“Whatever the measurement system is, it needs to be consistent, repeatable, and as unbiased as possible” Pearl Zhu[1] William Harvey discovered circulation in 1628 and century elapsed before Reverend Stephen Hales performed his famous experiment in 1733, demonstrating the rise of blood to height of eight feet, three inches, in glass pipe placed in artery of Horse. It was not until non-invasive occluding arm cuff devised by Scipione Riva Rocci in 1896 that clinical measurement of blood pressure (BP) became reality. He inflated cuff, until it occluded pulse distal to cuff. This application of external counter pressure until the pulse disappeared by palpation corresponds to peak systolic BP (SBP). Quantification of counterpressure was done by connecting the inflatable bag to mercury manometer� In April 1905, Russian surgeon-Nikolai Sergeevich Korotkoff described the measurement of BP by auscultation-peak systolic pressure corresponding to onset of audible sounds by Stethoscope distal to occluding cuff and disappearance of sounds to end-diastolic pressure� Alternative methods of BP measurement, using oscillometry, applanation tonometry, volume clamp method, and analysis of various parameters of arterial pulse wave, have been utilized for noninvasive measurement of arterial BP� The evolution of methods of BP measurement continues and the latest technique of non-invasive measurement of BP using Android smartphone, is commercially available but not yet approved by regulating organizations and professional societies� Direct intra-arterial pressure measurement by cannulation of the vessel is gold standard, but it is not practical for routine clinical measurement of ambulatory patients, as it is invasive and requires technical skill and is associated, although rarely with potential major complications of occlusion of vessels and injury to adjacent structures� Thus, indirect non-invasive measurement of BP is currently clinical standard� Most of these methods base the measurement of pressure, indirectly by applying counter pressure to blood vessels or analyzing various components of pulse wave recorded indirectly by device/sensors applied to blood vessels, transcutaneously� Abstract
{"title":"Blood Pressure Measurement in Clinical Practice Methods and Emerging Options","authors":"V. Rao","doi":"10.15713/ins.johtn.0161","DOIUrl":"https://doi.org/10.15713/ins.johtn.0161","url":null,"abstract":"“Whatever the measurement system is, it needs to be consistent, repeatable, and as unbiased as possible” Pearl Zhu[1] William Harvey discovered circulation in 1628 and century elapsed before Reverend Stephen Hales performed his famous experiment in 1733, demonstrating the rise of blood to height of eight feet, three inches, in glass pipe placed in artery of Horse. It was not until non-invasive occluding arm cuff devised by Scipione Riva Rocci in 1896 that clinical measurement of blood pressure (BP) became reality. He inflated cuff, until it occluded pulse distal to cuff. This application of external counter pressure until the pulse disappeared by palpation corresponds to peak systolic BP (SBP). Quantification of counterpressure was done by connecting the inflatable bag to mercury manometer� In April 1905, Russian surgeon-Nikolai Sergeevich Korotkoff described the measurement of BP by auscultation-peak systolic pressure corresponding to onset of audible sounds by Stethoscope distal to occluding cuff and disappearance of sounds to end-diastolic pressure� Alternative methods of BP measurement, using oscillometry, applanation tonometry, volume clamp method, and analysis of various parameters of arterial pulse wave, have been utilized for noninvasive measurement of arterial BP� The evolution of methods of BP measurement continues and the latest technique of non-invasive measurement of BP using Android smartphone, is commercially available but not yet approved by regulating organizations and professional societies� Direct intra-arterial pressure measurement by cannulation of the vessel is gold standard, but it is not practical for routine clinical measurement of ambulatory patients, as it is invasive and requires technical skill and is associated, although rarely with potential major complications of occlusion of vessels and injury to adjacent structures� Thus, indirect non-invasive measurement of BP is currently clinical standard� Most of these methods base the measurement of pressure, indirectly by applying counter pressure to blood vessels or analyzing various components of pulse wave recorded indirectly by device/sensors applied to blood vessels, transcutaneously� Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72372568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High blood pressure (BP) is the most common modifiable cardiovascular risk factor worldwide. Guidelines have been formulated all over the world addressing the issue of hypertension; however, the control rates for hypertension remains discouraging, particularly in the Philippines. In the latest National Nutrition and Health Survey, the prevalence of hypertension in the Philippines is 22.3% and is highest in individuals more than 70 years old. The problem with the survey that measurement was based only on single measurements done in doctors’ clinics.