[District program to improve the cardiovascular risk of resistant hypertensive patients in general medicine]. / Programme régional d'amélioration de la prise en charge en médecine gnérale du patient hypertendu résistant.

PURPOSE: To try to improve the cardiovascular risk of resistant hypertensive patients in general medicine in Brittany after using french hypertension recommendations. METHODS: 581 hypertensive patients under 3 antihypertensive drugs have asked for an exoneration of the patients' social contribution: 297 (51%) were uncontrolled at their general practitioner (GP) among whom 106 (36%) have refused to take part in the program. 191 resistant hypertensive patients followed by 170 different GP have been pre-included. After a meeting between the social security physician, the GP measured blood pressure (BP) with a validated BP device and passed it on to the patient for a self-BP measurement (SBPM). In the case of a confirmed resistance, after specialist opinion, the treatment was then modified and the patient was checked after four months by his GP for a new clinical and self BP measurement. RESULTS: After the initial automated BP measurement by GP, 51 patients (27%) had in fact controlled hypertension. Out of 136 resistant hypertensive patients (mean: 63 ys) during consultation (60% with systolic isolated hypertension), 121 (89%) have been closely followed during the whole study period among who 114 were also resistant with SBPM (94%). Only 8 patients (6%) were controlled at home. A check-up with specialist opinion was conducted: ECG (82%), echocardiography (59%), vascular echography (35%), funduscopy (30%), plasma renin/aldosterone measurement (15%), renal artery exploration (26%). Eight (7%) secondary hypertension have been founded. After 4 months, 32 (26%) obtained controlled hypertension during GP consultation and 15% during SBPM but the 20/32 controlled patients (62%) had a masked hypertension. Cholesterol levels (63% of dyslipidemics) and the body mass index (80% of overweighed patients) have not varied. On the contrary, 12/28 (48%) has stopped smoking. The coronary risk using Anderson's model has only decreased from 16.5% to 13.8%. CONCLUSION: If this health program has shown its feasibility and the good participation of the GPs, treatment of hypertension and others risk factors really remains insufficient. On the contrary, the use of a validated automatic BP device has been really well carried out. Its use has allowed reclassifying as controlled one third of the resistant hypertensive patients and as uncontrolled at home one patient out of two which were controlled with GP. These results prove the necessity to increase this BP measurement technique in this population.

[The sampan dwellers of the Vi Da district (Hue, 1993). Results of a survey preliminary to humanitarian aid intervention]. / Les sampaniers du quartier de Vi Da (Hué, 1993). Résultats d'une enquête préalable à l'intervention d'une association humanitaire.

This survey is a preliminary step in a cooperative health-care programme, run by the association Le Pélican. It was conducted in July 1993 among the sampan dwellers in the district of Vi Da (Hué), Vietnam. The People's Committee of the town of Hué hopes to improve the living conditions of the inhabitants of the district. The work of the association is part of a wider project of integrated cooperation (Cités unies développement) for the community of sampan dwellers. The survey describes the demography, the state of children's health, the attitudes and behaviour of women and heads of the household towards maternity, contraception, disease and the health-care system. The Vi Da community is young: 40.5% of the inhabitants are under 15 years of age. The main health problems involve mothers and children: 56% of children aged between 5 and 59 months suffer from malnutrition; 71% of those between 0 and 15 years of age have never been vaccinated. The use of contraceptives is inadequate. Health-care services, however, are numerous and are mainly in the private sector. Any health-care project undertaken in this district to improve the state of children's health will have to reinforce the immunisation coverage and set up health education programmes dealing with nutrition and family planning. This will require a better knowledge of the mentality of the sampan dwellers, of their socio-cultural environment and their attitudes to illness and health-care.