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Reardon B, Toles M, Cuddeback G, Travers D. Perceptions of ACT Team Members on the Implementation of Physical Health Services: A Qualitative Study. J Am Psychiatr Nurses Assoc 2024; 30:108-120. [PMID: 35220783 DOI: 10.1177/10783903221079800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults with severe mental illnesses have mortality rates 2.5 to 3 times higher than the general population, largely due to medical illnesses. Those with the most profound mental illnesses are served by assertive community treatment (ACT) teams that provide intensive mental health care; however, there are no clearly established models to integrate physical health treatment into ACT and this is a critical gap in the literature. AIMS To describe perceptions of ACT team members regarding services provided for their clients to treat physical health, how those services can be improved, and what implementation strategies would likely be needed to promote uptake and sustainability of those services on ACT teams. METHOD Qualitative interviews were conducted via Zoom using a semistructured interview guide with 19 employees from three ACT teams in a southeastern state. Interview transcripts were analyzed, using manifest content analysis, a form of qualitative analysis, to identify key themes in the interview transcripts. RESULTS ACT team members described limited physical health services for their clients. They reported (1) system-level barriers to improving physical health care, such as inadequate tools and training; and (2) patient-level barriers, such as limited awareness of physical care needs. ACT team members reported the need for additional medical staff and strengthened relationships with primary care providers. They also recommended changes in policy, education, and quality monitoring to implement new physical health care services. CONCLUSIONS Findings suggest intervention components and implementation strategies for improving physical health care of ACT consumers.
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Affiliation(s)
- Brandy Reardon
- Brandy Reardon, PhD, RN, University of North Carolina at Chapel Hill, NC, USA
| | - Mark Toles
- Mark Toles, PhD, RN, FAAN, University of North Carolina at Chapel Hill, NC, USA
| | - Gary Cuddeback
- Gary Cuddeback, PhD, MSW, MPH, University of North Carolina at Chapel Hill, NC, USA
| | - Debbie Travers
- Debbie Travers, PhD, RN, FAEN, Duke University, Chapel Hill, NC, USA
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Solomon M, Negussie YM, Bekele NT, Getahun MS, Gurara AM. Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study. BMC Cardiovasc Disord 2023; 23:258. [PMID: 37198582 DOI: 10.1186/s12872-023-03290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed. RESULT Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure. CONCLUSION More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.
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Affiliation(s)
- Menawork Solomon
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
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Attahiru M, Simon PL, Mutalub YB, Akangoziri MD, Grema BA. Predictors of blood pressure control amongst primary care patients of a teaching hospital in Bauchi, North-Eastern Nigeria. Niger Postgrad Med J 2023; 30:46-52. [PMID: 36814163 DOI: 10.4103/npmj.npmj_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background Poorly managed hypertension is still a serious global public health issue, despite medication. It is unclear what is causing treated hypertensive patients to have trouble achieving their target blood pressure (BP). Aim The goal of this study was to determine the predictors of BP control amongst hypertensive patients attending a teaching hospital in North-eastern Nigeria. Materials and Methods A cross-sectional study was conducted on 277 hypertensive patients from a tertiary healthcare institution. Data were analysed using version 20 of the Statistical Package for the Social Sciences (SPSS). Frequency and percentages were used to summarise data while Chi-square test was used to test for associations. To identify the factors linked to BP control, logistic regression was employed. At P < 0.05, predictors of BP control were found using adjusted odds ratios (AORs) with a 95% confidence interval (CI). Results The respondents' average age was 53.1 ± 14.6 years, of which 67.5% were female. The level of optimal BP control was 40.8%. Factors associated with reduced BP control include not currently married (AOR = 0.29 [95% CI: 0.16-0.53], P ≤ 0.0001), imperfect adherence (AOR = 0.37 [95% CI: 0.22-0.64], P ≤ 0.0001), taking more than two drugs (AOR = 0.3 [95% CI: 0.14-0.64], P = 0.001) and body mass index (BMI) ≥25 kg/m2 (AOR = 0.40 [95% CI: 0.22-0.72], P = 0.002). Conclusion The optimal BP control is alarmingly low in this setting. Marital status, medication adherence, increased pill burden and BMI ≥25 kg/m2 negatively affect the attainment of BP control.
