scholarly journals Treating patients with hypertension in Indonesia’s primary health care centre: A challenging condition

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Lucky Aziza Abdullah Bawazir ◽  
Wicensius Sianipar
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Primary Health Care ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Channel Blockers ◽  
Primary Health

Background: In Indonesia, hypertension treatment relies on primary health care services, and there are no current data on blood pressure control and hypertension treatment in Indonesia’s primary health care system.Methods: We conducted a cross-sectional study including all patients with hypertension (n = 273) who visited the Tegal Alur II Community Health Center in 2017. For all patients with hypertension, medical records containing the most recent blood pressure results and antihypertensive treatments were examined by the authors. The primary outcome in this study was optimal blood pressure control according to the Joint National Committee (JNC) VII guidelines.Results: The mean systolic and diastolic blood pressures were 143.7 mmHg (SD 18.5) and 87 mmHg (SD 11.4), respectively. Calcium channel blockers were the most frequently used antihypertensive agents (58.6%). Of all patients with hypertension, 27.1% achieved controlled blood pressure. Bivariate analysis revealed a significant association between antihypertensive agents and blood pressure control (p = 0.009). Multivariate analysis showed that calcium channel blockers were the strongest predictor of blood pressure control, with an adjusted odds ratio of 1.9 (95% confidence interval [CI] 1.1–3.5, p= 0.022).Conclusion: Controlled blood pressure was achieved by less than half of all patients with hypertension visiting the Tegal Alur II Community Health Center in 2017. The majority of patients with hypertension received single-drug therapy with calcium channel blockers, the most frequently used antihypertensive agents. There was a significant association between antihypertensive agents and blood pressure control.Funding: This study received no financial support from any specific funding agencies.

scholarly journals Blood Pressure Control and Antihypertensive Treatment Among Hemodialysis Patients—Retrospective Single Center Experience

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 590
Author(s):  
Piotr Skonieczny ◽  
Zbigniew Heleniak ◽  
Marek Karowiec ◽  
Stanisław Zajączkowski ◽  
Leszek Tylicki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Hemodialysis Patients ◽  
Channel Blockers ◽  
Renin Angiotensin Aldosterone System ◽  
The Mean

Background and Objectives: Hypertension affects at least 80% of hemodialysis patients. Inappropriate control of blood pressure is mentioned as one of the essential cardiovascular risk factors associated with development of cardiovascular events in dialysis populations. The aim of the cross-sectional, retrospective study was the evaluation of the antihypertensive treatment schedule and control of blood pressure in relation to the guidelines in the group of hemodialysis patients. Additionally, we assessed the level of decrease in blood pressure by each group of hypotensive agents. Materials and Methods: 222 patients hemodialyzed in a single Dialysis Unit in three distinct periods of time—2006, 2011, and 2016—with a diagnosis of hypertension were enrolled in the study. The analysis of the antihypertensive treatment was based on the medical files and it consisted of a comparison of the mean blood pressure results reported during the six consecutive hemodialysis sessions. Results: The mean values of blood pressure before hemodialysis were as follows: 134/77, 130/74, and 140/76 mmHg, after hemodialysis 124/74, 126/73, and 139/77 mmHg in 2006, 2011, and 2016 respectively. The goal of predialysis blood pressure control (<140/90) was achieved by up to 64.3% of participants in 2006 as compared to 49.4% in 2016. Additionally, the postdialysis goal (<130/90) reached 57.1% of the study population in 2006 as compared to 27.1% of patients in 2016. The differences in percentage of patients using single, double, triple, and multidrug therapy during observation were not statistically significant. The most often used drugs were ß-blockers, diuretics, and calcium channel blockers in all points of the study. Blockades of the renin–angiotensin–aldosterone system in 2006 and calcium channel blockers in 2011 and 2016 were the drugs with highest impact on lowering blood pressure. Conclusions: The goal of predialysis or postdialysis blood pressure control was achieved in a lower percentage of patients during the period of the study. Blockade of renin–angiotensin–aldosterone system and calcium channel blockers decrease the blood pressure significantly. It is necessary to achieve better control of blood pressure in prevention of cardiovascular incidents.

scholarly journals Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dylan Collins ◽  
Laura Inglin ◽  
Tiina Laatikainen ◽  
Mekhri Shoismatuloeva ◽  
Dilorom Sultonova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Primary Health Care ◽  
Blood Pressure Control ◽  
Regression Models ◽  
Pressure Control ◽  
Primary Health ◽  
Essential Interventions ◽  
Clinical Records

Abstract Background The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. Methods The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. Results 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. Conclusions It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.

Organization of the therapeutic education process in hypertension at the level of primary health care

2021 ◽  
pp. 52-58
Author(s):  
Alexandra Topa ◽  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Primary Health Care ◽  
Blood Pressure Control ◽  
Medical Staff ◽  
Pressure Control ◽  
Therapeutic Education ◽  
Planning Stage ◽  
Education Of Patients ◽  
Primary Health

High blood pressure is a major public health problem, with indicators of morbidity and mortality being alarming. Therapeutic education in hypertension increases the level of awareness, blood pressure control and prevents complications. The aim of the study is to evaluate the process of organizing the therapeutic education of patients with hypertension at the level of primary health care in the Republic of Moldova. Study design: descriptive, transversal, by applying the questionnaire developed in the interest of the study. Study methods: statistical, synthetic, comparative, graphical. Th e study involved 371 respondents, of which 65% family physicians, 35% nurses. The majority of medical staff (98.1%) consider therapeutic education important, 87.3% recognized the definition of therapeutic education and its benefits: blood pressure control (90.6%); decrease in mortality caused by complications (81.7%); increasing treatment compliance (72.5%); disease awareness (65.5%). The surveyed medical staff demonstrated a disproportionate involvement in the 4 stages of the organization process: 42.3% are involved in the planning stage, 93.0% - implementation 29.1% - evaluation and 54.2% - organization. The process of organizing therapeutic education is incomplete, due to the lack or insufficiency of planning and evaluation of therapeutic education of patients with hypertension.

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