6 months.We checked the risk factors of hypertension, blood pressure and provided hypertension control methods every 2 months. RESULTS: Mean systolic blood pressure decreased from 151.9 mmHg at the first visit to 141.1 mmHg at the last visit, and mean diastolic blood pressure also decreased from 93.6 mmHg to 87.1 mmHg (p<0.01).The number of workers who had regular exercise more than once a week increased from 7 (11.7%)at the first visit to 34 (56.7%)at the last visit, and the number of workers taking hypertensive medicines increased from 4 (6.7%) to 26 (43.3%)(p<0.01). The percentage of workers who either changed their life style or began taking hypertensive medication over the course of the action undertaken by the occupational health services showed a significant differences, 36.8%in the shorter intervention group, 43.5%in intermediate intervention group, and 72.2%in longer intervention group (p<0.05). Among those who were on shift work for less than 10 years was 32 (78.0%), while the corresponding number was only 9 (22.0%) for those who were on shift work for more than 10 years (p<0.01). CONCLUSIONS: This study showed that the visiting OHS was effective in bringing about a reduction in blood pressure, as well as an improvement in life style habits and in the use of medication. It suggests that occupational factors should be taken into account for the proper control of blood pressure in hypertensive apartment management workers.