Assessment of clinical profile among hypertensive patients, Meru, Kenya

Background: Non-communicable diseases (NCDs) are the leading cause of global morbidity and mortality. Globally, more than 1.28 billion adults are hypertensive and in Kenya, 24% of adult population has elevated blood pressure and 56% of these have never been screened for hypertension. Assessment of clinical profile helps guide the management of hypertensive patients towards obtaining normal blood pressure levels. The aim of this study was to investigate the clinical profile of hypertensive patients at the Meru Teaching and Referral Hospital in Kenya. Methods: A cross sectional survey was conducted and systematic random sampling was used to sample 75 hypertensive patients who participated in the study. The collected data were summarized using frequencies and percentages. Chi square was used to assess the relationship between the participants’ demographic characteristics, clinical profile and hypertension. Statistical significance was set at p?0.05. Results: The average mean age of the participants was 58.53 years and majority were female (52%). Thirty-three (33.3%) were overweight and 24% were obese. The mean body mass index (BMI) for both genders was 26.48±5.24, the mean waist-to-hip ratio (WHR) and waist circumference (WC) was 0.94 and 102.09 respectively with 85.3% of the participants having a substantially increased WHR. Diabetes was the most common comorbidity (70.73%). Of the five clinical profiles assessed (BMI, RBS, WHR, presence of comorbidities and drug used) only the presence of comorbidity was associated with BP levels ?2 (10.01,3), p=0.018. Conclusions: Participants had high blood pressure, BMI, WHR and WC readings as well as several comorbidities.

Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Effect of add-on L-arginine on blood pressure in hypertensive patients on antihypertensive treatment

Background: The prevalence of hypertension is rapidly increasing among both rural and urban populations and is a matter of concern in India. L-Arginine serves as a principle substrate for nitric oxide production which is a potent vasodilator. Aims and Objectives: This study was designed to determine the effects of oral L-arginine on blood pressure in hypertensive patients on antihypertensive drugs. Materials and Methods: This was a randomized clinical trial, registration in Clinical Trial Registry of India (CTRI) Registration number: CTRI/2019/03/018026. All patients with hypertension visiting the medicine outpatient department of Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni, were included in the study. Study participants were randomized into intervention group (I group) and control group (C group). The I group includes 74 participants and the C group includes 75 participants. The I group received antihypertensive therapy along with add-on L-arginine oral supplementation for 14 days. The C group received only standard antihypertensive therapy and had followed up similar to that of the participants of the I group. Results: The baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the I group and C group was statistically non-significant as analyzed by unpaired t-test, whereas in the I group, there was a significant decrease in SBP and DBP on the 1st, 2nd, and 3rd follow-up visits compared to the C group (Friedman test). Conclusion: The findings of the present study showed that add-on L-arginine supplementation at a dose of 3 g/d (L-arginine 5 g sachet) for 2 weeks in patients of hypertension resulted in significant decrease in the SBP and DBP.

Factores de riesgo cardiovascular en pacientes en hemodiálisis / Cardiovascular risk factors in patients on hemodialysis

Introducción: La enfermedad cardiovascular es la primera causa de muerte en los pacientes con enfermedad renal crónica. En los hipertensos, la enfermedad renal crónica es la segunda causa de muerte, el daño vascular sistémico es la norma. Objetivo: Identificar los factores de riesgo cardiovascular tradicionales y no tradicionales y su asociación con la enfermedad cardiovascular en pacientes en hemodiálisis. Material y Métodos: Estudio de corte transversal en 247 pacientes en hemodiálisis crónica. Las variables analizadas fueron: causas de enfermedad renal crónica, factores de riesgo cardiovascular tradicionales y no tradicionales y enfermedades cardiovasculares. Se determinaron tablas de frecuencias y estadísticas de asociación mediante Chi cuadrado. Para determinar el riesgo de mortalidad se utilizó la razón de prevalencia (RP). Se consideró como nivel de significación estadística a p<0,05 con 95 % de confiabilidad. Resultados: Las causas de enfermedad renal crónica predominantes fueron la hipertensión arterial con 35,6 por ciento y la Diabetes Mellitus tipo 2 con 33,1 por ciento. Los pacientes hipertensos tuvieron más probabilidades de presentar una enfermedad cardiovascular con 2,63 veces mayor que el grupo de referencia. En los factores de riesgo cardiovascular no tradicionales la mayor probabilidad la presentaron los pacientes con proteína C reactiva elevada con 5,19 veces, seguido de la hiperuricemia con 3,79 veces y las alteraciones del producto calcio-fósforo con una probabilidad de 3,27 veces. Conclusiones: Los factores de riesgo cardiovasculares tradicionales se relacionan significativamente con la presencia de enfermedad cardiovascular(AU)

