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Jensen AE, Søndergaard J, Kjær NK, Nielsen JB. Patients' views on usefulness and effects of a risk communication tool for cardiovascular disease: a qualitative analysis. BMC PRIMARY CARE 2024; 25:50. [PMID: 38310258 PMCID: PMC10837932 DOI: 10.1186/s12875-024-02279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Failing to comprehend risk communication might contribute to poor treatment adherence. Using hypertension as a case, we investigated how a risk communication tool for patients with an elevated risk of cardiovascular disease was perceived. METHODS As part of a large project featuring a randomised controlled trial in a general practice setting in the Region of Southern Denmark, we conducted a semi-structured individual interview study. The study included patients with hypertension who had used an intervention comprising a visual and dynamic cardiovascular risk communication tool, along with receiving recurring emails providing advice on a healthy lifestyle. The analyses were based on Malterud's Systematic Text Condensation. RESULTS This article focuses solely on the results of the interview study, which comprised a total of 9 conducted and analysed interviews. The IT setup had a major impact on adherence to the intervention. A positive impact was found when the IT setup was perceived as easy to use and accessible, while a negative impact was noted when it malfunctioned. The intervention increased patients' self-reported insight into risk of cardiovascular disease. Patients reported the intervention and their risk of cardiovascular disease to become less important to them when they had more severe comorbidities. The involved health professional was very important for treatment adherence when communicating risk visually. Patients expressed trust in their general practitioners, and the general practitioners' attitudes toward the intervention affected patients' perceptions of its usefulness. While the informants reported an increased awareness of their risk of cardiovascular disease, none of them felt more concerned. CONCLUSIONS Patients reported an increase in their perceived insight into the risk of cardiovascular disease but not an increased concern. Our findings align with previous studies emphasizing the importance of patients' motivation as well as risk perception for adherence. General practitioners have an important role when implementing new tools for patients.
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Affiliation(s)
- Anders Elkær Jensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
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Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database. J Hypertens 2021; 39:1134-1142. [PMID: 33967217 DOI: 10.1097/hjh.0000000000002785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hypertension is mostly managed in primary care. This study investigated the prevalence of diagnosed hypertension in Australian general practice and whether hypertension control is influenced by sociodemographic characteristics, duration since diagnosis or prescription of antihypertensive medications. METHODS Cross-sectional study using a large national database of electronic medical records of patients attending general practice in 2017 (MedicineInsight). RESULTS Of 1.2 million 'regular' patients (one or more consultations per year in every year from 2015 to 2017), 39.8% had a diagnosis of hypertension (95% confidence interval 38.7-40.9). Of these, 85.3% had their blood pressure (BP) recorded in 2017, and 54.9% (95% confidence interval 54.2-55.5) had controlled hypertension (<140/90 mmHg). BP control was lower in females (54.1%) compared with males (55.7%) and in the oldest age group (52.0%), with no differences by socioeconomic status. Hypertension control was lower among 'regular' patients recently diagnosed (6-12 months = 48.6% controlled) relative to those more than 12 months since diagnosis (1-2 years = 53.6%; 3-5 years 55.5%; >5 years = 55.0%). Among recently diagnosed 'regular' patients, 59.2% had no record of being prescribed antihypertensive therapy in the last 6 months of the study, of which 44.3% had controlled hypertension. For those diagnosed more than 5 years ago, 37.4% had no record of being prescribed antihypertensive patients, and 56% had normal BP levels. CONCLUSION Although the prevalence of hypertension varied by socidemographics, there were no differences in BP assessment or control by socioeconomic status. Hypertension control remains a challenge in primary care, and electronic medical records provide an opportunity to assess hypertension management.
