Health awareness and treatment compliance of high blood pressure among women in a peri-urban colony of Chandigarh, India

Health awareness is a central issue in the control of hypertension. In a cross-sectional survey among 1727 women of > 30 years, 2 blood pressure recordings were done in 1686 cases. The prevalence of hypertension was found to be 13.1% (221 out of 1686 cases). A random sub sample of 72 hypertensive women above 30 years of age from a peri-urban colony of Chandigarh was selected to find out health awareness and treatment compliance of hypertension. Sixty-three (87.5%) of the selected women were aware of their high blood pressure. However, only 12 women (16.7%) who were on treatment had achieved control of blood pressure (< 140/90 mm Hg). Main reasons for discontinuing the treatment were ignorance about the need of regular treatment (33.3%), high cost of medicines (19.44%) and non-availability of a family member who can go with the patient to hospital (9.72%). Twenty-six (36.1%) hypertensive women did not know the importance of weight reduction for controlling high blood pressure. Twenty-three (31.9%) hypertensive women were currently smoking. A comprehensive health education approach involving health care professionals, patients and general population should be launched to improve the care of hypertensives in the community.     

Chronic disease control and compliance--the HOPE worldwide Jamaica experience

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patient records of 1,091 chronic disease patients, aged >30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81% were female and 60% were hypertensive, 16% diabetic and 24% had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < or = 140/90 mmHg while 43% had BP <160/ 95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensives were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65%), reserpine (50%), ACE inhibitors (30%) and alpha-methyldopa (5%). There were 1,129 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38% controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECG) were done on 24% (n=267) of patients in the previous two years. Thirty-six per cent had evidence of left ventricular hypertrophy and 15% had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despitethe provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.     

上海邮电医院门诊高血压病患病率及危险因素综合分析

目的 了解我院门诊高血压病的患病率、知晓率血压病相关知识的了解程度,分析高血压病的多项危险因素与发病的关系,以得知目前高血压病防治中的薄弱点及控制高血压的发病应采取的积极措施。方法 在院普通门诊病人中按就诊比例及不同年龄段随机调查１０５４,进行血压检测和问卷调查。 结果 我院门诊病人中高血压的患病率已达４０．６％。高血压病人中年龄、体重、有高血压家族史、吸烟、口味咸、体力活动少均较非高血压组高（Ｐ     

Detection of hypertension. Blood pressure determination in outpatient clinics of medical school-affiliated training programs.

We evaluated past medical records and conducted a hypertension screening program in the outpatient clinic of a university hospital, a community hospital, and a city hospital, with the aid of specially trained high school students under the direction of a cardiovascular nurse. Fifty-one percent of the adult black outpatients had elevations of arterial blood pressure; one half of these patients were aware of a history of hypertension. Analysis of the clinic records showed that many patients who had made multiple visits to the clinic had never had a blood pressure recorded in their charts. If progress is to be made in the detection of hypertension, blood pressures must be routinely determined. This should be incorporated into all clinic routines, particularly in clinics staffed by physicians-in-training.     

Blood pressure control among type 2 diabetics

OBJECTIVE: To assess blood pressure (BP) control in patients with diabetes mellitus type 2 (DM type 2) treated in primary health care. METHODS: A cross-sectional study was conducted in primary health care at King Fahad Military Complex Hospital in Dhahran, Kingdom of Saudi Arabia, between August 2003 and February 2004, to assess blood pressure control in type 2 diabetics. A sample of 403 medical records of type 2 diabetic patients was selected using systematic random sampling after ordering the medical record numbers. The data were collected through a pre-coded checklist. RESULTS: Hypertension was found in 57.8% of diabetic patients with no statistically significant difference between males and females. The mean age of diabetic patients was significantly higher in hypertensives than non-hypertensives (p=0.001). The mean duration of hypertension was significantly higher in females (p=0.02). There were only 14.2% of hypertensive diabetic patients in whom blood pressure was controlled. Poor control was significantly associated with obesity, and a higher rate of complications. Blood pressure control correlated positively and significantly with the age of patients, and negatively with duration of diabetes and hypertension. The most commonly prescribed antihypertensive were angiotensin converting enzyme inhibitors in 29.3%, followed by angiotensin receptors blockers in 24.1%, and the least prescribed drug was thiazide diuretic. CONCLUSION: Blood pressure in diabetic patients needs to be given particular attention from all health care professionals, especially primary care family physicians, who should follow the new guidelines for better control of blood pressure, and fewer complications. Patient's awareness should be increased, through continuous health education with different modalities.     

