The competence of primary care doctors in the investigation of patients with elevated blood pressure: results of a cross-sectional study using clinical vignettes

2010 ◽  
Vol 16 (4) ◽  
pp. 784-789 ◽  
Author(s):  
Adam Windak ◽  
Barbara Gryglewska ◽  
Tomasz Tomasik ◽  
Krzysztof Narkiewicz ◽  
John Yaphe ◽  
...  
Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 315 ◽  
Author(s):  
Barua ◽  
Faruque ◽  
Banik ◽  
Ali

Background and objectives: Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. Materials and Methods: This cross-sectional study recruited 265 postmenopausal women of 40–70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen’s Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). Results: The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch’s approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). Conclusions: The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.


2021 ◽  
Vol 73 ◽  
pp. S77
Author(s):  
Tharun David Varghese M ◽  
Prabha Nini Gupta ◽  
Sunitha Viswanathan ◽  
Sivaprasad Kunjukrishnapilla

2019 ◽  
Vol 39 (2) ◽  
pp. 87-94
Author(s):  
Sujata Shakya ◽  
Shanti Bajracharya

Introduction: Hypertension is a chronic life threatening non- communicable disease. It increases the risk for cardiovascular diseases even leading to premature death. Almost half of the adults with hypertension had elevated blood pressure during childhood. With globalisation and lifestyle changes, adolescents are exposed to various risk factors. However, diagnosis in this population is difficult due to absence of symptoms. Thus, regular blood pressure screening is essential in these groups. This study aimed to find out the prevalence of hypertension and its determinants among the school going adolescents of Kathmandu, Nepal. Methods: This was a descriptive cross sectional study which included five private secondary schools of Kathmandu, Nepal. The adolescent students studying in classes VIII, IX and X were the study subjects. Two stage cluster random sampling technique was used to select 356 participants. Data collection was done by doing anthropometric measurements, blood pressure measurement and through self administered questionnaire. Results: The study depicted that the prevalence of elevated blood pressure was 12.4%, stage 1 hypertension 32.3% and stage 2 hypertension 9.8%. Similarly, 13.8% were overweight and 1.4% were obese. Bivariate analysis depicted significant association of prevalence of hypertension with gender, religion and obesity (p < 0.05). The multivariate analysis shows that the significant predictors of elevated blood pressure and/or hypertension were gender and obesity. Males were six times more likely to have elevated blood pressure (AOR = 6.058, CI = 2.571 - 14.274) and 2.8 times more likely to be hypertensive (AOR = 2.838, CI = 1.688 - 4.773) compared to females. Similarly, compared to obese/ overweight students, thin and normally built ones have less likelihood of having elevated blood pressure and hypertension. Conclusions: Hypertension has been prevalent among adolescents, due to various behavioural risk factors. This is really challenging and of public health significance. Regular screening of adolescents is essential for early detection and management of hypertension.


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