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- High Blood Pressure
- Hypertension Tools and Training
- 2018 ESC/ESH Clinical Practice Guidelines for the Management of Arterial Hypertension
- Hypertension clinical information and guidelines
Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries.
High Blood Pressure
Blood pressure control in hypertensive patients within Family Health Program versus at Primary Healthcare Units: analytical cross-sectional study. I MSc. Address for correspondence. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program FHP has the aims of promoting quality of life and intervening in factors that put this at risk.
The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months.
Key words: Hypertension. Health plan implementation. Public health. Population control. Health education. In the year , it was estimated that hypertension would affect around million adults worldwide: million of them in economically developed regions and million in developing regions. Among these, the main causes were acute myocardial infarction and stroke. Hypertension is one of the most important and most prevalent risk factors for the development of atherosclerosis.
It is the pathogenic basis for ischemic heart disease, cerebrovascular disease, kidney failure and peripheral vascular disease. It is chronic in nature and generally develops without symptoms over many years. Its high morbidity-mortality only comes to light 15 to 20 years after it starts.
For all these reasons, it is a public health challenge worldwide. Therefore, all efforts towards early detection of this disease, with appropriate treatment and adherence to treatment, are justified. The aim behind such efforts is to control blood pressure levels and have a favorable impact on the cardiac, cerebrovascular, renal and peripheral vascular complications of this disease.
Two recent studies have found a high prevalence of hypertension among the adult Brazilian population: This study found that Health programs and policies for controlling hypertension aim to diminish the complications, hospital admissions and deaths relating to hypertension. Furthermore, they aim to reduce the prevalence of hypertensive disease; increase the degree of knowledge among the population regarding the importance of controlling blood pressure; ensure access to primary healthcare services and medications for hypertensive individuals; and encourage community-based programs.
Its aim is to promote healthcare for individuals in a holistic, integrated and continuous manner, through care provision for families and communities. It also aims to improve quality of life and focus on biopsychological, economic, cultural and social issues. The minimum team at FHP units is composed of a physician, a nurse, one or two nursing auxiliaries and four to six health agents, who work not only at the units but also within the community, through home visits.
This had the aim of providing technical support for professionals working within the primary care network, with regard to attendance not only for cases of hypertension, but also for diabetes mellitus, which is another public health problem. The objective of the present study was to evaluate the rate of controlled hypertension among hypertensive patients who were followed up at FHP units, comparing this with the rate of such control among patients followed up at traditional PHUs.
Public-sector healthcare establishments that had been in operation for more than 12 months were selected. The FHP units needed to have a complete team one physician, one nurse, one to two nursing auxiliaries and four to six health agents.
For the PHUs, the inclusion criterion was that they should have at least one general clinician. Thouzet were randomly selected.
The units were initially included by means of a draw. The draw was carried out using the following method: 1 the units were classified as either FHP units or PHUs; 2 the units were sequentially numbered; 3 each of these numbers was placed separately in a medium-brown opaque envelope without any identification. After the draw, the units were submitted to the inclusion and exclusion criteria of the study. Each group was composed of patients of both genders aged over 18 years with a diagnosis of primary hypertension, independent of any presence of comorbidities.
All the patients selected had been undergoing follow-up for at least 12 months at the units. The data collected from the medical files included: blood pressure at the first consultation; blood pressure at the last consultation; medication prescribed at the penultimate consultation; number of medical consultations over the past year; number of nursing consultations over the past year; and number of participations in group activities over the past year.
Medical team member experience and qualifications were verified by directly asking each member for this information. The following individuals were excluded: patients under 18 years of age, patients who had been followed up for less than 12 months, patients who lived outside of the city, patients with a diagnosis of secondary hypertension, pregnant patients and patients whose pressure levels had not been recorded.
The outcome evaluated was blood pressure control. The blood pressure measurement equipment used in the units was of aneroid type Certified or Missouri models , and the units affirmed that these devices were calibrated every six months.
NAWA stethoscopes were used. There was no statistical difference according to sex or age in the two study groups Table 1. Only the patients followed up at FHP units had nursing consultations, group activities or home visits Table 3. There were no statistical differences in relation to monotherapy, use of two drugs or use of more than two drugs, among the groups followed up at PHUs and FHP units Table 4.
There was also no statistical difference regarding classes of antihypertensive drugs, either in monotherapy or in associations Table 5. We observed in our study that the proportion of the patients with blood pressure that was under control at the last consultation at the FHP units was Although the observed percentage control was unsatisfactory, it was similar to what has been described in the literature. We observed that the blood pressure control was better among the men studied at PHUs.
However, we were unable to explain this finding, taking into account the size of the sample. The attendance model proposed for the FHP aims towards health promotion through team actions relating to quality of life, with interventions applied to factors that place this quality of life at risk.
This is to be achieved through knowing the clientele better, not only at the units but also in their homes, and through detecting these people's real needs and encouraging them to recognize that their health and quality of life are citizens' rights.
With this model in mind, it was expected that when the HiperDia program was implemented within SUS, the FHP units would be more effective in controlling blood pressure, compared with the traditional model of the PHUs.
The teams at PHUs are not multidisciplinary and they act only in the PHUs: there are no consultations at patients' homes and no active searches for missing patients are conducted. However, what we found was that the blood pressure control at the FHP units was inferior to the control achieved at the traditional PHUs.
Our study compared populations that were very similar, formed by individuals who sought primary healthcare through SUS and who therefore were of comparable socioeconomic level. Furthermore, the groups were similar in terms of gender and age distribution. The medications provided are supplied by the city health authorities and the state government.
The HiperDia manual, containing guidance relating to diagnosing and managing high blood pressure, was available at all the units evaluated.