Assessing hypertension control in the community: the need for follow-up measurements to ensure clinical relevance.

In community surveys of hypertension control the diagnosis is often based on blood pressure measurements taken on only one visit. The clinical diagnosis of hypertension requires demonstration of sustained blood pressure elevation. We conducted a survey that contrasted the results of these two approaches to determining the prevalence of hypertension and the extent to which hypertension is detected and treated. A multistage random sample of 2737 people was selected, examined and interviewed on up to three occasions. Rates of hypertension prevalence and control were computed from data from one, two and three visits. The prevalence of hypertension was overestimated by 30% when the diagnosis was based on data from one rather than three visits, the rates being 149 and 115/1000. The prevalence of undetected hypertension was overestimated by 350%, the rates being 27 and 6/1000. The proportion of subjects with controlled hypertension was underestimated by 23%, at 56%, compared with 73%. These results confirm the need for follow-up measurements to provide a valid assessment of hypertension control in the community.     

Current status of treatment of severe hypertension.

Drug fashions have changed and older drugs have given place to others with less side effects. Drugs and combinations of drugs administered to 100 patients currently under treatment at a clinic for severe hypertensives are listed. The most popular drugs were thiazide diuretics, methyldopa, beta-adrenergic blocking drugs, clinidine and hydrallazine. A thiazide diuretic was a constant member of the drug combinations. About 60% of patients achieved "good" blood pressure control (diastolic blood pressure less than or equal to 100 mm Hg), 30% "fair" (diastolic blood pressure=100 to 110 mm Hg) and 10+ "poor" (diastolic blood pressure greater than 110 mm Hg). Similar proportions were in "good", "fair" and "poor" general health. The best prospect for improved management of hypertension probably lies in earlier treatment with current drug combinations.     

高血压的社区管理与医院内科门诊管理效果比较

目的 评价健康教育在社区高血压患者管理中的效果。方法 随机抽取北京复兴医院月坛社区卫生服务中心管理的高血压患者603例作为研究对象,以同期该院三里河内科门诊就诊的高血压患者617例作为对照,进行血压测量和问卷调查。结果 社区高血压患者高血压知识知晓率明显好于内科门诊高血压患者(P<0.01);其生活方式(遵医行为、体育锻炼、食盐量等)较好;血压控制情况也好于门诊患者(P<0.01)。结论 规范、定期的健康教育可以提高高血压患者对高血压知识的知晓情况,改善高血压患者的不良行为习惯;利用社区卫生服务站固定的合作关系及新型医患模式有利于健康教育、健康知识普及和取得治疗成效。     

Management of hypertension. Effect of improving patient compliance for follow-up care.

A radomized controlled trial was conducted in a metropolitan teaching hospital to determine whether improving follow-up of emergency room patients who had hypertension led to improvements in their medical care and blood pressure control. One hundred fourty four patients were randomly assigned into an intervention group and a control group. In the former, a follow-up clerk assigned patients in returning for follow-up care. Eighty-four percent of patients in this group and 63% of control patients returned to the clinic (P less than 0.1). However, five months after the patients' emergency room visits, 51% of patients in the intervention group and 53% of control patients were normotensive. There were more diagnostic and therapeutic measures in the intervention group, but long-term management was similar in both groups. Improvement in follow-up may not be by itself lead to blood pressure control among hypertensive patients.     