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Affiliation(s)
- Muhammad Attahiru
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Pitmang Labo Simon
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Yahkub Babatunde Mutalub
- Department of Clinical Pharmacology and Therapeutics/Department of Family Medicine, Abubakar Tafawa Balewa University/Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Mark Divine Akangoziri
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Bukar Alhaji Grema
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
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Galvis-Acevedo S, Candamil-Castillo AF, Herrera-Murgueitio JA, Calzada-Gutiérrez MT. [Social, clinical and psychosocial determinants associated with uncontrolled arterial hypertension in older adults. SABE Survey Colombia 2016]. Rev Esp Geriatr Gerontol 2022; 57:139-145. [PMID: 35550719 DOI: 10.1016/j.regg.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate sociodemographic, clinical and psychosocial characteristics that are associated with uncontrolled arterial hypertension (HANC) in older adults in Colombia. METHODS Secondary analysis of data from the National Survey of Health, Welfare and Aging (SABE Colombia 2016), in which men and women aged 60 years or older in the country who were not institutionalized were interviewed. The dependent variable was uncontrolled hypertension (HANC) (≥140/90mm Hg). The SABE survey surveyed 23694 older adults; 11264 had a diagnosis of arterial hypertension (HTA) and were taking antihypertensive medication. On the other hand, 5106 older adults, randomly selected, had their blood pressure taken. Participants previously diagnosed with HTA under medical management with antihypertensives and who had had their blood pressure taken at the same time were included, resulting in a sample of 2656 participants. Sociodemographic, clinical and psychosocial characteristics were evaluated. Univariate, bivariate, and multivariate analyzes with logistic regression were performed. RESULTS One thousand one hundred eighty-eight (44.7%) participants presented HANC. A higher prevalence of HANC was observed in adults older than 74 years (OR 1.31; 95% CI 1.09-1.57) and lower prevalence in residents of urban areas (OR 0.55; 95% CI 0.42-0.71). CONCLUSIONS Age over 74 years and living in a rural area were identified as variables associated with inadequate blood pressure control in non-institutionalized older adults in Colombia.
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Affiliation(s)
| | | | - Julián Alberto Herrera-Murgueitio
- Grupo de Investigación en Salud Sexual y Reproductiva, Departamento de Medicina Familiar. Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - María Teresa Calzada-Gutiérrez
- Grupo de Investigación en Gerontología y Geriatría, Departamento de Medicina Familiar. Facultad de Salud, Universidad del Valle, Cali, Colombia
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Obas KA, Bytyci-Katanolli A, Kwiatkowski M, Ramadani Q, Fota N, Jerliu N, Statovci S, Gerold J, Zahorka M, Probst-Hensch N. Strengthening Primary Healthcare in Kosovo Requires Tailoring Primary, Secondary and Tertiary Prevention Interventions and Consideration of Mental Health. Front Public Health 2022; 10:794309. [PMID: 35480592 PMCID: PMC9037373 DOI: 10.3389/fpubh.2022.794309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Kosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms. Methods PHC users (n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models. Results Poor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00–1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00–1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91–1.00). Conclusions Continued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap.
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Affiliation(s)
- Katrina Ann Obas
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Ariana Bytyci-Katanolli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Nicu Fota
- Accessible Quality Healthcare Project, Prishtina, Kosovo
| | - Naim Jerliu
- National Institute of Public Health, Prishtina, Kosovo.,Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | | | - Jana Gerold
- University of Basel, Basel, Switzerland.,Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Manfred Zahorka