Introduction: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. In hypertensive patients, chronic kidney disease is the second cause of death, and systemic vascular damage has become the norm. Objective: To identify traditional and non-traditional cardiovascular risk factors and their association with cardiovascular disease in patients on hemodialysis. Material and Methods: Cross-sectional study conducted on 247 patients on chronic hemodialysis. The variables analyzed included: causes of chronic kidney disease, traditional and non-traditional cardiovascular risk factors, and cardiovascular diseases. Frequency tables and association statistics were determined by the chi-square test. The prevalence ratio (PR) was used to determine the risk of mortality. The level of statistical significance was considered to be at p value of less than 0,05 with a reliability of 95 percentResults: The most frequent causes of chronic kidney disease were arterial hypertension (35,6 percent) and type 2 diabetes mellitus (33,1 percen). Hypertensive patients were 2,63 times more likely to present cardiovascular disease than the reference group. In the case of non-traditional cardiovascular risk factors, the patients with elevated C-reactive protein were 5,19 more likely to develop cardiovascular disease, followed by those with hyperuricemia that were 3,79 more likely, and the patients with alterations in calcium and phosphorous who were 3,27 times more likely to suffer from this disease. Conclusions: Traditional cardiovascular risk factors are significantly related to the presence of cardiovascular disease(AU)

Survey on the Actual Condition of the Do-shoho Period of Antihypertensive Drugs for the Introduction of the Refill Prescription System in Japan / 社会薬学

The number of diagnosed hypertensive patients in Japan is estimated to be 9.93 million according to a 2017 patient survey, and the potential number of actual hypertensive patients is estimated to be 43 million. The purpose of the present study was to clarify the actual condition of the Do-shoho (refill of the previous prescription) period for antihypertensive drugs prescribed for a long duration, and to obtain basic data for considering the introduction of a refill system in Japan. Data were collected from the patient medication profile of patients who were prescribed amlodipine OD tablets (Chemiphar®) from July 2012 to December 2019, and the Mann-Whitney U test or Kruskal-Wallis test were performed with the Do-shoho period as the test variable. A generalized linear model was used to analyze the items for which significant differences were obtained. The results of the analysis showed that the factors affecting the duration of the Do-shoho were the prescribing source, diagnosis, and the maximum number of prescription days. Of the patients surveyed (N=321), 199 (62.0%) had a Do-shoho duration of 6 months or longer, which was more than half of the total number of patients. The results suggest that many patients may be eligible for the refill prescription system if pharmacists are able to properly assess the continuation of prescriptions.

Factors on self-medication among adult hypertensive patients in a rural community

Introduction@#Self-medication is a global phenomenon which has potential risks. Patients with chronic diseases like hypertension are most likely to self-medicate. Despite several studies about self-medication among general population, there are no studies done regarding self-medication on hypertensive patients in the rural settings in the Philippines.@*Objective@#This study aimed to determine the factors on self-medication among adult hypertensive individuals in a rural community. Reason influencing self-medication, antihypertensive drugs used, source of medication and information about the medication were identified.@*Methods@#This descriptive cross-sectional study used simple random sampling on adult hypertensive patients who consulted at the Barangay Health Station and during Sitio visits. Data were gathered using Interview-guided Questionnaire that was validated, piloted and reliability tested. Data were analyzed by SPSS Version 26.@*Results@#One hundred fifty patients participated in the study. 94.7 % of them practice self-medication of antihypertensives mostly with Calcium Channel Blocker (68.3%) and Angiotensin Receptor Blockers (58.5%). Prevalent reasons influencing self-medication were availability of the drug (72.5%), previous experience with the disease or medication (68.3%), perception that disease is simple (67.6%) and reasons that revolve on saving time and money. 61.9% of respondents who practice self-medication obtain their medications at Barangay Health Center while 65.5 % bought from Community Private Pharmacy. Previous prescription is pervasive among the sources of information about the medications (93.7%). Other sources of information were family, and health center midwife or nurse.@*Conclusion and Recommendation@#Self-medication practice is prevalent among hypertensive patients in the rural community. Practices revolve on availability of medication, previous experience on the disease and medication, and saving time or money. Since the study was conducted on a rural community, further research could be done which would include urban setting, impact of self-medication on the blood pressure, and correlation of sociodemographic factors.

Effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients:a cross sectional survey

Background: Hypertension is defined as a systolic blood pressure of 140 mmHg or more, or a diastolic blood pressure of 90 mmHg or more or taking anti-hypertensive medication. The clinical presentation of high blood pressure may depend upon several factors such as age, gender, severity and duration of hypertension. There is a paucity of data exploring the role hypertension duration may play in shaping the relationship between blood pressure and signs and symptoms of hypertension. To evaluate the effect of hypertension duration on relationship between blood pressure and signs and symptoms in hypertensive patients.Methods: A cross-sectional study was carried out among 250 patients, aged 18 or above, with self-reported history of hypertension and on anti-hypertensive medication. Data were collected by means of a structured questionnaire whereas the blood pressure level was measured with the help of sphygmomanometer using stethoscope. Inferential analysis was performed by applying chi-square test whereas the significance level was set at 0.05.Results: The study results revealed that among patients with ≥5 years duration of hypertension headache history (P=0.021), edema (P=0.034), increased urinary frequency (P=0.031), sleep apnoea (P=0.016), palpitation (P=0.005) and confusion (p=0.021) were significantly associated with systolic whereas only increased urinary frequency (P=0.009) was significantly associated with diastolic blood pressure. Moreover, among patients with <5 years duration of hypertension vision problems (P=0.03), sleep apnoea (P=0.015) and palpitation (P=0.035) were significantly associated with systolic whereas sleep apnoea (P=0.048) and palpitation (P=0.028) were significantly associated with diastolic blood pressure.Conclusions: The study results showed that patients with higher blood pressure were more likely to have the signs and symptoms of hypertension. Also, patients with longer duration of hypertension had greater number of signs and symptoms associated with systolic hypertension.

Smoking and blood pressure levels in hypertensive patients: evaluating the role of gender, age and hypertension duration

Background: Hypertension is estimated to affect about 40% of adults above 25 years of age globally. While many of the risk factors of hypertension are well known, such is not the case with smoking. Pertinent published literature is heterogeneous, with a dearth of relevant local data. Objectives was to study the relationship between smoking and blood pressure levels in hypertensive patients and to assess the effects of gender, age and hypertension duration on such a relationship.Methods: A cross-sectional study was carried out on a total of 298 conveniently sampled patients, aged 18 or above, from the medical outpatient department of a secondary care hospital of Karachi. The relevant data were collected by means of a structured questionnaire whereas the blood pressure level was checked using sphygmomanometer with stethoscope. Mann Whitney U test was used for inferential analysis whereas the significance level was set at 0.05.Results: Overall, both the systolic and diastolic blood pressure levels were significantly associated with smoking history (p<0.05 for both) where they were found to be higher in smokers than in non-smokers. Furthermore, after gender, age and hypertension duration based stratifications; both the systolic and diastolic blood pressure levels were still significantly associated with smoking history in patients who were male, were ≥35 years old and had <5 years hypertension duration (p<0.05 for both) where they were again found to be higher in smokers than in non-smokers.Conclusions: The study results showed a significant association of positive smoking history with higher mean systolic and diastolic blood pressure levels, though after stratifying for gender, age and hypertension duration, this relationship persisted only in patients who were male, were ≥35 years old and had <5 years hypertension duration.

An Assessment Of Potential Drug-Drug Interactions In Hypertensive Patients In A Tertiary Care Hospital

Objective: To an assessment of potential drug-drug interactions in hypertensive patients in a tertiary care hospital. Methods: A prospective, observational study was conducted at a tertiary care hospital, Erode for a period of 8 mo. A sample of 480 patients was assessed for PDDIs using drug checker in Micromedex®-2.7. Results: A total of 430 patients were analyzed and it was found to be 396 (82.50%) hypertensive patients had PDDIs, and a sum total of 1160 PDDIs were observed. Potential drug-drug interactions (PDDIs) higher in female hypertensive patients [255 (64.39%)] compared to males. Incidences of PDDIs were found to be higher in the age group of 60-70 y were [177 (44.69%)] and incidences of interactions based on the duration of (4-6 d) hospital stays were 272 (68.68%). Moreover, 49.24% of patients were found to be prescribed with more than 7 drugs, with higher incidences of PDDIs. Some of the most common drug interacting pair was between aspirin and clopidogrel combination observed in 325 PDDIs in the major, with pharmacodynamics in nature. Conclusion: Clinical pharmacist ought to have the role of regular monitoring of drug therapy in identifying and preventing the medications that have the potential to cause drug-drug interactions, thereby minimizing the undesirable outcomes in drug medical care and improving the quality of care.

