scholarly journals Epidemiologic features and Management of Hypertension in Tunisia, the results from the NAtional TUnisian REgistry of HyperTensioN (NaTuRe HTN) about 25890 patients

2021 ◽  
Author(s):  
Leila Abid ◽  
Rania Hammami ◽  
Ikram Chatmouri ◽  
Meriam Drissa ◽  
Selim Boudiche ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Public Sector ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Therapeutic Education ◽  
Uncontrolled Hypertension ◽  
High Educational Level ◽  
The Public ◽  
Regular Control ◽  
Cardiovascular Profile

Abstract BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

scholarly journals Risk factors of uncontrolled hypertension in urban slums of Central India : A Community health worker based two-year follow up

2021 ◽  
Author(s):  
Abhijit P Pakhare ◽  
Anuja Lahiri ◽  
Neelesh Shrivastava ◽  
N Subba Krishna ◽  
Ankur Joshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Uncontrolled Hypertension ◽  
Optimal Blood Pressure

AbstractBackgroundHypertension is a leading cause of cardiovascular diseases its control is poor. There exists heterogeneity in levels of blood-pressure control among various population sub-groups. Present study conducted in framework of National Program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) in India, aims to estimate proportion of optimal blood pressure control and identify potential risk factors pertaining uncontrolled hypertension consequent to initial screening.MethodsWe conceived a cohort of individuals with hypertension confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen Accredited Social Health Activists (ASHAs) were trained from within these urban slum communities. Individuals with hypertension were linked to primary care providers and followed-up for next two years. Obtaining optimal blood-pressure control (defined as SBP< 140 and DBP<90 mm of Hg) was a key outcome. Role of baseline anthropometric, and CVD risk factors was evaluated as predictors of blood-pressure control on univariate and multivariate analysis.ResultsOf a total of 6174 individuals, 1571 (25.4%) had hypertension, of which 813 were previously known and 758 were newly detected during baseline survey. Two year follow up was completed for 1177 (74.9%). Blood-pressure was optimally controlled in 301 (26%) at baseline, and in 442 (38%) individuals at two years (absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical-inactivity, higher BMI and newly diagnosed hypertension were significantly associated with uncontrolled blood-pressure.ConclusionsIn the current study we found about six of every ten individuals with hypertension were on-treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.

Provider communication style and treatment intensification in uncontrolled hypertension

2016 ◽  
Vol 4 (2) ◽  
pp. 377
Author(s):  
Varsha Vimalananda ◽  
Jeffrey L Solomon ◽  
Barbara G Bokhour
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Quantitative Methods ◽  
Statistical Significance ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Provider Communication ◽  
Medication Regimen ◽  
Treatment Intensification ◽  
Questioning Style

Rationale, Aims and Objectives: Provider decisions to intensify antihypertensive medications are usually based on clinical metrics (i.e., blood pressure control), but may also be based on patient provided information. When providers use a participatory questioning style, patients share more information and providers may identify barriers to blood pressure control other than an inadequate medication regimen, such as poor adherence. Providers may in turn focus on such barriers rather than intensify treatment. We examined how providers’ question style influenced their treatment intensification for uncontrolled hypertension. Methods: We used qualitative and quantitative methods to analyze data from 43 audiorecorded clinical encounters. Transcripts were coded according to a priori categories including provider question style (open- and/or closed-ended) and whether treatment was intensified, as determined by interpretation of providers’ verbalizations. We used Fisher’s exact test to evaluate the association of provider questioning style with treatment intensification.Results: Providers used a mix of open- and closed-ended questions less frequently than they used closed-ended questions alone. Treatment intensification was less common when a mix of questions was used instead of closed-ended questions alone, although this difference did not reach statistical significance (29% vs. 73% of instances, p=0.07).Conclusions: Provider communication that invites patient participation may elicit more information about patient behavior, but may not impact decisions about treatment intensification in uncontrolled hypertension. Future studies should examine this question among a larger sample and investigate the relationship of participatory communication to improvements in blood pressure control.

scholarly journals Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Luu Quang Thuy ◽  
Nguyen Hoang Thanh ◽  
Le Hong Trung ◽  
Pham Huy Tan ◽  
Hoang Thi Phuong Nam ◽  
...  
Keyword(s):  
Social Support ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Structural Characteristics ◽  
Pressure Control ◽  
Information Support ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
Adherence Score ◽  
Practical Support

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension ( n = 220 ) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension ( adjusted   OR = 1.52 , 95 % CI = 1.22 − 1.89 ). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension ( adjusted   OR = 0.98 , 95 % CI = 0.96 − 1.00 ). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score ( coef . = − 0.08 ; 95 % CI = − 0.12 − 0.03 ). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score ( coef . = 0.10 ; 95 % CI = 0.04 − 0.17 and coef . = 0.19 ; 95 % CI = 0.06 − 0.32 , respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

scholarly journals Guest Editorial: Challenges in Resistant Hypertension

2016 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Thomas Kahan ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Premature Death ◽  
Pressure Control ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
Caregiver Support ◽  
The Individual

Hypertension is the major risk factor for disease and premature death. Although the efficacy of antihypertensive therapy is undisputed, few patients reach target blood pressure. Steps to improve treatment and control include assessment of global cardiovascular risk for the individual patient, improving caregiver support, education and organisation, increasing treatment persistence, using out of office blood pressure monitoring more often, detecting secondary hypertension forms, and referring patients with remaining uncontrolled hypertension to a specialist hypertension centre. In conclusion, there is room for improvement of blood pressure control in hypertensive patients. The clinical benefit of improved blood pressure control may be considerable. This may be particularly true for patients with resistant hypertension.

scholarly journals Hemodynamic monitoring using thoracic bioimpedance – an optimal solution for the treatment of hypertension

2018 ◽  
Vol 91 (4) ◽  
pp. 474-478
Author(s):  
Anca Daniela Farcas ◽  
Florin Petru Anton ◽  
Mihaela Mocan ◽  
Luminita Animarie Vida-Simiti
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Hemodynamic Monitoring ◽  
Antihypertensive Drugs ◽  
Optimal Solution ◽  
Pressure Control ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Tailored Therapy ◽  
Electrical Bioimpedance

Hypertension is a major issue of public health because of its increasing prevalence and multiple complications caused by failing to achieve an efficient blood pressure control. Considering hypertension as a hemodynamic disorder allows to prescribe a tailored therapy guided by individual hemodynamic parameters, therefore leading to an increased rate of control. We present the case of a 59 years old diabetic, dyslipidemic and obese male who, although treated with 5 classes of antihypertensive drugs had uncontrolled hypertension that caused left ventricular failure. Using the HOTMAN system of hemodynamic monitoring using thoracic electrical bioimpedance allowed a quick identification of the cause and guided the therapy, achieving blood pressure control after 5 days of treatment. Treating hypertension by identifying the underlying hemodynamic imbalance allows prescribing a tailored therapy and shortens the initiation and stabilization phases of treatment.

scholarly journals Controlling resistant hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Renal Hypertension ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Aldosterone Antagonists ◽  
Improve Blood Pressure Control ◽  
Blood Pressures

Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.

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