- University of Basel, Basel, Switzerland.,Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Desta M, Yibeltal D, Memiah P, Ayenew T, Mulugeta H, Gedefaw M, Bewket Kidanie B, Birhanu MY, Tessema Z, Mengist B, Alene M, Simieneh MM, Ewunetie AA, Shiferaw WS, Yeshitila YG. Antihypertensive medications adherence and associated uncontrolled blood pressure among hypertensive patients in Ethiopia: systematic review and meta-analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kinfe DG, Berhe G, Gidey K, Demoz GT. Blood Pressure Control, Left Ventricular Hypertrophy and Treatment Practice Among Hypertensive Patients in Ethiopia. Int J Gen Med 2020; 13:903-916. [PMID: 33116783 PMCID: PMC7585827 DOI: 10.2147/ijgm.s273668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Globally, hypertension is the most important public health issue and is a increasing health problem in Ethiopia. Blood pressure (BP) control is an ultimate therapeutic goal of hypertensive patients in reducing early complications of hypertension. Hence, this study was sought to examine the magnitude of uncontrolled BP, left ventricular hypertrophy (LVH), and treatment practice. Predictors of uncontrolled BP and LVH were also investigated. Methods A hospital-based cross-sectional study was conducted among 223 outpatients with hypertension on follow-up at Ayder Comprehensive Specialized Hospital (ACSH). Hypertensive patients with ≥18 years old who had been on follow-up care for at least 3 months were included in the study. Severely ill patients requiring urgent medical care and wheelchair-bound individuals or persons who had difficulty standing steady and pregnant women were excluded. Data were collected using a structured questionnaire and patients’ chart review. Data were entered and analyzed using SPSS version 22.0. To identify predictors, binary logistic regression model analysis was performed. Statistical significance was set at P-value of < 0.05. Results The magnitude of uncontrolled BP (>140/90mmgH) and LVH was found to be 31.4% and 39.5%, respectively. More than half (53%) of participants were on at least two antihypertensive drug combinations of different classes. Uncontrolled BP was significantly associated with poor adherence to salt reduction in meal (Adjusted Odds Ratio (AOR) =8.552, 95% CI: 2.853, 15.638, P<0.001), non-adherence to medications (AOR =2.886, 95% CI: 1.710, 3.935, P<0.001), and taking triple-drug therapy (AOR=7.228, 95% CI: 1.110, 10.57, P=0.039). Presence of LVH was significantly associated with abdominal obesity (AOR= 2.2, 95% CI: 1.399, 4.69, P=0.003), age of ≥60 years (AOR= 2.421, 95% CI: 1.263, 4.639, P=0.008), and uncontrolled BP (AOR= 3.16, 95% CI: 1.208, 5.232, P=0.021). Conclusion In this study, a significant proportion of patients with uncontrolled BP and LVH were found. Abdominal obesity, older age and uncontrolled blood pressure were predictors of LVH. Therefore, tailored interventions targeting BP control to reduce the magnitude of LVH and other early complications of hypertension deemed to be compulsory.
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Affiliation(s)
| | - Gebretsadik Berhe
- Department of Epidemiology, School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Kibreab Gidey
- Department of Internal Medicine, School of Medicine, Mekelle University, Mekelle, Ethiopia
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Obas KA, Gerold J, Bytyçi-Katanolli A, Jerliu N, Kwiatkowski M, Ramadani Q, Statovci S, Zahorka M, Probst-Hensch N. Study protocol: a prospective cohort on non-communicable diseases among primary healthcare users living in Kosovo (KOSCO). BMJ Open 2020; 10:e038889. [PMID: 32963070 PMCID: PMC7509972 DOI: 10.1136/bmjopen-2020-038889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/08/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION With the lowest life expectancy in the Balkans, underlying causes of morbidity in Kosovo remain unclear due to limited epidemiological evidence. The goal of this cohort is to contribute epidemiological evidence for the prevention and control of non-communicable diseases such as depression, hypertension, diabetes and chronic respiratory disease in Kosovo as the basis for policy and decision-making, with a spotlight on the relationships between non-experimental primary healthcare (PHC) interventions and lifestyle changes as well as between depression and the course of blood pressure. METHODS AND ANALYSIS PHC users aged 40 years and above were recruited consecutively between March and October 2019 from 12 main family medicine centres across Kosovo. The data collected through interviews and health examinations included: sociodemographic characteristics, social and environmental factors, comorbidities, health system, lifestyle, psychological factors and clinical attributes (blood pressure, height, weight, waist/hip/neck circumferences, peak expiratory flow and HbA1c measurements). Cohort data were collected annually in two phases, approximately 6 months apart, with an expected total follow-up time of 5 years. ETHICS AND DISSEMINATION Ethical approvals were obtained from the Ethics Committee Northwest and Central Switzerland (Ref. 2018-00994) and the Kosovo Doctors Chamber (Ref. 11/2019). Cohort results will provide novel epidemiological evidence on non-communicable diseases in Kosovo, which will be published in scientific journals. The study will also examine the health needs of the people of Kosovo and provide evidence for health sector decision-makers to improve service responsiveness, which will be shared with stakeholders through reports and presentations.
