Hypertension: Diagnosis and management in primary care

2021 ◽  
pp. 175573802110194
Author(s):  
Ayesha Afroze ◽  
Imran Mohammed
Keyword(s):  
Primary Care ◽  
Treatment Strategies ◽  
Organ Damage ◽  
Evidence Based ◽  
Common Condition ◽  
Diagnosis And Management ◽  
Hypertension Diagnosis ◽  
Untreated Hypertension ◽  
Considerable Strain

The global prevalence of hypertension is high and continues to rise, making it an increasingly common condition managed in primary care. Untreated hypertension can cause end-organ damage leading to complications that increase morbidity and mortality from cardiac, renal, and cerebrovascular disease. Hypertension can significantly affect an individual patient’s quality of life and can cause a considerable strain on the healthcare system. If hypertension is detected early, these events are avoidable, as there is an opportunity for intervention at a much lesser cost. Several proven, highly effective, and well-tolerated lifestyle and drug treatment strategies can achieve reduction in blood pressure. The aim of this article is to illustrate evidence-based steps that are applicable in the diagnosis and management of hypertension in primary care.

Do rhinology care pathways in primary care influence the quality of referrals to secondary care?

2013 ◽  
Vol 127 (4) ◽  
pp. 364-367 ◽  
Author(s):  
N Su ◽  
P P Cheang ◽  
H Khalil
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Secondary Care ◽  
Evidence Based ◽  
Care Pathways ◽  
Diagnosis And Management ◽  
Care Guidelines ◽  
Evidence Based Guidelines ◽  
Referral Letters

AbstractBackground:Chronic sinusitis is the most common routine presentation for a general ENT surgeon. The 2007 ‘Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps’ aimed to deliver evidence-based guidelines for the diagnosis and management of rhinosinusitis in specialist and primary care.Objective:The aim of this audit was to assess the information provided in the referral letters to the ENT department regarding patients with potential rhinosinusitis, and compare this to the information required for the rhinology care pathways.Method:We evaluated one month of referrals to the ENT department.Results:The quality of information in the referral letters was poor. Only 22 per cent of patient referrals included basic information about symptoms, duration and treatment.Conclusion:We plan to investigate why general practitioners are not complying with the pathway. In addition, the pathways will be more widely disseminated via the ‘Map of Medicine’ (an online resource for general practitioners). This should facilitate the receipt of the best evidence-based treatment for patients prior to referral to secondary care.

scholarly journals SAT-558 A Dedicated Endocrine Hypertension Service Increases the Timely Diagnosis of Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jun Yang ◽  
Yin Y Lim ◽  
Renata Libianto ◽  
Jimmy Shen ◽  
Morag Jennifer Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Aldosteronism ◽  
Pressure Control ◽  
Organ Damage ◽  
Antihypertensive Medications ◽  
Endocrine Hypertension ◽  
Treatment Naïve ◽  
Hypertension Diagnosis ◽  
The Impact

Abstract Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk that could be averted with targeted treatment. An Endocrine Hypertension Service (EHS), encompassing an education program, streamlined diagnostic tests and dedicated PA clinic, was developed to address this issue. Aims: To analyse the impact of Victoria’s first dedicated EHS on the pattern of PA diagnoses. Methods: Socio-demographic and clinical data from all patients who attended the EHS since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results: The proportion of referrals from primary care increased (20% in Y1 to 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1 to 19% in Y3). Patients with a hypertension diagnosis of 5 years or less at the time of referral to EHS increased from 34% in Y1 to 45% in Y3 whilst the percentage of patients with a hypertension diagnosis of more than 10 years decreased from 50% in Y1 to 35% in Y3. Consistent with an earlier presentation, the proportion of patients with end-organ damage at the time of referral decreased from 44% in Y1 to 29% in Y3. Almost a third of the PA patients had unilateral disease; all of those who underwent adrenalectomy had biochemical cure. Patients with bilateral PA were treated with spironolactone. Their systolic/diastolic blood pressure decreased by 15/12 mmHg in Y1, 17/13 mmHg in Y2 and 23/11 mmHg in Y3; while the mean number of antihypertensive medications decreased from 2.9 to 1.8 in Y1, 2.7 to 2.0 in Y2 and 2.2 to 1.6 in Y3 Conclusion: The EHS has facilitated an increase in referrals for PA screening from primary care, resulting in the earlier diagnosis of PA, when less complications are present, and optimised patient outcomes. A broader uptake of such a clinical service, integrated with education outreach, will bridge the gap between the reported high prevalence of PA and the actual low diagnostic rates.

The diagnosis and management of insomnia in the United Kingdom Armed Forces

2015 ◽  
Vol 101 (1) ◽  
pp. 80-88
Author(s):  
LD Baker ◽  
RH Coetzee
Keyword(s):  
Primary Care ◽  
United Kingdom ◽  
Armed Forces ◽  
Common Condition ◽  
Diagnosis And Management ◽  
The United Kingdom ◽  
Care Facilities ◽  
Military Populations ◽  
Clinical Considerations

AbstractInsomnia is a common condition among patients presenting to primary care facilities in both civilian and military populations. This article considers the diagnosis, management and clinical considerations of managing this condition, along with the occupational and operational considerations for the United Kingdom Armed Forces.

