A Comparison between Multimedia and Traditional Education in Encouraging Adherence to Treatment Regimen in Patients with Hypertension

Background: Adherence to treatment regimen plays a crucial part in the prevention of the consequences of hypertension, thus identification and employment of effective educational methods to enhance patients' adherence to their treatment plans is important. Objective: The present study compares the effectiveness of multimedia and traditional methods of patient education in persuading patients with hypertension to stick to their treatment regimens. Methods: Conducted in 2019, the present study is an experimental work of research which lasted for 5 months. A convenience sample of 160 patients who visited the clinic and cardiac sections of a hospital located in the south-west of Iran was selected and then randomly divided into an intervention and a control group. The intervention consisted of multimedia education provided in 6 sessions and telephone follow-ups. The control group was given the traditional care. The research instruments were a demographics questionnaire and a medication adherence scale. Data were collected before, immediately after, and one month after the intervention. The collected data were analyzed using SPSS v. 19, independent t-test, and chi-square test. Results: The difference between the adherence to treatment regimen scores of the two groups as calculated immediately after and one month after the intervention was found to be statistically significant (P<0.001). Conclusion: Patient education via multimedia can significantly increase patients' adherence to their treatment regimens. Accordingly, it is recommended that nurses and other healthcare providers utilize this new educational approach to facilitate patient education and enhance adherence to treatment plan in patients with hypertension.

Prevalence of Obstructive Sleep Apnoea Syndrome (OSAS) and Its Association with Hypertension in Jatinangor West Java

Background: Hypertension is a global health problem, with the prevalence increasing by 30% from 2013 to 2018 in Indonesia. Furthermore, obesity, a major risk factor for hypertension, has also escalated by 50%. Hence, the incidence of Obstructive Sleep Apnoea Syndrome (OSAS), which is strongly associated with hypertension and obesity, is expected to increase. OSAS is part of the complex sleep disorder breathing syndrome, but there is a lack of data regarding its prevalence and association with hypertension. Objective: To investigate the prevalence of OSAS and its association with hypertension in Jatinangor, West Java, Indonesia. Methods: A cross-sectional study was conducted from September to October 2018 of subjects from two villages in Indonesia selected by purposive sampling. Fifteen neighbourhoods were chosen by the cluster random sampling method, with a total of 1,308 respondents included in this study. Inclusion criteria were age > 17 years old and resident in the village for more than one year. OSAS was determined by a 4-variable screening tool questionnaire (4-V) and hypertension was measured by a standardised method (average of three measurements in each session with a one-minute break using a digital device); both measurements were performed by trained health cadres. All results were statistically analysed using chi-square and logistic regression. Results: Of the total of 1308 respondents included in this study, 33 (2.5%) had OSAS and 299 respondents (22.8%) had hypertension. In the population with OSAS, 18 respondents (54.5%) had hypertension, significantly higher (p<0.001) compared to the non-OSAS group (22%). After adjustment for age, gender, and Body Mass Index (BMI), OSAS was still an independent predictor of hypertension (OR = 4.3, p = 0.000). Conclusion: The prevalence of OSAS in the Jatinangor district of Indonesia is 2.5% and it is significantly associated with hypertension.

Association of Insulin Secretion Level on Lipid Fractions and Risk of Arterial Hypertension

Background: The existing literature reports results on the association of lipid parameters with the level of insulin secretion and the risk of arterial hypertension. Objective: This study evaluated the role of the insulin dosage and lipid fractions in the risk of arterial hypertension in type 2 diabetic patients in Western Algeria. Methods: This was a cross-sectional observational study involving 101 subjects with type 2 diabetes mellitus. The data collected was about the biodemographic profile of the participants. We performed multiple regressions to test the effect of insulin concentration on the parameters studied. Results: The multiple regression analytical study showed that HOMA-IR, BMI and waist circumference were predictors for the insulinemia response variable (P<0.05). It should be noted that in insulinopenia, insulin secretion is positively and significantly correlated with non-HDL-C (P=0.037), and it is also significantly and positively correlated with LDL-C (P=0.042). Multiple regression also shows that SBP and DBP are significantly and positively related to insulin resistance. Our data suggest a possible direct relationship between fasting insulin and blood pressure. Conclusion: Monitoring of circulating insulin concentrations is critically important in a population of type 2 diabetics.

Hypertension and its Relation with Waist to Hip Ratio in Women Referred to Bojnurd Urban Health Centers in 2014

Introduction: North Khorasan province has one of the highest rates of hypertension. One of the main causes of hypertension is obesity. Obesity is one of the most important public health problems around the world as a risk factor for non-communicable diseases. Since a similar study was not conducted in Bojnurd, we examined the relationship between waist to hip ratio with hypertension. Methods: The present cross-sectional study was conducted on women referring to Bojnurd health centers. To analyze the data, we used t-test, chi-square, multiple logistic regression and Pearson correlation in Stata 12 software. Results: In this cross-sectional study, the prevalence of systolic blood pressure was 14.78% and diastolic blood pressure was 15.65%. So waist to the hips showed the highest correlation with the changes in hypertension. Conclusion: There are significant relationships between the age and the number of pregnancies with the risk of hypertension. Since a significant percentage of people are unaware of the existence of hypertension, changing diet and having regular physical activity along with social support is an important strategy.