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Affiliation(s)
- Katrina Ann Obas
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jana Gerold
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ariana Bytyçi-Katanolli
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Naim Jerliu
- National Institute of Public Health, Prishtina, Kosovo
- University of Prishtina, Prishtina, Kosovo
| | - Marek Kwiatkowski
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Manfred Zahorka
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Nicole Probst-Hensch
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Aberhe W, Mariye T, Bahrey D, Zereabruk K, Hailay A, Mebrahtom G, Gemechu K, Medhin B. Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study. Pan Afr Med J 2020; 36:187. [PMID: 32952831 PMCID: PMC7467626 DOI: 10.11604/pamj.2020.36.187.23312] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction uncontrolled hypertension is a major risk factor for cardiovascular, renal, and cerebrovascular morbidities and mortalities. This study aims to assess the prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients. Methods: hospital-based cross-sectional study was conducted. Systematic random sampling technique was used to select 396 hypertensive patients. Respondents were interviewed and their medical charts were reviewed using pretested structured questionnaire. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable logistic regression analysis using those variables with P-value ≤ 0.25 in the bivariable analysis. Results of the total 396 hypertensive patients the prevalence of uncontrolled hypertension was found to be 48.6%. One fourth (26.1%), 231(59.1%), 289(73.9%), and 151(38.6%) hypertensive respondents were non adherent to anti-hypertensive medication, physical exercise, low salt diet, and weight management respectively. Age ≥50 years old (AOR = 2.33, 95%CI: 1.25, 4.35), non-adherence to anti-hypertensive medication, (AOR = 1.82 95%CI: 1.08, 3.04), non-adherence to physical exercise (AOR = 1.79 95%CI: 1.13, 2.83), non-adherence to low-salt diet (AOR = 1.98 95%CI: 1.18,3.31), and non-adherence to weight management (AOR = 2.06, 95%CI: 1.31, 3.23) were significantly associated with uncontrolled hypertension. Conclusion the prevalence of uncontrolled hypertension was high. Older hypertensive patients, non-adherent to their medications, physical inactivity, non-adherent to low salt diet and non-adherent to weight management were more likely to have uncontrolled hypertension. Therefore, more effort should be dedicated to those identified modifiable risk factors to maximize blood pressure control.
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Affiliation(s)
- Woldu Aberhe
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Teklewoini Mariye
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Degena Bahrey
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Kidane Zereabruk
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Abrha Hailay
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Guesh Mebrahtom
- School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Kibrom Gemechu
- College of Health Sciences and School of Nursing, Adigrat University, Tigray, Ethiopia
| | - Brhanu Medhin
- College of Health Sciences and School of Nursing, Samara University, Samara, Afar, Ethiopia
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Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, Mosisa G, Oluma A. Magnitude and Determinants of Uncontrolled Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Nekemte Referral Hospital, Western Ethiopia. Integr Blood Press Control 2020; 13:49-61. [PMID: 32368134 PMCID: PMC7183335 DOI: 10.2147/ibpc.s245068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension is the leading cause of morbidity and mortality among non-communicable diseases. The rate of blood pressure (BP) control among hypertensive patients is poor and the reasons for poor control of BP remain poorly understood globally. Therefore, this study aimed to assess the magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at Nekemte referral hospital (NRH). Methods A hospital-based cross-sectional study was conducted from February to April 2018 at NRH. BP control status was determined by the average consecutive BP recordings across the 3 months. The data was entered and analyzed using SPSS version 20.0 and p-value <0.05 was considered statistically significant. Results Out of 297 study participants included, the majority were females, 181 (60.9%), and the mean age of the patients was 59.4 ±10.4 years. About half, 137 (46.12%), of the patients had at least one comorbidity and the most common class of anti-hypertensive medication was angiotensin-converting enzyme inhibitors (88.2%). The mean of systolic blood pressure was 132.41± 15.61mmHg, while the mean of diastolic blood pressure was 84.37± 9.32 mmHg. The proportion of participants with optimally controlled BP was 63.6% and 36% were adherent to their medications. Male sex (Adjusted Odd Ratio [AOR]: 1.89, 95% CI: 1.09-4.84), illiteracy (AOR= 1.56, 95% CI: 1.22-6.78), duration of hypertension diagnosis > 10 years (AOR= 2.01, 95% CI: 1.04-16.11), non-adherence (AOR= 3.14, 95% CI: 1.35-10.76) and lack of physical exercise (AOR= 2.8, 95% CI: 1.16-6.74) were positively associated with uncontrolled BP status. Whereas age older than 55 years (AOR= 0.38, 95% CI: 0.11-0.92) was negatively associated with uncontrolled BP. Conclusion BP control was relatively achieved in about two-third of pharmacologically treated patients. We recommend better health education and care of patients to improve the rate of BP control status.