Chronic diseases management in the Jamaican setting: HOPE worldwide Jamaica's experience

The prevalence of hypertension and diabetes in Jamaica is very high. Hypertension is present in 3 out of 10 Jamaicans over the age of 30 years while the prevalence of diabetes mellitus varies between 13% and 18% for Jamaicans over 15 years. HOPE worldwide Jamaica is a 7-year-old private voluntary organization that collaborates with the government of Jamaica to provide a mobile medical service to poor rural communities. The records between January 1999 and December 1999 of 1091 chronic disease patients aged > 30 years were reviewed. The average recorded age of the patients was 64 years and 82% among them were females. 60% had hypertension, 16% had diabetes and 24% had both diabetes and hypertension. There were 2390 visits for hypertension, with an average of 2 visits per patient. 34% of patients had a blood pressure of < or = 140/90 mmHg while 43% had a blood pressure < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. 44% of the patients with hypertension were non-compliant at the time of their visit. Antihypertensive treatment included thiazide diuretics (65%), reserpine (50%), angiotensin converting enzyme (ACE) inhibitors (30%) and alpha-methyldopa (5%). There were 1122 visits for diabetes, with an average of 2 visits per patient. Among the diabetic patients 23% were controlled to a fasting blood glucose (FBG) level of less than 6.7 mmol/l and 38% to below 8 mmol/l. 30% of the diabetic patients were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). 14% of the diabetic patients were on treatment with insulin: insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECGs) were done in the previous two years on 267 patients (29%), among whom 38% had evidence of left ventricular hypertrophy and 16% of ischaemic heart disease. The level of blood pressure and blood glucose control was inadequate despite the provision of regular monitoring, surveillance and improved access to medication. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs and some other factors continue to militate against improved compliance and control. HOPE worldwide Jamaica is currently implementing programs to improve patient education, especially in compliance, to provide access to more effective medication with convenient once-daily dosage regimens, and to develop support groups among chronic disease patients in order to improve compliance and control.     

高血压患者于门诊治疗血压控制达标的情况及其影响因素分析

目的：本研究主要就高血压患者行门诊治疗后的血压控制达标情况展开分析,并对其相关影响因素进行探讨。方法以我院门诊2013年11月-2014年11月所收治的120例高血压患者作为研究对象,对患者的相关资料进行调查、记录,对其血压控制达标率进行统计,采用Logistic回归分析来对影响门诊血压控制达标率的相关因素进行分析。结果本研究所有患者的血压控制总达标率为34.16%,达标患者主要集中在心血管专科就诊患者中,该人群的钙离子拮抗剂(CCB)使用量较大,β受体阻滞剂的使用量次之,在1级血压达标患者中,有62例患者采用单一药物来进行治疗,2种药物连用的血压控制达标率为44.17%;Logistic分析结果显示CCB、心内科专科随诊是导致高血压控制达标的独立因素,高收缩压史是导致血压控制不达标的独立危险因素。结论为了使门诊高血压药物治疗的血压控制达标,就必须定期开展心血管专科门诊随诊,并对患者的治疗方案进行及时调整;最好选用药物联合应用的方式来进行治疗,且在联合用药中,最好含有CCB。     

Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial

A 5-year trial involving 201 men and women with high-normal blood pressure at baseline demonstrated the ability to reduce the incidence of hypertension in participants randomized to nutritional-hygienic intervention compared with a control group. The incidence of hypertension was 8.8% among 102 intervention group participants vs 19.2% among 99 control group members. The odds ratio for the incidence of hypertension in the control group was 2.4. Mean trial blood pressure also was lower in the intervention compared with the control group (-1.2 and -1.9 mm Hg, respectively, for diastolic blood pressure at work-site and office visits and -1.3 and -2.0 mm Hg, respectively, for systolic blood pressure at the two sites). Net weight loss in the intervention group averaged 2.7 kg during the trial; sodium intake was reduced by 25% and reported alcohol intake decreased by 30%. The majority of intervention participants also reported an increase in physical activity. Effect on blood pressure was related particularly to degree of weight loss. Results indicate that even a moderate reduction in risk factors for hypertension among hypertension-prone individuals contributes to the primary prevention of the disease.     

Effectiveness of a program to improve hypertension screening in primary care.

OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension screening practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Two hospital-based family medicine centres (FMCs). PATIENTS: In the study FMC, two study groups of randomly selected adult patients: 425 who visited the FMC before implementation of the screening improvement program (from Apr. 1, 1983, to Mar. 31, 1984) and 418 who visited it afterward (from Apr. 1, 1986, to Mar. 31, 1987). These patients were matched with 392 and 442 control patients respectively seen during the same time frames at the second FMC. INTERVENTIONS: Educational sessions for physicians to standardize blood pressure measurement and knowledge of the recommendations from the Canadian Hypertension Society on hypertension screening and diagnosis, and specific operational incentives to improve hypertension screening, including a reference guide placed in each physician's office, a coloured form for recording blood pressure measurements placed in every patient's chart and a follow-up and recall card file. MAIN OUTCOME MEASURE: Frequency of blood pressure measurements recorded in patient charts. RESULTS: The hypertension screening rate was 60% per year in the study group before program implementation and 79% in the study group afterward; the corresponding rates in the two control groups were 72% and 59% (p < 0.0001). Patients were more likely to be screened if they visited the physician for a periodic health examination than for other problems (e.g., psychosocial or dermatologic) and if they had a scheduled appointment rather than no appointment. Physician characteristics that were positive predictors of screening were low age, female sex and payment on a salary basis. CONCLUSION: Physician education and incentives are effective in improving hypertension screening practices in hospital-based FMCs without incurring additional costs or other use of resources. Further evaluation of such a program should be undertaken in other primary care settings.     

A collaborative audit of the management of hypertension in general practice.

We carried out an audit of the management of essential hypertension in general practice, against standards based on current guidelines. We examined the records of 882 hypertensive subjects (on medication) in whom hypertension had been diagnosed between January 1989 and December 1993, from 14 general practices in the Portsmouth and South East Hampshire Health Authority. The overall prevalence of hypertension was 3.5%. Pretreatment blood pressure had been measured on three or more occasions in 87% of patients. Pretreatment blood pressure was equal to or greater than 150/95 mmHg in 96% and 160/100 mmHg in 86.5% of patients. A thiazide diuretic was the initial drug of choice in 30% of patients, with beta-blockers being the most popular initial treatment. Ninety per cent of patients had had their blood pressure measured at least once during the preceding year. In 82.5% of patients, current blood pressure was less than 150/95 mmHg, while 44% achieved a current blood pressure less than 140/90 mmHg. We conclude that the prevalence of hypertension in this population was lower than expected, suggesting the need for improved screening. We also propose that the initial treatment choice should be a thiazide in the majority, which would result in significant cost saving. The blood pressure control was suboptimal compared to current guidelines.     

Association between high blood pressure and deep periodontal pockets: a nested case-referent study

A hypertension screening project was performed jointly at a dental clinic and a primary health care centre. In this report the hypothesis that there is an association between high diastolic blood pressure and deep periodontal pockets was tested. A total of 1,239 consecutive patients aged 35-65 years had their blood pressure measured before the dental examination or had a known hypertension. Information on medical history and tobacco use was obtained by interview and dental status was recorded. Fifty-four subjects had known hypertension and 141 had previously unknown diastolic blood pressure >90 mmHg (cases). For each case an age, sex and tobacco-use matched referent was chosen from those with diastolic blood pressure < or =90 mmHg. Significantly more cases than referents had periodontal pockets > or = 5 millimeters deep. In multivariate analyses the prevalence of deep periodontal pockets was associated with blood pressure status also after adjustment for the small differences between the groups in age, sex, tobacco use and number of teeth. In conclusion there was an association between diastolic blood pressure and prevalent deep periodontal pockets. Whether the relationship is a causal one remains to be explored. Screening for high blood pressure at regularly visits at the dental clinic may give the dental care a new important role in the public health field.     