[1] The use of conventional measurement of BP done in the office BP monitoring (OBPM) has been the norm in the diagnosis and management, but this method has downsides, particularly of white coat hypertension and masked hypertension, which are quite common for both untreated and treated hypertensives. The reliability of OBPM is questioned with issues such as the unstandardized setting and conditions of clinics, observer bias and errors, and the small number of readings. There is also a discordance in the measurements of OBPM compared to out-of-office BP (OBP) measurements which could have an effect on the “true underlying BP reading” of the individual.[2] Home BP monitoring (HBPM) refers to the measurement of BP at home, ideally by the individual. It is optimal when the patient is seated at rest at around the same time in the morning and evening, usually a period of 1 week.[2,3] The readings are recorded using a validated, automated BP device and are then conveyed to the physician for interpretation. This method is appealing to most patients and can lead to more awareness and control of their hypertension. HBPM allows standardization of conditions, leading to little measurement variability and reproducibility of readings. Home BP (HBP) measurements can easily identify patients with white coat, masked, and sustained hypertension. HBPM is also widely available and can provide day-to-day BP variability values.[3-5] Despite the several advantages of HBP measurements, it has yet to gain popularity in the Philippines due to the cost of the automated BP machines, lack of patient training, and the preferential use of OBP of physicians. Abstract
{"title":"Advocating Home Blood Pressure Monitoring in Improving Hypertension Control in the Philippines","authors":"R. Oliva","doi":"10.15713/ins.johtn.0154","DOIUrl":"https://doi.org/10.15713/ins.johtn.0154","url":null,"abstract":"High blood pressure (BP) is the most common modifiable cardiovascular risk factor worldwide. Guidelines have been formulated all over the world addressing the issue of hypertension; however, the control rates for hypertension remains discouraging, particularly in the Philippines. In the latest National Nutrition and Health Survey, the prevalence of hypertension in the Philippines is 22.3% and is highest in individuals more than 70 years old. The problem with the survey that measurement was based only on single measurements done in doctors’ clinics.[1] The use of conventional measurement of BP done in the office BP monitoring (OBPM) has been the norm in the diagnosis and management, but this method has downsides, particularly of white coat hypertension and masked hypertension, which are quite common for both untreated and treated hypertensives. The reliability of OBPM is questioned with issues such as the unstandardized setting and conditions of clinics, observer bias and errors, and the small number of readings. There is also a discordance in the measurements of OBPM compared to out-of-office BP (OBP) measurements which could have an effect on the “true underlying BP reading” of the individual.[2] Home BP monitoring (HBPM) refers to the measurement of BP at home, ideally by the individual. It is optimal when the patient is seated at rest at around the same time in the morning and evening, usually a period of 1 week.[2,3] The readings are recorded using a validated, automated BP device and are then conveyed to the physician for interpretation. This method is appealing to most patients and can lead to more awareness and control of their hypertension. HBPM allows standardization of conditions, leading to little measurement variability and reproducibility of readings. Home BP (HBP) measurements can easily identify patients with white coat, masked, and sustained hypertension. HBPM is also widely available and can provide day-to-day BP variability values.[3-5] Despite the several advantages of HBP measurements, it has yet to gain popularity in the Philippines due to the cost of the automated BP machines, lack of patient training, and the preferential use of OBP of physicians. Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81544762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systemic hypertension (HTN) is the most common identifiable risk factor for the development of cardiovascular diseases (CVD). Epidemiological studies have shown strong association between elevated arterial blood pressure (BP) and the development of coronary artery disease (CAD), stroke cerebrovascular accident, renal failure, aortic dissection, peripheral arterial disease (PAD), and heart failure (HF)�[1] There is enough evidence to suggest that lowering BP has a significant impact on morbidity and mortality.