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Affiliation(s)
- Ginenus Fekadu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Abdi Adamu
- Shanan Gibe Hospital, Jimma, Oromia Regional State, Ethiopa
| | - Mohammed Gebre
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Busha Gamachu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Sciences, Mettu University, Mettu, Ethiopa
| | - Muktar Abadiga
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Getu Mosisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
| | - Adugna Oluma
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopa
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Martins RDS, Santiago LM, Reis MT, Roque AC, Pinto M, Simões JA, Rosendo I. Implications for medical activity of differences between individuals with controlled and uncontrolled hypertension. Rev Port Cardiol 2020; 38:745-753. [PMID: 32019713 DOI: 10.1016/j.repc.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare clinical characteristics, medical activity, and family and social characteristics of individuals with controlled and uncontrolled hypertension. METHODS This was an observational study on an alphabetically organized randomized sample of individuals suffering from hypertension in a primary care setting followed by 25 general practitioners at three clinics in the Central region of Portugal in mid-2018. Electronic medical records of individuals with an ICPC-2 classification of hypertension were analyzed. Epidemiologic, family, social and therapeutic data were gathered for descriptive and inferential analysis. RESULTS From a total population of 8750 patients classified as having hypertension, a representative sample of 387 individuals (n=369 required for a 95% confidence interval and 5% error margin) was studied. The incidence of uncontrolled hypertension was 56.1%, significantly higher among those living alone (p=00.24) or in a nuclear family (p=0.011), in lower socioeconomic classes (p=0.018), and prescribed anti-inflammatory drugs (p=0.018). The calculated cardiovascular risk was no higher for uncontrolled hypertension (p=0.116). Therapeutic inertia was not found either in number of medicines or in their association (p=0.274). No other studied variables showed a significant difference. Binary logistic regression revealed that living alone or in a nuclear family, and in a family with low socioeconomic level, were associated with uncontrolled hypertension, this model representing 9.6% of the likelihood of having uncontrolled hypertension. CONCLUSIONS Medical activity in general practice and other settings should, in the light of these findings, ally therapeutic competencies with knowledge gained from studying individual, family and social characteristics in order to improve blood pressure control.
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Affiliation(s)
| | - Luiz Miguel Santiago
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | | | | | - José Augusto Simões
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
| | - Inês Rosendo
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Daray FM, Hunter F, Anastasia A, Fornaro M. Psychometric properties of the Patient Health Questionnaire nine-item version (PHQ-9) for use among hospitalized non-psychiatric medical patients. Gen Hosp Psychiatry 2019; 61:69-75. [PMID: 31715389 DOI: 10.1016/j.genhosppsych.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- F M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Argentina.
| | - F Hunter
- José Ramos Mejia Hospital, Buenos Aires, Argentina
| | - A Anastasia
- National Institue for Social Security, Latina, Italy
| | - M Fornaro
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, Naples, Italy
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Implications for medical activity of differences between individuals with controlled and uncontrolled hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Urtasun M, Daray FM, Teti GL, Coppolillo F, Herlax G, Saba G, Rubinstein A, Araya R, Irazola V. Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina. BMC Psychiatry 2019; 19:291. [PMID: 31533674 PMCID: PMC6751851 DOI: 10.1186/s12888-019-2262-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. METHODS We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed. RESULTS One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach's alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson's correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6-8 for mild cases, 9-14 for moderate and 15 or more for severe depressive symptoms respectively. CONCLUSIONS The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.