Regulation of Biogenesis and Fusion/Fission Processes of Vascular Mitochondria In Aldosterone-Induced Hypertension

Background:Aldosterone plays a key role in the development of endothelial dysfunction and hypertension. The regulation of biogenesis and fusion/fission processes of vascular mitochondria has not been examined in aldosterone-induced hypertension. Thereby, we sought to explore in greater depth the role of aldosterone in mitochondrial biogenesis and fusion/fission processes in hypertension and the associated increases in oxidative stress.Methods:Male Wistar rats received aldosterone (1mg/Kg/day) + 1% NaCl as drinking water for 3 weeks.Results:Systolic blood pressure was elevated (p<0.05) in aldosterone-treated rats. eNOS and p-eNOSSer1177protein expression was down regulated (p<0.05) and NADPH oxidase subunit p22phox expression was increased (p<0.05) in aldosterone-treated rats. Expression of mitochondrial biogenesis proteins SIRT1, PGC1α, PPARγ, and TFAM decreased (p<0.05) in aldosterone-treated rats. Protein expression of vascular DRP1, OMA1 and S-OPA1 up regulated (p<0.05) in aldosterone-treated rats. MFN1 and L-OPA1 (p<0.05) decreased in aldosterone-treated animals.Conclusion:The results showed that, in aldosterone-treated rats, hypertension is likely associated with increased oxidative stress in the aorta and with changes in the regulation of two key mitochondrial processes such as biogenesis and fusion/fission processes. The overall mitochondrial alterations observed in the study may play a role in aldosterone-derived vascular oxidative stress and hypertension.

Characteristics of Syrian and Lebanese Diabetes and Hypertension Patients in Lebanon

Background:Given the protracted nature of the crisis in Syria, the large caseload of Syrian refugee patients with non-communicable diseases, and the high costs of providing non-communicable disease care, implications for Lebanon’s health system are vast.Objective:To provide a profile of the health status of diabetes and hypertension patients enrolled in a longitudinal cohort study in Lebanon.Methods:A longitudinal cohort study was implemented from January 2015 through August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth application on the quality of care and health outcomes for patients in primary health care facilities in Lebanon offering low-cost services serving both Syrian refugees and Lebanese host communities. This paper presents baseline characteristics of enrolled patients, providing an overall health status profile.Results:Among participants, 11.5% of patients with hypertension and 9.7% of patients with diabetes were previously undiagnosed. Quality of care, measured as the proportion of patients with biometrics reported and whose condition is controlled, is less than ideal and varied by geographic location. Controlled blood pressure measurements were observed in 64.2% of patients with hypertension; HbA1C values indicated diabetes control in 43.5% of the patients.Conclusion:Differences in diagnostic history and disease control between Syrian and Lebanese patients and across geographic regions were observed, which could be applied to inform strategies aimed at improving diagnosis and quality of care for hypertension and diabetes in primary care settings in Lebanon.

Treatment Assessment Among Hypertensive Patients of a Rural Polyclinic in Russia: The Results of Structured Questionnaire

Background: Information on treatment obtained from hypertensive patients could add the data of medical records and reveal the problems addressed to hypertensives’ attitudes and behavior. Objective: To evaluate patients’ knowledge on hypertension and treatment behavior at a rural polyclinic with the help of structured questionnaire. Methods: We interviewed 83 patients with essential hypertension (64.6±9.6 yo; 30% - men) who referred to a polyclinic of a rural settlement in the Saratov region of the Russia. Consecutive patients with hypertension diagnosis specified in their medical records, visiting a therapeutist or cardiologist on one randomly selected workday, were enrolled in our study. The appointment took place during 1-31 July 2015. Eleven district therapeutists, two general practitioners and the only cardiologist of the polyclinic participated in the study. Structured questionnaire for patients with elevated Blood Pressure (BP) proposed by S.N. Gerasimov et al. (2015) was used for interviewing. The questionnaire included 16 questions addressed to the following issues: Awareness of hypertension and risk factors, BP self-monitoring, non-pharmacological and pharmacological treatment, adherence to antihypertensive therapy, referrals to medical care. Results: Ninety percent of respondents have known previously about BP elevation. Ninety four percent of patients had a tonometer at home. Eighty four percent of hypertensives measured their BP no rare than once a week, and fifty four percent did it every day. Eighty eight percent of study participants took antihypertensive drugs regularly. Only 36% of patients could be classified as adherent to therapy according to the Morisky-Green scale. Ninety two percent of respondents received one or more advices on lifestyle modification. Eighty two percent underwent diet counseling. Two-third of participants were advised to reduce their weight. About half of hypertensives were asked by the doctor to increase their physical activity. One-third of patients received smoking cessation advice, and the same part of enrollees received advice on alcohol consumption. The majority of patients (62.7%) were interested in organization of special follow-up program. Conclusion: With the help of structured questionnaire we revealed high frequency of BP self-measurement among visitors of rural polyclinic in Saratov region whereas the adherence to antihypertensive medication was low. We observed good level of knowledge on non-pharmacologic treatment interventions and revealed patients’ interest in special follow-up program. Such program should be addressed to the increase of patients’ adherence to treatment.

Mobile Device for Monitoring of Cardiovascular System State Based on Assessment of Synchronization of its Low-Frequency Rhythms

We develop an autonomous mobile device for continuous monitoring of cardiovascular system functional state, which is based on the assessment of synchronization between the low-frequency oscillations in heart rate and blood flow having a basic frequency close to 0.1 Hz.

Suboptimal Adherence to Antihypertensive Treatment: Causes and Management

Suboptimal adherence to antihypertensive treatment is very common and is associated with poor control of blood pressure and increased risk for cardiovascular events. Therefore, frequent evaluation of compliance is essential in all hypertensive patients. Simplifying treatment regimens, using fixed-dose combinations and long-acting agents improves adherence, facilitates achievement of treatment targets and reduces cardiovascular morbidity and healthcare expenditures. Accordingly, physicians should be educated to implement these changes in hypertensive patients, particularly in those who require multiple antihypertensive agents to achieve blood pressure controls and in those who receive additional medications for comorbidities.