Hypertension in Russia: Changes Observed After 4 Years of a Comprehensive Health System Improvement Program in the Yaroslavl Region.

Rates of cardiovascular mortality and morbidity in Russia have been among the highest in Europe. A comprehensive health system improvement program targeting better diagnosis and control of hypertension was undertaken in the Yaroslavl Region of Russia. This initiative was a joint program between clinicians, the Department of Health and Pharmacy of the Yaroslavl Region, and Novartis Pharma LLC. From 2011 to 2014, the blood pressure control rate improved substantially (94% relative improvement), the percentage of patients with a systolic blood pressure ≥180 mm Hg decreased (from 10% to 5%), and there was a reduction in stroke incidence rate from 4.6 to 3.7 per 1000 population. During this same period, significant changes were made to the way hypertension was diagnosed and treated across all regional government polyclinics, and the use of antihypertensive therapies increased.

Changes in hypertension treatment in the yaroslavl region of Russia: improvements observed between 2 cross-sectional surveys.

This prospective before-and-after survey of hypertensive patients visiting government-run outpatient health facilities in the Yaroslavl Region of Russia assessed blood pressure (BP)-related endpoints following initiation of a comprehensive health system improvement program for hypertension. Two cross-sectional surveys, one at baseline and the other approximately 1 year after program initiation, evaluated the primary measure of BP control rate. Secondary measures included mean BP levels and distribution, cardiovascular risk factors, and associated conditions, heart rate levels, and antihypertensive therapy. From the 2011 survey (n=1794) to the 2012 survey (n=2992), BP control rate (<140/90 mm Hg) significantly increased from 16.8% to 23.0%, reflecting a 37% relative improvement (P<.0001). Mean BP level was significantly reduced from 151/90 mm Hg to 147/88 mm Hg (P<.0001). Severe uncontrolled hypertension (systolic BP ≥180 mm Hg) was reduced from 9.7% to 6.4% (P<.0001). Implementing a guidelines-based treatment protocol with medical and patient education programs resulted in physician behavior change and improved patient BP control.

A cross-sectional survey of hypertension diagnosis and treatment practices among physicians in Yaroslavl Region, Russia.

INTRODUCTION: In Russia, cardiovascular (CV) mortality is the leading cause of death. With the prevalence of hypertension in adults reaching 40%, hypertension is a key priority for health authorities to improve its prevention, diagnosis, and treatment. This requires an evaluation of current clinical practices in order to develop specific improvement initiatives. METHODS: This cross-sectional survey was conducted in 39 outpatient institutions of Yaroslavl region from April to May 2011. A total of 180 physicians (154 general practitioners [GPs]; 26 cardiologists) completed diaries on 10 consecutive patients whose visits were related to hypertension. This survey was approved by the Department of Health and Pharmacy of Yaroslavl region. RESULTS: A total of 1,794 diaries (1,525 from GPs; 269 from cardiologists) were analyzed. The majority of patients were women (60%), mean age was 60 years, and most (97%) were on antihypertensive therapy. Mean blood pressure (BP) was 151/90 mmHg and goal BP (<140/90 mmHg) was achieved in 17% of patients. The distribution of patients' systolic BP (SBP) was: 20% controlled (<140 mmHg), 44% SBP 140-159 mmHg, 26% SBP 160-179 mmHg, and 10% SBP≥180 mmHg. The most common CV risk factors included left ventricular hypertrophy (72% of patients), abdominal obesity (54%), dyslipidemia (48%), family history of early CV events (33%), smoking (24%), and type 2 diabetes (21%). Heart diseases and cerebrovascular diseases were reported in 48% and 15% of patients, respectively, and regular alcohol consumption was mentioned by 37%. CONCLUSION: The majority of patients with hypertension had additional CV risk factors and associated clinical conditions. Blood pressure control rates in Yaroslavl region are similar to those for Russia as a whole, but much lower than countries that have successfully implemented comprehensive hypertension intervention programs, such as Canada.