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Affiliation(s)
- María Urtasun
- 0000 0004 0439 4692grid.414661.0South American Center of Excellence in Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina ,0000 0004 1937 0239grid.7159.aSocial and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcalá de Henares, Madrid, Spain
| | - Federico Manuel Daray
- 0000 0001 0056 1981grid.7345.5Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina ,0000 0001 1945 2152grid.423606.5National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Germán Leandro Teti
- Emergency Acute Inpatient Unit, “Braulio A. Moyano” Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - Fernando Coppolillo
- 0000 0001 0056 1981grid.7345.5Family Medicine Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Herlax
- 0000 0001 0056 1981grid.7345.5Family Medicine Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Saba
- Center of psychology, psychiatry and mental health Horus, Buenos Aires, Argentina ,Institute of criminology, National Directorate of the Federal Prison Service, Buenos Aires, Argentina
| | - Adolfo Rubinstein
- 0000 0004 0439 4692grid.414661.0South American Center of Excellence in Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ricardo Araya
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vilma Irazola
- South American Center of Excellence in Cardiovascular Health (CESCAS), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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Gebremichael GB, Berhe KK, Zemichael TM. Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018. BMC Cardiovasc Disord 2019; 19:121. [PMID: 31117945 PMCID: PMC6532230 DOI: 10.1186/s12872-019-1091-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/30/2019] [Indexed: 01/28/2023] Open
Abstract
Background Despite the availability and improvement in diagnostic and therapeutic interventions with proven benefits in reducing cardiovascular morbidity and mortality, control rates of hypertension remain poor and grossly inadequate. Around one billion individuals are living with uncontrolled hypertension globally. Uncontrolled hypertension among hypertensive patients on treatment in Ethiopia ranges from 11.4 to 69.9%. Therefore, the aim of this study was to determine the magnitude and associated factors of uncontrolled hypertension among hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia 2018. Methods and materials Hospital-based cross-sectional study design was conducted from February 16–April 30/2018. Simple random sampling method was used to select 320 participants. Data was collected using interviewer administered standard structured questionnaire. Self-care practice measuring tool was adopted from hypertension self-care activity level effects (H-scale). Data was entered to and cleaned by Epi Info version 7 and it was exported to SPSS version 22 for analysis. Binary logistic regression model (AOR, 95% CI and p-value < 0.05) was used to determine the predictors of uncontrolled hypertension. Result From the total respondents, 164 (51.2%) were females. The mean age of the respondents was 53.83 + 14.52 years. Prevalence of uncontrolled hypertension was found 52.5%. Overweight (AOR = 4.527, 95% CI: 2.247–9.123), co-morbidity (AOR = 2.112, 95% CI: 1.218–3.662), non-adherence to anti-hypertensive medication (AOR = 2.062, 95% CI: 1.030–4.129), non-adherence to physical activity (AOR = 1.931, 95% CI: 1.074–3.470) and non-adherence to alcohol abstinence (AOR = 2.093, 95% CI: 1.109–3.948) are independent predictors of uncontrolled hypertension. Conclusion the prevalence of uncontrolled hypertension is high. Patients’ adherence to antihypertensive medication, physical exercise and alcohol abstinence should be maximized. Weight reduction and early identification and management of co-morbidities are also crucial.
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Affiliation(s)
| | - Kalayou Kidanu Berhe
- School of Nursing College of Health Science, Mekelle Univesity, Tigray, Ethiopia
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16
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Moss KO, Still CH, Jones LM, Blackshire G, Wright KD. Hypertension Self-Management Perspectives From African American Older Adults. West J Nurs Res 2019; 41:667-684. [PMID: 29954259 PMCID: PMC6274623 DOI: 10.1177/0193945918780331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
African Americans are disproportionately impacted by hypertension, suffering earlier onset and greater severity of the disease, and premature cardiovascular mortality, than the general population. Managing hypertension is an unending concern for African American older adults. A better understanding of the self-management preferences of this vulnerable population will lead to the enhanced design of culturally acceptable interventions. This descriptive study examined focus group participants' perspectives on engaging in hypertension self-management activities with the goal of developing a co-created intervention. This study was part of a mixed methods study for which audio- and graphically-recorded focus groups were conducted with community-dwelling African American older adults ( N = 31) diagnosed with hypertension. The majority of the participants were women (87%); the mean age was 72 years ( SD = 7.53). Themes derived from data analyses centered on primary stressors of communication, healthy eating, and sleep related to blood pressure self-management. Based on these, the researchers co-created educational interventions.
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Affiliation(s)
- Karen O Moss
- 1 Case Western Reserve University, Cleveland, OH, USA
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17
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Sherman L, Pelter MA, Deamer RL, Duan L, Batech M. Association between encounter frequency and time to blood pressure control among patients with newly diagnosed hypertension: a retrospective cohort study. J Clin Hypertens (Greenwich) 2018; 20:429-437. [PMID: 29450983 DOI: 10.1111/jch.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
This retrospective cohort study of 95 957 patients from a large integrated healthcare organization was conducted to examine whether the frequency and intervals between outpatient encounters were associated with achieving blood pressure (BP) control. Patients were followed up until they were censored or achieved BP control up to 1 year. Additionally, this study examined the time to BP control. On average, follow-up was significantly longer in patients with uncontrolled BP at 292.9 days compared with 232.2 days in those with BP control. The controlled BP group had significantly more encounters on average compared with the uncontrolled BP group (4.1 vs 3.1, standardized difference 0.33). As the number of days increased between encounters from the 1 to < 14 days, there was a consistently lower likelihood of achieving BP control. Encounter intervals of ≥180 days were associated with the lowest likelihood of achieving BP control. These findings suggest that there may be an optimal number of encounters to benefit patients with hypertension.