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Zhao M, Woodward M, Vaartjes I, Millett ERC, Klipstein-Grobusch K, Hyun K, Carcel C, Peters SAE. Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e014742. [PMID: 32431190 PMCID: PMC7429003 DOI: 10.1161/jaha.119.014742] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Sex differences in the management of cardiovascular disease have been reported in secondary care. We conducted a systematic review with meta‐analysis of systematically investigated sex differences in cardiovascular medication prescription among patients at high risk or with established cardiovascular disease in primary care. Methods and Results PubMed and Embase were searched between 2000 and 2019 for observational studies reporting on the sex‐specific prevalence of aspirin, statins, and antihypertensive medication prescription, including beta blockers, calcium channel blockers, angiotensin‐converting enzyme inhibitors, and diuretics, in primary care. Random effects meta‐analysis was used to obtain pooled women‐to‐men prevalence ratios for each cardiovascular medication prescription. Metaregression models assessed the impact of age and year on the findings. A total of 43 studies were included, involving 2 264 600 participants (28% women) worldwide. Participants’ mean age ranged from 51 to 76 years. The pooled prevalence of cardiovascular medication prescription for women was 41% for aspirin, 60% for statins, and 68% for any antihypertensive medications. Corresponding rates for men were 56%, 63%, and 69% respectively. The pooled women‐to‐men prevalence ratios were 0.81 (95% CI, 0.72–0.92) for aspirin, 0.90 (95% CI, 0.85–0.95) for statins, and 1.01 (95% CI, 0.95–1.08) for any antihypertensive medications. Women were less likely to be prescribed angiotensin‐converting enzyme inhibitors (0.85; 95% CI, 0.81–0.89) but more likely with diuretics (1.27; 95% CI, 1.17–1.37). Mean age, mean age difference between the sexes, and year of study had no significant impact on findings. Conclusions Sex differences in the prescription of cardiovascular medication exist among patients at high risk or with established cardiovascular disease in primary care, with a lower prevalence of aspirin, statins, and angiotensin‐converting enzyme inhibitors prescription in women and a lower prevalence of diuretics prescription in men.
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Affiliation(s)
- Min Zhao
- Julius Global Health Julius Centre for Health Sciences and Primary Care Utrecht Medical Centre Utrecht University Utrecht Netherlands
| | - Mark Woodward
- The George Institute for Global Health University of Oxford United Kingdom.,The George Institute for Global Health University of New South Wales Sydney Australia.,Department of Epidemiology John Hopkins University Baltimore MD
| | - Ilonca Vaartjes
- Julius Global Health Julius Centre for Health Sciences and Primary Care Utrecht Medical Centre Utrecht University Utrecht Netherlands.,Global Geo and Health Data center Utrecht University Utrecht The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health Julius Centre for Health Sciences and Primary Care Utrecht Medical Centre Utrecht University Utrecht Netherlands.,Division of Epidemiology & Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Karice Hyun
- Faculty of Medicine and Health Westmead Applied Research Centre University of Sydney Australia
| | - Cheryl Carcel
- The George Institute for Global Health University of New South Wales Sydney Australia.,Sydney School of Public Health Sydney Medical School University of Sydney New South Wales Australia
| | - Sanne A E Peters
- Julius Global Health Julius Centre for Health Sciences and Primary Care Utrecht Medical Centre Utrecht University Utrecht Netherlands.,The George Institute for Global Health University of Oxford United Kingdom
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Jensen AE, Søndergaard J, Kjær NK, Jackson R, Nielsen JB. Danish Evaluation of Your Heart Forecast (DANY): study protocol for a cluster randomised controlled trial on an interactive risk-communication tool aimed at improving adherence of patients with high blood pressure. Trials 2020; 21:11. [PMID: 31900231 PMCID: PMC6942322 DOI: 10.1186/s13063-019-3886-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background To improve communication of risk messages, they must be communicated in a way that is understandable and relevant to the patient. Communicating risk of cardiovascular disease is a complex and individualised task, since the risk itself is a combination of multiple personal risk factors. Raised blood pressure is but one of these risk factors. In Denmark, only one-third of hypertensive patients are adequately treated, with regards to national clinical guidelines. One reason for this problem is low treatment adherence; tools with documented effects for increasing adherence of patients are limited. Our objective is to evaluate the effect of a personalised, interactive and dynamic risk-assessment and risk-communication tool: ‘Your Heart Forecast’ (YHF) on blood pressure control, primary non-compliance, health literacy and patient empowerment. Methods Cluster-randomised controlled trial in general practice. Effect measures are adherence, blood pressure, lipid levels and empowerment at inclusion and after 6 and 12 months. To identify other benefits or possible adverse effects of the intervention, qualitative interviews will be conducted with a subgroup of patients. Discussion The investigators will explore effects of Your Heart Forecast on patients’ health literacy, adherence, empowerment and blood pressure control. The DANish evaluation of Your heart forecast (DANY) project will be the first to rigorously evaluate effects of YHF in Denmark and to link adherence of hypertensive patients exposed to YHF with the national databases of prescriptions and health services provided. Trial registration Clinicaltrials.gov, NCT04058847. Registered on 16 August 2019.