Serum Electrolytes and Red Blood Cell Membrane Potential of Hypertensive Patients

Serum electrolyte and red blood cell membrane potential of hypertensive patients in Owerri metropolis were investigated. A total of 50 volunteer subjects were used for the study. Thirty (30) of the volunteer subjects were hypertensive subjects and were used as test subjects; while the remaining 20 subjects were healthy subjects with normal blood pressure used as normentensive subjects (control). Results observed showed increased red blood cell (RBC) K+ and Cl- in hypertension subjects against normentensive subjects. Apart from K+ which reduced significantly (p<0.05), other electrolyte ions of the serum increased significantly (p<0.05) in hypertensive subjects against normentensive subjects. However, Na+ and Cl- membrane potential was not significantly (p>0.05) altered in hypertensive subjects against normotensive subjects while K+ was significantly (p<0.05) altered. The observed alterations in the parameters investigated in hypertensive subjects in the present study could be as a result of a host of derangements involving electrolyte metabolism, altered membrane transport and a possible increase in membrane fragility. This study has shown the serum electrolyte and red blood cell membrane potential of hypertensive patients in Owerri metropolis.

Study on the sleep quality and its influencing factors in rural hypertensive patients in Xuanen country of Hubei Province / 中华疾病控制杂志

Objective To investigate sleep quality and it’s influencing factors of hypertensives among rural area in Hubei Province. Methods The method of stratified sampling by selecting 569 hypertensives in Xuanen county of Hubei was applied to perform the questionnaire survey, including the sociodemographic data, daily life habits and physical health data, as well as pittsburgh sleep quality index(PSQI) and compliance of hypertensive patients scale(CHPS). Results The average score of PSQI in 569 hypertensives was 7.25±3.61, of which 251(44.11%) hypertensives were poor sleep quality. The influencing factors of sleep quality for hypertensives are gender (P=0.006, OR=1.626), the number of other diseases(P=0.001, OR=1.520), regular exercise (P=0.033, OR=0.660) and the compliance of hypertensives (P=0.024, OR=1.707). Conclusions The sleep quality of rural hypertensives in Xuanen county, Hubei Province is poor, which is affected by different factors. Therefore effective measures should be taken to improve the sleep quality of hypertensives.

Exercise Training Improves Heart Rate Recovery after Exercise in Hypertension

Abstract Aim: This study tested the hypothesis that: 1- the exercise training would improve the heart rate recovery (HRR) decline after maximal exercise test in hypertensive patients and; 2- the exercise training would normalize HRR decline when compared to normotensive individuals. Methods: Sixteen hypertensive patients were consecutively allocated into two groups: Exercise-trained (n = 9, 47±2 years) and untrained (n = 7, 42±3 years). An exercise-trained normotensive group (n = 11, 41±2 years) was also studied. Heart rate was evaluated by electrocardiogram. The autonomic function was evaluated based on heart rate changes on the first and the second min of recovery after the maximal exercise test. Exercise training consisted of three 60-minute exercise sessions/week for 4 months. Results: In hypertensive patients, exercise training significantly increased the HRR decline in the first (-19±2 vs. -34±3 bpm, P = 0.001) and second (-33±3 vs. -49±2 bpm, P = 0.006) minutes after the maximal exercise test. In addition, after exercise training, the initial differences in the HRR decline after exercise between hypertensive patients and normotensive individuals were no longer observed (first minute: -34±3 vs. -29±3 bpm, P = 0.52, and second minute: -49±2 vs. -47±4 bpm, P = 0.99). Conclusion: Hypertension causes a delay in HRR after the maximal exercise test yet the exercise training normalizes HRR during the post-exercise period in hypertensive patients.