With regard to the medical professionals working in the two types of unit, we observed that they presented different characteristics, such as the length of time since graduation and the different specialties represented. Differences in specialties lead to the hypothesis that the results encountered might have been influenced by this factor, but in this respect, not only the physicians' original training but also their continuing training would have to be taken into account.
Davis and Taylor-Vaisey 10 suggested that continuing education among physicians leads to better performance in relation to treatment for cardiovascular disease and in relation to dealing with its risk factors.
Schneider et al. Data from the Brazilian Ministry of Health 13 published in showed that between and , the introductory training provided by the ministry, which ought to be given before or immediately after setting up the teams at the FHP units, reached averages of Specific training for these teams in relation to managing hypertension reached averages of only In the State of Rio de Janeiro, these averages went up to Continuing healthcare education has been provided over this period, with material from the Ministry of Health and delivery by professionals from within the public healthcare system.
Most of the physicians working in the nine PHUs of the municipality had been trained in internal medicine. We observed that the larger number of consultations that took place at the FHP units, in relation to the number of consultations at PHUs, was not reflected in better control over hypertension. We suspect that both the quality of the consultation and the physicians' training were factors that may have influenced the results.
Haynes demonstrated that despite the known need for adherence to treatment in order to control high blood pressure, there was great difficulty in achieving this. Several models have been tested with a view to improving the adherence to treatment for chronic diseases. Another important point regarding adherence to treatment for these diseases relates to the drugs used and their prescription. A meta-analysis conducted by Schroeder, 17 in which drugs administered once or twice a day were tested, showed a single study in which a decrease of 6 mmHg in systolic pressure, with important repercussions on diastolic pressure, was found with the use of drugs taken once a day.
Data from the Primary Care Department 18 have shown that the drugs most used within HiperDia are ACE angiotensin-converting enzyme inhibitors, diuretics and beta blockers. In our study, the type of monotherapy most used was ACE inhibitors and the combination most used was ACE inhibitors with diuretics. However, the monotherapy did not show better blood pressure control, considering that the ACE inhibitor used was captopril, which has to be taken as at least three doses per day.
Our study presents certain limitations, given that the data were extracted from the medical files. Moreover, although both types of unit took their guidance from the HiperDia program, both for measuring blood pressure and for diagnosing hypertension and treating it, the blood pressure measurements were performed by different people and we cannot be absolutely sure that the diagnostic criteria and case management were followed equally in the two groups.
The results show that the level of hypertension control in both types of unit is still unsatisfactory. New studies are needed in order to identify the possible obstacles that may be influencing these results. Global burden of hypertension: analysis of worldwide data. Mortalidade - Brasil. Accessed in Oct 7. J Bras Med. Arq Bras Cardiol. Accessed in Aug Vassar stats: website for statistical computation. Accessed in May Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.
Z Arztl Fortbild Qualitatssich. J Hypertens. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev. Interventions for enhancing medication adherence.
Hypertension Tools and Training
To measure your blood pressure, a specialist places an inflatable cuff around your arm and measures your blood pressure using a pressure-measuring gauge. A blood pressure reading, as shown in the blood pressure monitor in the image, measures the pressure in your arteries when your heart beats systolic pressure in the first number, and the pressure in your arteries between heartbeats diastolic pressure in the second number. Your doctor will ask questions about your medical history and do a physical examination. The doctor, nurse or other medical assistant will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. Your blood pressure generally should be measured in both arms to determine if there is a difference.
Blood pressure relationship with risk of cardiovascular and renal events. Importance of hypertension-mediated organ damage in refining cardiovascular risk assessment in hypertensive patients. Advantages and disadvantages of ambulatory blood pressure monitoring and home blood pressure monitoring. Clinical indications for out-of-office blood pressure measurements. Using hypertension-mediated organ damage to help stratify risk in hypertensive patients.
2018 ESC/ESH Clinical Practice Guidelines for the Management of Arterial Hypertension
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Distribution of blood pressure BP control based on 4 methods of assessment and 3 criteria for control.
Hypertension clinical information and guidelines
Clinical information for diagnosis and management of atrial fibrillation Clinical resources for health care professionals to improve the management of patients with heart failure. Heart Health Checks have been supported by Medicare since April Should population-based CVD risk assessment models make way for individualised risk prediction techniques?
Blood pressure control in hypertensive patients within Family Health Program versus at Primary Healthcare Units: analytical cross-sectional study. I MSc. Address for correspondence.
and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on. Clinical Practice.
Конечно, Джабба прав. Поскольку числовая строка бесконечна, всегда можно заглянуть дальше и найти еще одно простое число. Между 0 и 1 000 000 более 70 000 вариантов. Все зависит оттого, что выбрал Танкадо. Чем больше это число, тем труднее его найти. - Оно будет громадным, - застонал Джабба.
Она помахала ему рукой. - Подождите, мистер. Ну что еще? - застонал. - Хочет предъявить мне обвинение во вторжении в личную жизнь. Девушка волокла за собой туристскую сумку.
Это совсем молоденькая девушка. Лет пятнадцати-шестнадцати. Волосы… - Не успев договорить, он понял, что совершил ошибку. Кассирша сощурилась. - Вашей возлюбленной пятнадцать лет.
Затем она, наверное, вмонтирует алгоритм в защищенный чип, и через пять лет все компьютеры будут выпускаться с предустановленным чипом Цифровой крепости. Никакой коммерческий производитель и мечтать не мог о создании шифровального чипа, потому что нормальные алгоритмы такого рода со временем устаревают. Но Цифровая крепость никогда не устареет: благодаря функции меняющегося открытого текста она выдержит людскую атаку и не выдаст ключа.