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Affiliation(s)
- Anders Elkær Jensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Rod Jackson
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
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Bawazir LAA, Sianipar W. Treating patients with hypertension in Indonesia's primary health care centre: A challenging condition. Glob Cardiol Sci Pract 2019; 2019:e201914. [PMID: 31799289 PMCID: PMC6865183 DOI: 10.21542/gcsp.2019.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Lucky Aziza Abdullah Bawazir
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National Teaching Hospital
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Wallentin F, Wettermark B, Kahan T. Drug treatment of hypertension in Sweden in relation to sex, age, and comorbidity. J Clin Hypertens (Greenwich) 2017; 20:106-114. [DOI: 10.1111/jch.13149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Fredrik Wallentin
- Karolinska Institutet; Department of Clinical Sciences; Danderyd Hospital; Division of Cardiovascular Medicine; Stockholm Sweden
| | - Björn Wettermark
- Karolinska Institutet; Department of Medicine/Solna; Centre for Pharmacoepidemiology; Stockholm Sweden
- Public Healthcare Services Committee; Stockholm County Council; Stockholm Sweden
| | - Thomas Kahan
- Karolinska Institutet; Department of Clinical Sciences; Danderyd Hospital; Division of Cardiovascular Medicine; Stockholm Sweden
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Overgaard Andersen U, Ibsen H, Tobiassen M. On the transition from a nurse-led hypertension clinic to hypertension control in primary care: identifying barriers to and factors acting against continuous hypertension control. Blood Press 2016; 25:263-7. [PMID: 27090684 DOI: 10.3109/08037051.2016.1156909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many hypertensive patients are not treated to target and hence do not benefit fully from the blood pressure-related improvements in cardiovascular health. Hypertensive patients who had primarily been treated to a target goal in a nurse-led hypertension clinic were re-examined to evaluate whether their target goal blood pressure was maintained after their discharge from the hypertension clinic for further control in primary care, and to evaluate potential barriers to and factors acting against continuous hypertension control. The median observation time was 3.6 years (range 3 months to 7.9 years). Only 45.2% of the patients were well controlled at the time of re-examination. No patient-related factors (age, body mass index, gender, attitudes towards medication) predicted the outcome. Two factors were significant in the reduction in continuous hypertension control: the cooperation between the patient and health personnel and the shared commitment towards the target goal were discontinued; and many patients did not make control visits to the general practitioner's office. In conclusion, maintained strict control of hypertension requires both continued close collaboration between the patient and health personnel, with an emphasis on treatment goals, and systematic control visits.
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Affiliation(s)
- Ulla Overgaard Andersen
- a The Hypertension Clinic, Department of Cardiology , Holbaek University Hospital , Holbaek , Denmark
| | - Hans Ibsen
- a The Hypertension Clinic, Department of Cardiology , Holbaek University Hospital , Holbaek , Denmark
| | - Minja Tobiassen
- a The Hypertension Clinic, Department of Cardiology , Holbaek University Hospital , Holbaek , Denmark
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Hoffmann-Petersen N, Lauritzen T, Bech JN, Pedersen EB. High Prevalence of Hypertension in a Danish Population Telemedical Home Measurement of Blood Pressure in Citizens Aged 55-64 Years in Holstebro County. Am J Hypertens 2016. [PMID: 26208671 DOI: 10.1093/ajh/hpv116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Home blood pressure (HBP) is prognostically superior to office BP (OBP) and similar to ambulatory BP measurements. We determined the prevalence of hypertension using HBP with telemedical data transmission in the municipality of Holstebro, Denmark (57,000 citizens). METHODS Using the Civil Registration System, we invited citizens aged 55-64 years to have their OBP and HBP measured using telemedical data transmission. Elevated OBP was defined as ≥140/90mm Hg. HBP was measured 3 times daily on 3 consecutive days with 3 measurements on each occasion. HBP was the mean of all measurements on day 1 and 3, and hypertension was defined as ≥135/85mm Hg. RESULTS We included 3,102 citizens who had performed at least 12 HBP measurements during day 2 and 3. Group 1: (n = 1,464, 47%) had both normal OBP and HBP. Group 2: (n = 838, 27%) had both elevated OBP and HBP indicating persistent hypertension. Group 3: (n = 560, 18%) had elevated OBP and normal HBP indicating white coat hypertension (WCH). Group 4: (n = 240, 8%) had normal OBP and elevated HBP indicating masked hypertension (MH). Thus, 1,078 (35%, groups 2 and 4) were untreated or insufficiently treated. Awareness of hypertension was registered in 950 patients (31%) and of these 49% had a normal HBP. CONCLUSIONS This is the first large-scale study to eliminate completely reporting bias by using telemedical transmission of BP data. One third of citizens in the age group 55-64 years had an abnormally high HBP, and one fourth either had WCH or MH. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identification number: NCT02355392.