Changes In The Haemodynamic Response Following Endotracheal Intubation And Laryngeal Mask Airway Insertion In Hypertensive Patients– A Comparative Study

Endotracheal intubation with the help of a laryngoscope has become a routine part of delivering a general anaesthetic. In general, intubation is indicated for patients who are at risk of aspiration and for those undergoing surgical procedures (1,2).Tracheal intubation causes a reflex increase in sympathetic activity that may result in rise in blood pressure, heart rate, and arrhythmia (3). Achange in plasma catecholamine concentrations also has been demonstrated to be a part of the stress response to tracheal intubation. Various supraglottic devices have provided conflicting evidence of an attenuated haemodynamic response. Materials and Methods:100 Patients divided into two groups (n=50)of 25-60 years of age of either sex with hypertension stage-1 of ASAgrade II on oral anti-hypertensives drugs were selected for the study and endotracheal tube inserted in ETgroup where as LMAinserted in group LMA.Results:Haemodynamics (heart rate, blood pressure, rate pressure product) changes is more in group ETafter induction compared to group LMA.Conclusion:Pressor response and duration of the pressor response to laryngeal mask airway insertion is much less than that of laryngoscopy and endotracheal intubation which establishes the usefulness of LMAin hypertensive patients.

The effects of isometric resistance training conducted using handgrip exercise on blood pressure variability in hypertensive patients with minor ischemic stroke / 中国实用护理杂志

Objective The present study aimed to evaluate the effects of isometric resistance training(IRT)conducted using handgrip exercise on blood pressure variability (BPV) and heart rate variability (HRV) in hypertensive patients with minor ischemic stroke (MIS).Methods One hundred and twenty-five hypertensive patients with MIS were included in the present study. Patients were randomized into two groups with random number table. Patients in the control group (n=60) were nursed in the routine care in department of neurology, while patients in the experimental group (n=65) received the IRT.The 24-hour ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM- 2430, A&D Inc.,Tokyo,Japan).The 24- hour ambulatory electrocardiography measurement was performed using electrocardiocorder(PI200A-A, QunTian Inc.,Shanghai,China).The BPV ratio and the HRV ratio were assessed in the two groups. Results 24 hours after the intervention, intervention group 24 hours systolic blood pressure variation coefficient and diastolic blood pressure variation coefficient were(10.16 ± 1.95)％,(12.6 ± 7.15)％,the control group, respectively (12.92 ± 2.79)％, (17.38±4.49)％, two groups compare the difference was statistically significant (t=6.450, 4.435, P<0.05). Intervention group of normal sinus R- R period between the standard deviation, to the phase difference between adjacent R- R , root mean square value of the whole difference in more than 50 ms continuous period of percentage between normal R-R and triangle Index were (173.3±58.5) ms, (115.9±74.4), (54.8± 24.1)％, (53.3 ± 15.1).The control group was(128.7 ± 40.2)ms, (82.1 ± 35.2),(39.9 ± 17.1)％, (30.6 ± 14.9), and the difference between the two groups was statistically significant(t=-8.439--3.207, all P<0.05). Conclusions Isometric resistance training conducted using handgrip exercise could increase the HRV and decrease the BPV in hypertensive patients with MIS. These results indicated that the IRT may improve the life quality of hypertensive patients with MIS.

Effect of patients with anxiety and depression in elderly patients with hypertension antihypertensive effect of psychological intervention combined with Flupentixol and Melitracen Tablets / 中国生化药物杂志

Objective To study the influence analysis of patients with anxiety and depression in elderly patients with hypertension antihypertensive effect of psychological intervention combined with Flupentixol and Melitracen Tablets.Methods 60 elderly patients with hypertension accompanied by anxiety and depression in our hospital from January 2014 to December 2016 were selected as the subjects.They were randomly divided into the control group and the experimental group, with 30 patients in each group.The control group was treated with conventional antihypertensive treatment, the experimental group were given psychological intervention combined with treatment of Flupentixol and Melitracen Tablets.The clinical indexes of the experimental group and the control group were compared and analyzed.Results After the corresponding treatment, the effective rate of antihypertensive treatment in the experimental group was 28 cases, and the effective rate of depressurization was 93.3%.The effective rate of antihypertensive treatment in the control group was 21, and the effective rate of antihypertensive treatment was 70%.After treatment, the HAMD score and HAMA score of the experimental group were significantly lower than those before the treatment, and the score of the experimental group was significantly lower than that of the control group, with statistical difference(P<0.05).Conclusion The treatment of elderly hypertensive patients with anxiety and depression in patients with better antihypertensive effect of psychological intervention combined with Flupentixol and Melitracen Tablets, can improve the depression and anxiety of patients in a large extent, high safety, is further applied in clinical significance.

