Reasons for not achieving control: therapeutic inertia in monitoring hypertension in primary care.

2020 ◽  
Author(s):  
Arleen De León Robert ◽  
Carmen López-Alegría ◽  
Isabel María Hidalgo-García ◽  
María Concepción Escribano-Sabater ◽  
José Joaquin Antón-Botella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Monitoring ◽  
Total Sample ◽  
University Hospital ◽  
Clinical Inertia ◽  
Hypertensive Patients ◽  
Therapeutic Inertia ◽  
Clinical Ethics Committee

Abstract Background: Physicians’ failure to change/adjust treatments after learning of poor follow-up control in hypertensive patients can be defined as clinical inertia, a frequent and serious problem that affects health care activity at the international level. Method: A total of 153 hypertensive patients under 80 years of age who met the inclusion and exclusion criteria and had received ambulatory blood pressure monitoring (ABPM) for 24 hours as the follow-up method to evaluate their level of blood pressure (BP) control. One year after data collection, the included patients were studied retrospectively, and the changes introduced by their physicians were checked based on their results. Results: Sixty-five hypertensive patients (42.5%) out of the total sample (153) were classified as poorly controlled; of these, 36 were subject to therapeutic inertia (55%). Of the 29 hypertensive patients who did undergo treatment adjustment (45%), 15 (52%) underwent adjustment before the month of notification. Conclusion: Therapeutic inertia in the care of hypertensive patients continues to be a common problem in primary care. Young hypertensive patients of male sex, smokers and nondiabetic patients were the most affected groups. Test record: Registered retrospectively by the Clinical Ethics Committee of the José María Morales Meseguer University Hospital with the code EST: 62/17

Abstract 18144: Mobile Phone Text Messaging Improves Antihypertensive Drug Adherence in the Community

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Paola Varleta ◽  
Carlos Akel ◽  
Monica Acevedo ◽  
Claudia Salinas ◽  
Javier Pino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Mobile Phone ◽  
Antihypertensive Drug ◽  
Educational Level ◽  
Text Messaging ◽  
Health Concern ◽  
Drug Adherence ◽  
Hypertensive Patients

Introduction: Hypertension is a major public health concern and the leading cause of cardiovascular disease worldwide. Prevalence of adequate blood pressure control is low and it is mainly associated to poor antihypertensive drug adherence. We hypothesized that education through mobile phone text messaging (SMS) would improve antihypertensive drug adherence in hypertensive patients followed in a primary care setting. Methods: Recently diagnosed hypertensive patients receiving antihypertensive drug treatment for less than 6 months were randomised to receive SMS related to improve drug adherence and to follow a healthy life style or no messages. Exclusion criteria were history of stroke, heart failure, myocardial infarction and hemodialysis. Patients were recruited from 12 different primary care clinics in Santiago, Chile, where free antihypertensive drug therapy was provided. All patients signed an informed consent after which a survey was performed. Compliance was assessed using Morinsky- Green-Levine Questionnaire.Text messages were sent every 12± 2 days. After a 6-month follow-up, a new survey was applied. An Ordinary Least Squares regression model was used to analyse the net difference between the two groups. Results: A total of 314 subjects were recruited, mean age 60 ±10 years, 35% male, 67% with low or medium educational level (≤12 years). Mean drug pill number was 2.1 per day and the mean time of drug prescription was 4±1 months; 150 subjects were randomised to text messages. No statistical difference between the control and the intervention groups in regards to gender, age, educational level, blood pressure and baseline compliance was found. Eleven patients were lost of follow-up. Adherence in the control group decreased from to 59,7 % at baseline to 51,7% ( p<0,05) at 6 months. By contrast, in the intervention group, it increased from 50,9 % to 62,7 % ( p<0,05). The absolute difference in mean adherence rate between the two groups was 19,8 % (Standard error: 0.081, p: 0.015). Conclusion: This study shows that education through SMS in patients with recently prescribed antihypertensive drugs improved adherence to treatment. SMS could become a good and easy- to- use intervention tool to overcome low adherence to drug treatments in the community.

scholarly journals Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care

2016 ◽  
Vol 11 (2) ◽  
pp. 49-56 ◽  
Author(s):  
Mohamed Alami ◽  
Mustapha El Hattaoui ◽  
Mehdi Seqat ◽  
Jamaa Sadik ◽  
Aicha Aouad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Uncontrolled Hypertension ◽  
Newly Diagnosed ◽  
High Cardiovascular Risk ◽  
Prospective Longitudinal Study ◽  
Hypertensive Patients ◽  
Prospective Longitudinal

Background: Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. Methods: This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. Results: A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40–60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. Conclusions: More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

scholarly journals The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oleg V. Mamontov ◽  
Andrey V. Kozlenok ◽  
Alexei A. Kamshilin ◽  
Evgeny V. Shlyakhto
Keyword(s):  
Blood Pressure ◽  
Cold Stress ◽  
Valsalva Maneuver ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Peripheral Resistance ◽  
Autonomic Regulation ◽  
Tilt Test ◽  
Hypertensive Patients

Purpose. Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients. Methods. All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination. Results. We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, P<0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P<0.05) but with higher peripheral resistance (1.36 ± 0.19 vs. 0.89 ± 0.25, P<0.001) and respiratory-range blood pressure variability (BPV) (18.2 ± 14.2 vs. 6.2 ± 4.2 mmHg, P<0.001). Higher total-range BPV (103 ± 51 vs. 65 ± 45 mmHg, P<0.05) in patients who had a stroke was observed. Initial diastolic orthostatic hypertension (6.6 ± 10.8 vs. 0.4 ± 6.3 mmHg, P<0.05) and lower Valsalva index (1.36 ± 0.11 vs. 1.82 ± 0.37, P<0.05) in patients who suffered a new ACC were important findings as well. Conclusions. This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.

Feasibility of a Pilot Randomized Hypertension Screening Initiative in the Preoperative Setting.

2021 ◽  
Author(s):  
Sofia Diaz ◽  
Luying Yan ◽  
Feng Dai ◽  
Bin Zhou ◽  
Matthew M. Burg ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Pilot Study ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
New Haven ◽  
Post Surgery ◽  
Counseling Group ◽  
Intervention Home

Abstract Objectives: This pilot study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions.Methods: A prospective randomized pilot study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment and felt satisfied with the study.Results: There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EMR. 36 (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their Primary Care provider. 17 of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. 61 participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. Conclusions: This pilot study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. Trial Registration: Clinicaltrials.gov, NCT03634813. Registered 16 of August 2018, https://clinicaltrials.gov/ct2/show/NCT03634813

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