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Affiliation(s)
- Nikolai Hoffmann-Petersen
- University Clinic of Nephrology and Hypertension, Department of Medical Research and Medicine, Holstebro Hospital and Aarhus University, Holstebro, Denmark;
| | - Torsten Lauritzen
- University Clinic of Nephrology and Hypertension, Department of Medical Research and Medicine, Holstebro Hospital and Aarhus University, Holstebro, Denmark
| | - Jesper Nørgaard Bech
- University Clinic of Nephrology and Hypertension, Department of Medical Research and Medicine, Holstebro Hospital and Aarhus University, Holstebro, Denmark
| | - Erling Bjerregaard Pedersen
- University Clinic of Nephrology and Hypertension, Department of Medical Research and Medicine, Holstebro Hospital and Aarhus University, Holstebro, Denmark
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Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens 2014; 31:2094-102. [PMID: 24107738 DOI: 10.1097/hjh.0b013e3283638b1a] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The increased risk of cardiovascular morbidity and mortality associated with arterial hypertension is particularly pronounced in patients with type 2 diabetes mellitus. Blood pressure control is, therefore, decisively important but often not sufficiently achieved. OBJECTIVE The primary objective of this study was to evaluate the antihypertensive effect of low dose spironolactone added to triple therapy for resistant hypertension in patients with type 2 diabetes measured by ambulatory monitoring. Secondary objectives were to evaluate the effects on glycaemic control and urinary albumin excretion as well as adverse effects. METHODS In a multicentre, double-blind, randomized, placebo-controlled study 119 patients with blood pressure at or above 130/80 mmHg despite triple antihypertensive therapy were included. One tablet of 25 mg spironolactone or placebo was added to previous treatment and increased to two if blood pressure below 130/80 mmHg was not achieved after 4 weeks. Blood pressure was measured by ambulatory monitoring at baseline and after 16 weeks. RESULTS The study was completed by 112 patients, 57 randomized to spironolactone and 55 to placebo. Average daytime placebo-corrected blood pressure was reduced by 8.9 (4.7-13.2)/3.7 (1.5-5.8) mmHg. Also office blood pressure, night-time, 24-h and pulse pressures were reduced significantly. Urinary albumin/creatinine ratio was significantly reduced in the spironolactone group. Glycaemic control remained unchanged. Hyperkalemia was the most frequent adverse event leading to dose reduction in three cases and discontinuation in one, whereas gynaecomastia was not reported. CONCLUSION Low dose spironolactone exerts significant BP and urinary albumin creatinine ratio lowering effects in high-risk patients with resistant hypertension and type 2 diabetes mellitus.
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Qvist I, Thomsen MD, Lindholt JS, Ibsen H, Hendriks JM, Frost L. Self-reported knowledge and awareness about blood pressure and hypertension: a cross-sectional study of a random sample of men and women aged 60-74 years. Clin Epidemiol 2014; 6:81-7. [PMID: 24600247 PMCID: PMC3933349 DOI: 10.2147/clep.s53706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In general, it is assumed that patient education, by increasing knowledge, may change behavior and lifestyle and promote health. In this context, it is a surprise that knowledge and awareness about blood pressure and hypertension among elderly people is poor. We hypothesized that knowledge about blood pressure and hypertension would be better among individuals with self-reported hypertension compared with subjects without self-reported hypertension. Methods We mailed a questionnaire to a random sample of 1,000 subjects living in the municipality of Silkeborg, Denmark. The study sample was drawn from the Central Person Registry. Results The response rate was 72%. Of these, 43% of responders had self-reported hypertension. The people with self-reported hypertension were older, less educated, had higher self-reported blood cholesterol levels, had higher body weight, and more often had a family history of hypertension. More than 80% reported that overweight and obesity increases blood pressure. More than 60% reported that untreated hypertension may cause heart disease or stroke. More than half of the responders did not know their blood pressure, and only 21% knew that hypertension can occur without symptoms. Knowledge about hypertension was independent of self-reported hypertension status, but awareness about blood pressure was most prominent among those with self-reported hypertension. Conclusion General knowledge about blood pressure and hypertension was reasonable, but there is still room for improvement in elderly people’s knowledge and awareness of blood pressure.