Algunos resultados postintervención en el control, tratamiento y complicaciones de la hipertensión arterial. Policlínico Universitario Héroes del Moncada. Cárdenas, 2014 / Several post-intervention outcomes in the control, treatment and complications of arterial hypertension. University Policlinic Heroes del Moncada. Cardenas 2014

Introducción: la educación del hipertenso y del equipo de salud son elementos primordiales para el mejor control de la hipertensión arterial. Objetivo: elevar los pacientes controlados al 70 %. Materiales y métodos: se realizó un estudio epidemiológico cuasiexperimetal. La intervención se dirigió a médicos de familias, grupos básicos de trabajo, comunidad e hipertensos. Se seleccionaron dos muestras (350 hipertensos diferentes), antes y después de la intervención, realizándose encuestas, mediciones con comparaciones de resultados; test estadístico: Chi2, Odds ratio, valor p. Resultados: los hipertensos controlados y adherencia al tratamiento aumentaron, con diferencias estadísticamente significativas, p<0,05. No hubo diferencias entre los 5 medicamentos más utilizados. En la postintervención, presentaron asociación estadística significativa con hipertensos controlados: adherencia al tratamiento, dieta baja en sal y grasa, consumo de frutas y vegetales, y no fumar. Las medias de presión diastólica, sistólica y las complicaciones disminuyeron, con diferencias estadísticamente significativas, p<0,05. Conclusiones: aumentaron los hipertensos controlados y se lograron mejoras en la calidad de vida de los hipertensos.

Background: the education of the hypertensive patient and the health team are important elements for the better control of arterial hypertension. Objective: increasing controlled patients to 70 %. Materials and Methods: A quasi-experimental epidemiologic study was carried out. The intervention was headed to family physicians, basic work teams, the community and hypertensive patients. Two samples were chosen (350 different hypertensive patients), before and after interventions, applying interviews, measuring with results comparisons, statistical tests: Chi2, Odds ratio and P value. Outcomes: The controlled hypertensive patients and treatment adherence increased, with significant statistical differences, p<0.05. There were not differences between the five most used medications. In the post-intervention period, treatment adherence, low salt and fat diet, fruits and vegetables consumption, and no smoking showed significant statistic association with controlled hypertensive patients. The average diastolic and systolic pressure and complications decreased, with significant statistical differences p<0.05. Conclusions: The controlled hypertensive patients increased and the life quality of the hypertensive patients improved.

Exploring Medicine Information Needs of Hypertensive Patients Using Short Message Service.

Aims: To explore the pattern of unmet medicine information needs of hypertensive patients on long term therapy and their attitude to use of SMS (mobile phone short message service) for medicine information exchange with hospital pharmacists. Sample: 117 hypertensive patients on long term therapy who had been accessing care for at least one year. Study Design: An exploratory medicine information exchange programme followed by a cross-sectional survey. Place and Duration of Study: Outpatient Clinic of Department of Cardiology at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between October, 2010and May, 2011. Methods: Patients were prompted with SMS twice weekly for 5-8 months for use of their medication with advice to send their medicine information needs to the hospital pharmacist. Received messages were subjected to content analysis to identify their themes. A semi-structured questionnaire was used to explore patient attitude to the use of SMS. The 17-item questionnaire was designed on a 5-point Likert scale for responses with weights of 0-4. Data obtained were analysed using both descriptive and inferential statistics. These include frequencies and mean of weighted averages (MWA); tests of relationships, associations and of differences in means. Results: A total of 63 SMS texts were received from the respondents and 44% of the messages expressed medicine information needs. Majority of the enquiries were related to indications and adverse effects. The patients’ attitude to the use of SMS for medicine information exchange with pharmacists was generally positive (MWA=3.13) with no significant demographic effects. Some (46%) of the patients called for institutionalisation of the medicine information exchange programme. Conclusion: The unmet medicine information needs of chronic hypertensive patients in the study were related mainly to indications and side effects of prescribed and nonprescribed medications and the patients clamoured for use of SMS in redressing the anomaly.