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices

CONTEXT: The US primary care safety net is composed of a loose network of community health centers, hospital outpatient departments, and physicians' offices. National data on how the mix of patients and services differ across sites are needed. OBJECTIVE: To develop and contrast national profiles of patient and service mix for primary care. DESIGN, SETTING, AND PATIENTS: Comparative analyses of 3 national surveys of primary care visits occurring in 1994: for data on physician's office visits, the National Ambulatory Medical Care Survey (NAMCS); for hospital outpatient department data, the National Hospital Ambulatory Medical Care Survey (NHAMCS); and for data on community health centers, the Bureau of Primary Health Care's 1994 Survey of Visits to Community Health Centers. A time trend analysis also was conducted using the 1998 NAMCS and NHAMCS. MAIN OUTCOME MEASURES: National estimates of primary care visit rates, types of patient presentation, patient case-mix, disposition of patients, and management interventions in 1994, and compared with 1998 data. RESULTS: The US population made 1.3 primary care visits per person in 1994, which accounted for 43.5% of all ambulatory visits to physicians' offices, community health centers, and hospital outpatient departments. Primary care visits per person were 20% lower for Hispanics and 33% lower for black, non-Hispanic persons compared with white, non-Hispanic persons. Visits to community health centers were more likely to be made by ethnic minorities, patients with Medicaid or no insurance, and rural dwellers than visits made to the other delivery sites. Visits at hospital outpatient departments were made by sicker populations and were characterized by less continuity than the other delivery sites. Controlling for patient mix, visits made to hospital outpatient departments were more commonly associated with imaging studies, minor surgery, and specialty referrals than those made to physicians' offices. In 1998, the US population made an estimated 3. 4 visits per person, 45.6% of which were primary care visits. National estimates of primary care visit rates and patient mix and practice pattern comparisons between hospital outpatient departments and physicians' offices were similar in 1998 and 1994. CONCLUSIONS: Expanding community health centers will likely improve access to primary care for vulnerable US populations. However, enhancing access to of physicians' offices is also needed to bolster the safety net. The greater service intensity and poorer continuity for primary care visits in hospital outpatient departments that we observed raises concern about the suitability of these clinics as primary care delivery sites. JAMA. 2000;284:2077-2083.     

Use of shopping centres in screening for hypertension

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.

Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient's arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.

The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.

     

Outcome among untreated hypertensives in the general population in Taiwan.

The outcome of untreated hypertension was investigated in a population of 17,713 persons in southern Taiwan who were aged 15 or over when they had taken part in a blood pressure survey in 1963. In the 27-year follow-up period, 55.8% of the overall mortality was comprised of those who were found to be hypertensive (as defined by WHO) in 1963, 31.3% by borderline hypertensives, and 22.6% by normotensives. The 27-year mortality rate due to stroke was much higher in hypertensives than in normotensives (11.4% vs 1.8%, respectively). The 5-year survival rates for mild, moderate and severe hypertensives were 89.9%, 82.7% and 72.3%, respectively, and the 20-year rates were 60.2%, 37.2% and 25.2%, respectively. The causes of death were also recorded: among hypertensives, stroke accounted for 23.2% of all deaths of known cause, cancer 20.5%, cardiovascular disease 21.7%, respiratory disease 11.8%, and other causes 22.9%. From the results, it is concluded that obvious differences in mortality and cause of death exist between untreated hypertensives and normotensives.     

Evaluation of screening for hypertension in general practice with an automatic machine

An automatic device for measuring blood pressure was used to screen all patients aged 30 to 65 years registered at a health centre. Of those who were eligible, 55% attended. Patients with previously recognised hypertension were more common among the attenders than among the non-attenders. High readings obtained on the automatic device possibly deterred some patients from reattending for follow up measurements of blood pressure. Although the device is quick and easy to use, the logistic challenge of formal blood pressure screening is considerable. Hypertension was discovered in 52 patients (mean diastolic pressure greater than 100 mm Hg). Retrospective analysis of their medical records showed that a third had had an abnormal blood pressure reading noted during the past 10 years and no further action had been taken, and almost three quarters had attended their practitioner during the previous year without having a blood pressure measurement recorded. One year after the screening procedure two fifths of the newly discovered hypertensive patients had defaulted from follow up and treatment. Automatic devices are not a short cut to the discovery of occult hypertension. Case finding by routine measurement of blood pressure at surgery visits is more efficient.