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Affiliation(s)
- Ina Qvist
- Department of Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Marie D Thomsen
- Department of Vascular Surgery, Viborg Regional Hospital and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jes S Lindholt
- Department of Vascular Surgery, Viborg Regional Hospital and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark ; Centre of Individualized Medicine in Arterial Diseases, Department of Cardiothoracic and Vascular Department T, Odense University Hospital, Odense, Denmark
| | - Hans Ibsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Jeroen Ml Hendriks
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lars Frost
- Department of Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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Čikara A, Pavličević I, Perić I. Level of hypertension control: comparison of a rural and urban family practice centre in South Croatia. Wien Klin Wochenschr 2013; 125:173-9. [PMID: 23508873 DOI: 10.1007/s00508-013-0339-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 02/22/2013] [Indexed: 01/06/2023]
Abstract
AIM Arterial hypertension is a serious public health problem because of its frequency and poor management. We compared hypertension control between rural and urban environment over 5 years. Initial hypothesis: arterial pressure control is better in urban (Split) than in rural (Trilj) environment. METHODS Historic prospective study was conducted in two family medicine outpatient clinics. Data for the years 2005, 2006, and 2010 were analyzed. One hundred and seventeen subjects diagnosed with arterial hypertension in 2005 were examined: 66 in a rural and 51 in urban outpatient clinic. Their average age was 60.92 ± 10.03 (range 30-82 years). Blood pressure records at the onset of the study, the first, and fifth year of treatment, risk factors, and therapy were analyzed. T-test and χ(2)-test were used in statistical data analysis. RESULTS In the urban clinic, more subjects were smokers, had positive family history, were overweight, and had registered hyperlipidemia. Initial mean arterial pressure readings were similar in both the clinics. Decrease was recorded in the following 5 years. During this study the use of ACE inhibitors (ACEI) (Split by 45 %, Trilj by 133 %) and calcium channel blockers (CCB) (Split by 76.9 %, Trilj by 525 %) was increased. The number of patients receiving monotherapy was reduced. CONCLUSIONS Better arterial pressure control was recorded in the urban clinic, where, after 5 years, despite increased frequency of additional risk factors, the number of normotensive patients was higher than that in the rural one. Hypertension control in both settings was still poor. Hypertensive patients should participate actively in the treatment.
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Affiliation(s)
- Anita Čikara
- University Hospital Centre Split, Spinčićeva 1, 21000, Split, Croatia.
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Paulsen MS, Andersen M, Thomsen JL, Schroll H, Larsen PV, Lykkegaard J, Jacobsen IA, Larsen ML, Christensen B, Sondergaard J. Multimorbidity and blood pressure control in 37 651 hypertensive patients from Danish general practice. J Am Heart Assoc 2012; 2:e004531. [PMID: 23525411 PMCID: PMC3603256 DOI: 10.1161/jaha.112.004531] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Patients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have additional comorbidities, is lacking. We aimed to investigate the association of comorbidities with BP control using a large cohort of hypertensive patients from primary care practices. Methods and Results Using the Danish General Practice Database, we included 37 651 patients with hypertension from 231 general practices in Denmark. Recommended BP control was defined as BP <140/90 mm Hg in general and <130/80 mm Hg in patients with diabetes. The overall control rate was 33.2% (95% CI: 32.7 to 33.7). Only 16.5% (95% CI: 15.8 to 17.3) of patients with diabetes achieved BP control, whereas control rates ranged from 42.9% to 51.4% for patients with ischemic heart diseases or cerebrovascular or peripheral vascular diseases. A diagnosis of cardiac heart failure in addition to diabetes and/or CVD was associated with higher BP control rates, compared with men and women having only diabetes and/or CVD. A diagnosis of asthma in addition to diabetes and CVD was associated with higher BP control rates in men. Conclusion In Danish general practice, only 1 of 3 patients diagnosed with hypertension had a BP below target. BP control rates differ substantially within comorbidities. Other serious comorbidities in addition to diabetes and/or CVD were not associated with lower BP control rates; on the contrary, in some cases the BP control rates were higher when the patient was diagnosed with other serious comorbidities in addition to diabetes and/or CVD.