Intervención integral educativa en hipertensión arterial. Policlínico Héroes del Moncada. Municipio de Cárdenas, 2013 / Integral educative intervention in arterial hypertension. Policlinic Heroes del Moncada. Cardenas Municipality, 2013

Se realizó la descripción de una intervención integral dirigida a médicos de familias y grupos básicos de trabajo, en consulta externa, a la comunidad y a los hipertensos del Policlínico Héroes del Moncada, del 1 de enero al 31 de diciembre de 2013. Se consignaron los temas que se impartirán a los médicos de familia y a los grupos básicos de trabajo, según la guía del Programa de Hipertensión Arterial. Se señalaron los acápites que deben ser llenados en la historia clínica y las acciones a desarrollar por el médico de familia en la consulta externa del hipertenso. Se expresaron las actividades y el procedimiento de intervención en la comunidad, así como la metodología y el programa para llevar a cabo en las escuelas de hipertensos.

We described an integral intervention directed to family physicians and basic work groups in external consultation, to the community and hypertensive patients of the Policlinic Heroes del Moncada, carried out from January 1st to December 31st 2013. The themes taught to family physicians and basic work groups were identified taking into account the Arterial Hypertension Program guidelines. We indicated the items of the clinical record that should be filled out and the actions the family physician should develop in the hypertensive patient external consultation. We explained the activities and the intervention procedure in the community, and also the methodology and program to develop in the hypertensive patients’ schools.

Effect of Losartan and Amlodipine on Heart Rate Variability In Essential Hypertensive Patients.

Background: Essential hypertension is characterized by sympathovagal imbalance that is responsible for arrhythmias and sudden cardiac death. Antihypertensive drugs restores sympatho vagal balance. Losartan and amlodipine are common antihypertensive drugs. Objective: To compare the effect of losartan and amlodipine on heart rate variability (HRV) in hypertensive patients . Methods: This prospective analytical study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from July 2012 to June 2013. For this study, 120 newly diagnosed hypertensive patients without any treatment (group B, age 30-55 years) were selected from the Out Patients Department of cardiology, BSMMU, Dhaka on their first day of visit. 60 apparently healthy normotensive subjects were also studied as control (group A). HRV of the patients were measured both before and after they were treated with two different antihypertensive drugs (losartan and amlodipine) separately. According to the selection of drug these patients were divided into two groups. Group B1 included 60 patients received losartan 50 mg daily and group B2 included 60 patients treated by amlodipine 5 mg daily. They were observed once before the treatment (B1a&B2a) and after3 months medication(B1b & B2b ) and also after 6 months medication (B1c & B2c ). For assessing HRV, Mean heart rate (HR),Mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were recorded by a polyrite. Data were compared among before treatment, after 3 months treatment and after 6 months treatment. For statistical analysis ANOVA, independent sample‘t’ test and paired sample ‘t’ were performed. Results: Mean resting pulse rate, mean heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly higher(P<0.001) and mean R-R interval, SDNN, RMSSD were significantly lower(P<0.001) in patients before treatment compared to those of healthy normotensive subjects and to the values after treatment. In both drug groups, SDNN, RMSSD,mean R-R interval were found significantly higher after 6 months of treatment compared to their values after 3 months treatment and also close to the values in normotensive subjects. In losartan group RMSSD were found significantly higher (p<0.01) and mean R-R interval,SDNN were found though higher but not significant than the corresponding values in amlodipine treated patients after 6 months treatment. Conclusion: Vagal modulation is decreased in untreated hypertensive patients which is increased by treatment with both losartan and amlodipine but the effect is more pronounced in losartan. The decreased autonomic function was improved better with longer treatment duration.

Factors affecting treatment adherence for patients with hypertension by structural equation model / 中国实用护理杂志

Objective To explore the factors of treatment adherence for patients with hypertension.Methods Data were collected among 520 patients with essential hypertension from 2009 to 2010.It investigated the factors of treatment adherence for patients with hypertension by self-report scales.Results Structural equation model analysis showed age,self-rated health,self-eificacy,quality of life,family function and health concept were all directly associated with treatment adherence,and these variables explained 52.0％ of the total variance.Self-efficacy and quality of life were regarded as mediators in predicting treatment adherence of hypertensive patients,other variables indirectly affected adherence behavior by two mediators.Age and self-efficacy showed a strong independent predictive role to adherence.Conclusions Healthcare providers should take effective measures to improve treatment adherence for patients with hypertension based on patients characteristic once they make reasons for adherence clear,which can enhance quality of life,control blood pressure and prevent complications.