[2] Out of all CV disorders, CAD and HF contribute to the majority of deaths. Thus, prevention, early detection, and control of HTN are of paramount importance. HTN is aptly classified as Stage A HF because of their strong association. Treatment of HTN in patients with HF must take into consideration the type of HF that is present: HF with reduced ejection fraction (HFrEF), in which systolic function is impaired; or HF with preserved ejection fraction (HFpEF), in which diastolic function is impaired but systolic function is preserved� Management guidelines are well established for HFrEF, but less certain for HFpEF� HF patients are nearly evenly divided between those with reduced left ventricular (LV) systolic function and those with preserved LV systolic function. Elderly hypertensives are more prone to HF� Any increase in BP above 120 mmHg systolic or 85 mmHg diastolic is associated with increased risk of developing CAD and eliminating this risk factor is a major concern of primary prevention�[3] Long-standing BP elevations promote endothelial injury, resulting in impaired nitric oxide (vasodilator) release and increased release of inflammatory mediators that promote the development of atherosclerosis and vascular occlusion. Uncontrolled HTN is also responsible for the occurrence of acute coronary events in patients with chronic stable angina�
{"title":"Therapeutic Principles in Hypertension Management in Patients with Congestive Heart Failure and Coronary Artery Disease","authors":"B. Sudhakar","doi":"10.15713/ins.johtn.0165","DOIUrl":"https://doi.org/10.15713/ins.johtn.0165","url":null,"abstract":"Systemic hypertension (HTN) is the most common identifiable risk factor for the development of cardiovascular diseases (CVD). Epidemiological studies have shown strong association between elevated arterial blood pressure (BP) and the development of coronary artery disease (CAD), stroke cerebrovascular accident, renal failure, aortic dissection, peripheral arterial disease (PAD), and heart failure (HF)�[1] There is enough evidence to suggest that lowering BP has a significant impact on morbidity and mortality.[2] Out of all CV disorders, CAD and HF contribute to the majority of deaths. Thus, prevention, early detection, and control of HTN are of paramount importance. HTN is aptly classified as Stage A HF because of their strong association. Treatment of HTN in patients with HF must take into consideration the type of HF that is present: HF with reduced ejection fraction (HFrEF), in which systolic function is impaired; or HF with preserved ejection fraction (HFpEF), in which diastolic function is impaired but systolic function is preserved� Management guidelines are well established for HFrEF, but less certain for HFpEF� HF patients are nearly evenly divided between those with reduced left ventricular (LV) systolic function and those with preserved LV systolic function. Elderly hypertensives are more prone to HF� Any increase in BP above 120 mmHg systolic or 85 mmHg diastolic is associated with increased risk of developing CAD and eliminating this risk factor is a major concern of primary prevention�[3] Long-standing BP elevations promote endothelial injury, resulting in impaired nitric oxide (vasodilator) release and increased release of inflammatory mediators that promote the development of atherosclerosis and vascular occlusion. Uncontrolled HTN is also responsible for the occurrence of acute coronary events in patients with chronic stable angina�","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88214606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
• It is important to obtain accurate BP values before labeling as RH. Standard BP measurement protocols are required to segregate true RH from apparent RH. • To minimize measurement artifacts. • To get a BP value which represents true out-of-office BP. • BP has to be measured accurately in office setting by trained individuals to avoid problem of white-coat effect. • Automated office BP in which a series of BP measurements are made in office usually mimicks daytime recordings.[1] Optimal therapy
{"title":"Resistant Hypertension: Overview","authors":"K. Krishnakumar","doi":"10.15713/ins.johtn.0147","DOIUrl":"https://doi.org/10.15713/ins.johtn.0147","url":null,"abstract":"• It is important to obtain accurate BP values before labeling as RH. Standard BP measurement protocols are required to segregate true RH from apparent RH. • To minimize measurement artifacts. • To get a BP value which represents true out-of-office BP. • BP has to be measured accurately in office setting by trained individuals to avoid problem of white-coat effect. • Automated office BP in which a series of BP measurements are made in office usually mimicks daytime recordings.[1] Optimal therapy","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74542359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arnold Benjamin C. Mina, Maria Vinny Defensor-Mina, D. Morales
Pioneer Faculty, Department of Internal Medicine, Adventist University of the Philippines-College of Medicine, Silang Cavite, Philippines, Consultant, Department of Medicine, Section of Cardiology, University of Perpetual Help Medical Center Heart and Vascular Institute, Biñan Laguna, Philippines, Department of Internal Medicine, Adventist University of the Philippines–College of Medicine, Silang Cavite, Philippines, Consultant in Rheumatology, University of Perpetual Help Medical Center Heart and Vascular Institute, Biñan Laguna, Philippines, Department of Medicine, Section of Cardiology, Faculty and Consultant, University of the Philippines College of Medicine, Philippine General Hospital, Manila Doctors Hospital, Philippines, Philippine College of Physicians, Philippine Heart Association, Philippine Society of Hypertension, Philippine Lipid and Atherosclerosis Society, Philippines