Diagnosis and management of headaches in adults

2020 ◽  
Vol 13 (6) ◽  
pp. 336-343
Author(s):  
Tajvinder Kaur Grewal ◽  
Aravindhan Baheerathan
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Common Reason ◽  
Time Constraints ◽  
Headache Disorders ◽  
Recurrent Headache ◽  
Diagnosis And Management

Migraine and other severe recurrent headache disorders are highly prevalent disabling conditions, and are a common reason for presentation to primary care. Headaches can have a significant impact on an individual’s quality of life, resulting in huge costs to healthcare and the economy. This highlights the importance of being able to assess, diagnose and manage this symptom appropriately within the time constraints of a 10-minute consultation. This article will focus on an approach to the assessment of patients presenting with headache and a framework for managing the headache disorders commonly encountered in primary care.

Fatigue and HIV

2017 ◽  
Author(s):  
William Breitbart ◽  
Anna L. Dickerman
Keyword(s):  
Quality Of Life ◽  
Treatment Adherence ◽  
Symptom Management ◽  
Treatment Strategies ◽  
Hiv And Aids ◽  
Evidence Based ◽  
Important Condition ◽  
Evidence Based Treatment ◽  
The Past

Fatigue is commonly reported by persons with HIV and AIDS and is associated with impaired physical function, reduced quality of life, and suboptimal treatment adherence. Patients regard fatigue as an important condition to be addressed because it is disabling and distressing. In the past, fatigue was overlooked and undertreated by physicians, but clinicians caring for persons with HIV and AIDS have been giving more attention to symptom management and patients’ quality of life. Increased attention to symptom management in HIV and AIDS warrants familiarity with major issues in evaluation and treatment of fatigue. This chapter reviews the definition and assessment of fatigue, prevalence of fatigue in HIV/AIDS and its impact on patients, medical and psychological causes of fatigue, and evidence-based treatment strategies.

Chagas disease: comments on the 2018 PAHO Guidelines for diagnosis and management

2019 ◽  
Vol 26 (7) ◽  
Author(s):  
Francesca F Norman ◽  
Rogelio López-Vélez
Keyword(s):  
Chagas Disease ◽  
Chronic Infection ◽  
Treatment Strategies ◽  
Organ Damage ◽  
Response To Treatment ◽  
Serological Tests ◽  
Diagnosis And Management ◽  
Endemic Areas ◽  
Health Organization ◽  
The Individual

AbstractBackgroundChagas disease, or American trypanosomiasis, is a protozoan infectious disease endemic throughout most of the Americas, caused by the trypanosome, Trypanosoma cruzi, and mainly transmitted to humans by reduviid or kissing bugs. Some progress has been achieved in control of the disease mainly in endemic areas, but migration flows have acted as drivers for the emergence of the disease mainly in non-endemic areas of Europe and North America. Most imported cases of Chagas disease in Europe are reported in migrants from highly endemic areas of countries such as Bolivia and Paraguay, and reports of Chagas disease in travellers are extremely rare.MethodsPan American Health Organization (PAHO) recently updated their guidelines on the diagnosis and management of Chagas. These guidelines and their applicability to migrants and travellers are reviewed.ResultsPAHO recommends the use of two serological tests for diagnosis of chronic infection (allowing for the use of a single sensitive test followed by confirmation in special settings such as the screening of potential blood donors). The indication for specific trypanocidal treatment of acute infections, children and women of child-bearing age remains as before, with either benznidazole or nifurtimox being the treatment of choice. For chronic infection with/without organ damage, treatment recommendations are less well defined. Although treatment is generally not recommended in patients with visceral involvement, decisions regarding treatment need to be tailored to the individual. Either benznidazole or nifurtimox may be used for initial treatment.ConclusionsThe recent PAHO Guidelines provide a framework to aid the diagnosis and management of this infection, but several aspects such as the underdiagnosis of infections, the multidisciplinary approach to patient management, the investigation of novel biomarkers of disease progression/response to treatment and the development of new treatment strategies are areas which should be further strengthened.

Otitis externa

2018 ◽  
Vol 11 (6) ◽  
pp. 298-304
Author(s):  
Emma Dickson
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
General Practice ◽  
Otitis Externa ◽  
External Auditory Meatus ◽  
Diagnosis And Management

Otitis externa is inflammation of the external auditory meatus. It is a common, acute and chronic presentation to general practice, with around 10% of the population suffering at least one episode. Pain and itching are common symptoms and affect quality of life. Identifying the cause of otitis externa can be a challenge. This article considers different presentations of otitis externa, their diagnosis and management in primary care.

scholarly journals Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

2011 ◽  
Vol 57 (6) ◽  
pp. 793-798 ◽  
Author(s):  
David B Sacks ◽  
Mark Arnold ◽  
George L Bakris ◽  
David E Bruns ◽  
Andrea Rita Horvath ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Laboratory Analysis ◽  
Published Data ◽  
Expert Committee ◽  
Evidence Based ◽  
Diagnosis And Management ◽  
Hb A1c ◽  
Patients With Diabetes ◽  
Practice Committee

BACKGROUND Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. CONTENT In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A1c (Hb A1c) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.

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