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Affiliation(s)
- Maja S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Nexøe J, Wilche JP, Niclasen B, Kjeldsen AB, Færgemann C, Munck A, Lauritsen JM. Violence- and alcohol-related acute healthcare visits in Greenland. Scand J Public Health 2012; 41:113-8. [PMID: 23242207 DOI: 10.1177/1403494812469852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to describe emergency admissions in Greenland's healthcare system, and the extent to which admissions were associated with alcohol abuse or violence. Furthermore, we aimed to test whether data on emergencies in Greenland could be registered in a reliable way by simple means. METHODS Registration of all emergencies presented in 15 out of 17 of Greenland's health districts in the period 21 May to 7 June 2010. RESULTS In the 17-day registration period, 2403 emergencies were registered. In 10% of cases the patients were clinically alcohol intoxicated. When reason for presentation were mental or social problems, attempted suicide, accidents, or violence, 24, 50, 15, and 59% respectively were intoxicated. Alcohol intoxication was statistically significantly more often associated with advanced treatment (e.g. evacuation, hospitalisation, or follow up by doctor or nurse). CONCLUSIONS This study confirms that violence- and alcohol-related emergencies put a considerable strain on Greenland's healthcare system. Due to the short observation period, we have not been able to describe the actual extent of the problem in detail, nor was it possible to estimate whether this problem is more pronounced in Greenland than in other countries, for example Denmark.
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Affiliation(s)
- Jørgen Nexøe
- University of Southern Denmark, Odense C, Denmark.
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Reuther LØ, Paulsen MS, Andersen M, Schultz-Larsen P, Christensen HR, Munck A, Larsen PV, Damsgaard J, Poulsen L, Hansen DG, Christensen B, Søndergaard J. Is a targeted intensive intervention effective for improvements in hypertension control? A randomized controlled trial. Fam Pract 2012; 29:626-32. [PMID: 22565110 DOI: 10.1093/fampra/cms031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High blood pressure (BP) is one of the most important risk factors for stroke, and antihypertensive therapy significantly reduces the risk of cardiovascular morbidity and mortality. However, achieving a regulated BP in hypertensive patients is still a challenge. OBJECTIVE To evaluate the impact of an intervention targeting GPs' management of hypertension. METHODS A cluster randomized trial comprising 124 practices and 2646 patients with hypertension. In the Capital Region of Denmark, the participating GPs were randomized to an intensive or to a moderately intensive intervention group or to a control group and in Region Zealand and Region of Southern Denmark, practices were randomized into a moderately intensive intervention and to a control group. The main outcome measures were change in proportion of patients with high BP and change in systolic BP (SBP) and diastolic BP (DBP) from the first to the second registration. RESULTS The proportion of patients with high BP in 2007 was reduced in 2009 by ~9% points. The mean SBP was reduced significantly from 2007 to 2009 by 3.61 mmHg [95% confidence interval (CI): -4.26 to -2.96], and the DBP was reduced significantly by 1.99 mmHg (95% CI: -2.37 to -1.61). There was no additional impact in either of the intervention groups. CONCLUSION There was no impact of the moderate intervention and no additional impact of the intensive intervention on BP.
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Affiliation(s)
- Lene Ørskov Reuther
- Department of Clinical Pharmacology, Bispebjerg Hospital, København NV, Denmark.
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Paulsen MS, Andersen M, Munck AP, Larsen PV, Hansen DG, Jacobsen IA, Larsen ML, Christensen B, Sondergaard J. Socio-economic status influences blood pressure control despite equal access to care. Fam Pract 2012; 29:503-10. [PMID: 22234552 DOI: 10.1093/fampra/cmr130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Denmark has a health care system with free and equal access to care irrespective of age and socio-economic status (SES). We conducted a cross-sectional study to investigate a possible association between SES and blood pressure (BP) control of hypertensive patients treated in general practice. METHODS We enrolled 184 general practices and 5260 hypertensive patients. The general practitioners reported information about BP and diagnosis of diabetes. Information about education, income, antihypertensive drug treatment and other co-morbidity was retrieved from relevant registers from Statistics Denmark. The outcome measure was BP control defined as BP <140/90 mmHg in general and <130/80 mmHg in diabetics. RESULTS Patients <65 years and with an educational level of 10-12 years had increased odds ratio (OR) of BP control compared to patients with an educational level <10 years. Patients ≥65 years had increased OR of BP control if they were married/cohabiting as compared to being single, whereas education and income had no impact in this age group. Diabetics had significantly reduced odds of BP control irrespective of age, educational or income level. CONCLUSIONS Despite equal access to care for all patients, SES had significant impact on BP control in this survey. Diabetes and cardiovascular disease also had a substantial influence irrespective of age, educational and income level.
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Affiliation(s)
- M S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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