{"title":"The Impact of the 2017 American College of Cardiology/American Heart Association and the 2018 European Society of Cardiology/European Society of Hypertension Guidelines on the Asian Population: Is it Time for Our Own Asian Hypertension Guidelines?","authors":"Arnold Benjamin C. Mina, Maria Vinny Defensor-Mina, D. Morales","doi":"10.15713/ins.johtn.0153","DOIUrl":"https://doi.org/10.15713/ins.johtn.0153","url":null,"abstract":"Pioneer Faculty, Department of Internal Medicine, Adventist University of the Philippines-College of Medicine, Silang Cavite, Philippines, Consultant, Department of Medicine, Section of Cardiology, University of Perpetual Help Medical Center Heart and Vascular Institute, Biñan Laguna, Philippines, Department of Internal Medicine, Adventist University of the Philippines–College of Medicine, Silang Cavite, Philippines, Consultant in Rheumatology, University of Perpetual Help Medical Center Heart and Vascular Institute, Biñan Laguna, Philippines, Department of Medicine, Section of Cardiology, Faculty and Consultant, University of the Philippines College of Medicine, Philippine General Hospital, Manila Doctors Hospital, Philippines, Philippine College of Physicians, Philippine Heart Association, Philippine Society of Hypertension, Philippine Lipid and Atherosclerosis Society, Philippines","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73420334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The tracking phenomenon of childhood hypertension (HTN) is widely recognized. Large population-based longitudinal studies showed that a hypertensive child would carry on to become a hypertensive adult.[1] Thus, early recognition and intervention while still at the pediatric age group will prevent these future adults from adding on to the burgeoning population of adult hypertensives at risk for devastating stroke, myocardial infarction, congestive heart failure, arrhythmia, and other cardiovascular events. Over the years, new clinical knowledge, breakthroughs, and scientific evidence have made it difficult for physicians to thresh out crucial medical information necessary for everyday clinical decisions. Hence, clinical guidelines were formulated to assist practitioners in making more consistent and efficient judgments at the bedside and outpatient clinics. Clinical practice guidelines have increasingly become a standard part of clinical practice. These systematically developed recommendations developed into influencing rules of operation at the clinics, hospitals, and even health directives of insurers and government policymakers to standardize practice and improve clinical outcomes. In the Philippines, there is no clinical practice guideline drafted for pediatric HTN. The American Academy of Pediatrics (AAP) and the European Society of HTN (ESH) guidelines have served as the references and the sole basis for the standard of care. From the time, the guideline updates were published Abstract
{"title":"A Closer Look at the Latest United States and European Pediatric Hypertension Guidelines and its Impact on Local Practice","authors":"Lourdes Paula R. Resontoc, D. Bonzon","doi":"10.15713/ins.johtn.0152","DOIUrl":"https://doi.org/10.15713/ins.johtn.0152","url":null,"abstract":"The tracking phenomenon of childhood hypertension (HTN) is widely recognized. Large population-based longitudinal studies showed that a hypertensive child would carry on to become a hypertensive adult.[1] Thus, early recognition and intervention while still at the pediatric age group will prevent these future adults from adding on to the burgeoning population of adult hypertensives at risk for devastating stroke, myocardial infarction, congestive heart failure, arrhythmia, and other cardiovascular events. Over the years, new clinical knowledge, breakthroughs, and scientific evidence have made it difficult for physicians to thresh out crucial medical information necessary for everyday clinical decisions. Hence, clinical guidelines were formulated to assist practitioners in making more consistent and efficient judgments at the bedside and outpatient clinics. Clinical practice guidelines have increasingly become a standard part of clinical practice. These systematically developed recommendations developed into influencing rules of operation at the clinics, hospitals, and even health directives of insurers and government policymakers to standardize practice and improve clinical outcomes. In the Philippines, there is no clinical practice guideline drafted for pediatric HTN. The American Academy of Pediatrics (AAP) and the European Society of HTN (ESH) guidelines have served as the references and the sole basis for the standard of care. From the time, the guideline updates were published Abstract","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89068339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Much attention has been paid to kidneys and heart as targets of end-organ damage due to hypertension� However, both large and small artery brain vasculature are probably more vulnerable to this end-organ damage� Many prospective studies have addressed the relationship between high blood pressure (BP) and memory decline. The overall impression does suggest that midlife hypertension has a strong association with late-life dementia of both vascular dementia (VaD) and Alzheimer’s disease (AD) type. The aim of this article is to review the available literature on the subject of hypertension as a cause of dementia�
{"title":"Hypertension as a Cause of Dementia","authors":"S. Kaul","doi":"10.15713/ins.johtn.0162","DOIUrl":"https://doi.org/10.15713/ins.johtn.0162","url":null,"abstract":"Much attention has been paid to kidneys and heart as targets of end-organ damage due to hypertension� However, both large and small artery brain vasculature are probably more vulnerable to this end-organ damage� Many prospective studies have addressed the relationship between high blood pressure (BP) and memory decline. The overall impression does suggest that midlife hypertension has a strong association with late-life dementia of both vascular dementia (VaD) and Alzheimer’s disease (AD) type. The aim of this article is to review the available literature on the subject of hypertension as a cause of dementia�","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90787146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Villanueva, Cheryl E. Flores-Riva, Josephine R. Valdez
Hypertension (HTN) is the chronic elevation of blood pressure (BP) sufficient to increase the risk of HTN-mediated organ damage and other related complications in the general population, particularly in the presence of comorbidities.[1-4] It is the level of BP at which the benefits of lifestyle interventions or medical therapy outweigh the risks of treatment.[5] In 2015, the global prevalence of hypertension (HTN) was estimated to be 1.13 billion.[6] There is around 30–45% of adults worldwide diagnosed with HTN. Majority of those diagnosed with elevated BP are males. This is consistent across different countries regardless of socioeconomic status.[7] The aging population, sedentary lifestyles, and obesity contribute to the rise of HTN cases globally, with an estimated increase in disease prevalence to close to 1.5 billion by 2025.[8]
{"title":"Treatment of Hypertension in the Different Stages of Chronic Kidney Disease","authors":"A. Villanueva, Cheryl E. Flores-Riva, Josephine R. Valdez","doi":"10.15713/ins.johtn.0158","DOIUrl":"https://doi.org/10.15713/ins.johtn.0158","url":null,"abstract":"Hypertension (HTN) is the chronic elevation of blood pressure (BP) sufficient to increase the risk of HTN-mediated organ damage and other related complications in the general population, particularly in the presence of comorbidities.[1-4] It is the level of BP at which the benefits of lifestyle interventions or medical therapy outweigh the risks of treatment.[5] In 2015, the global prevalence of hypertension (HTN) was estimated to be 1.13 billion.[6] There is around 30–45% of adults worldwide diagnosed with HTN. Majority of those diagnosed with elevated BP are males. This is consistent across different countries regardless of socioeconomic status.[7] The aging population, sedentary lifestyles, and obesity contribute to the rise of HTN cases globally, with an estimated increase in disease prevalence to close to 1.5 billion by 2025.[8]","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84314791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-24DOI: 10.2174/1876526201810010060
S. Doocy, E. Lyles, Zeina Fahed, Abdalla Mkanna, K. Kontunen, G. Burnham
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.To provide a profile of the health status of diabetes and hypertension patients enrolled in a longitudinal cohort study in Lebanon.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.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.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.
{"title":"Characteristics of Syrian and Lebanese Diabetes and Hypertension Patients in Lebanon","authors":"S. Doocy, E. Lyles, Zeina Fahed, Abdalla Mkanna, K. Kontunen, G. Burnham","doi":"10.2174/1876526201810010060","DOIUrl":"https://doi.org/10.2174/1876526201810010060","url":null,"abstract":"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.To provide a profile of the health status of diabetes and hypertension patients enrolled in a longitudinal cohort study in Lebanon.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.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.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.","PeriodicalId":38918,"journal":{"name":"Open Hypertension Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42488490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-30DOI: 10.2174/1876526201810010052
O. Posnenkova, S. N. Gerasimov, Y. V. Popova, V. Gridnev, A. Kiselev
Information on treatment obtained from hypertensive patients could add the data of medical records and reveal the problems addressed to hypertensives’ attitudes and behavior. To evaluate patients’ knowledge on hypertension and treatment behavior at a rural polyclinic with the help of structured questionnaire. 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. 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. 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.
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