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Affiliation(s)
- Liliana Sherman
- Department of Pharmacy, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Mitchell A Pelter
- Department of Pharmacy, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Robert L Deamer
- Kaiser Permanente Drug Education, Ventura County, Oxnard, CA, USA.,Department of Pharmacy Administration, Kaiser Permanente, Woodland Hills, CA, USA
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Muleta S, Melaku T, Chelkeba L, Assefa D. Blood pressure control and its determinants among diabetes mellitus co-morbid hypertensive patients at Jimma University medical center, South West Ethiopia. Clin Hypertens 2017; 23:29. [PMID: 29299337 PMCID: PMC5744392 DOI: 10.1186/s40885-017-0085-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/30/2017] [Indexed: 12/14/2022] Open
Abstract
Background Hypertension is the major contributor to cardiovascular diseases related morbidity and mortality. Blood pressure is not well controlled in the majority of patients with both diabetes and hypertension. The main objective of this study was to assess blood pressure control and its determinants among diabetes mellitus co- morbid hypertensive ambulatory patients. Methods Hospital based cross sectional study was conducted among diabetes mellitus co-morbid hypertensive ambulatory adult patients based on the inclusion criteria. Patient specific data was collected using structured data collection tool. Data was analyzed using statistical software package, SPSS version 20.0. To identify the independent predictors of blood pressure control, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at p-value <0.05. Patient’s written informed consent was obtained after explaining the purpose of the study. Patients were informed about confidentiality of the information obtained. Results From a total of 131 study participants 51.14% were males with the mean (SD) age of the 50.69 ± 13.71. The mean duration of time since the diagnosis of hypertension was 7.44 ± 5.11 years. The mean (SD) SBP was 149.79 ± 16.32 mmHg, while the mean (SD) DBP was 89.77 ± 9.34 mmHg. More than one fourth (25.20%) of study participants had a controlled SBP, while about 27.48% had a controlled DBP. The overall control of BP was achieved in about 57 (43.51%) of the study participants. Older age (≥50 years) (AOR = 2.06; 95% CI: 2.65–7.79; P = 0.002), female gender (AOR = 1.42; 95% CI: 1.19–2.14; P = 0.042), duration of hypertension (AOR = 2.88, 95% CI: 1.27, 8.31, P = 0.02), non-adherence (AOR 2.05; 95% CI: 2.61–9.33; P = 0.01) and uncontrolled blood sugar(AOR = 1.65; 95% CI: 2.14–3.32; P = 0.04) are independent predictors for uncontrolled blood pressure. Conclusions Blood pressure control to target goal was suboptimal in the study area. Diabetic patients who were older, female, live longer duration with hypertension, non-adherent to their medications and poor glycemic control were more likely to have uncontrolled BP. Therefore, more effort should be dedicated to control the blood pressure in diabetics.
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Affiliation(s)
- Sintayehu Muleta
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, P.O.Box:378, Jimma, Oromia Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, P.O.Box:378, Jimma, Oromia Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, P.O.Box:378, Jimma, Oromia Ethiopia
| | - Desta Assefa
- Department of Pharmaceutics, School of Pharmacy, Institute of Health, Jimma University, P.O.Box:378, Jimma, Oromia Ethiopia
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Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse 2017; 53:607-621. [PMID: 28831843 DOI: 10.1080/10376178.2017.1368401] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Effective self-care behavior can help reduce hypertension complications, but the rate of engagement in self-care behavior is relatively low among elderly patients. OBJECTIVES To examine levels of self-care and factors affecting self-care among elderly patients with uncontrolled hypertension compared with those with controlled hypertension. DESIGN Cross-sectional survey. METHODS A total of 255 elderly patients were selected to measure hypertensive patients' self-care behavior and self-efficacy, knowledge of hypertension management, family support, and perceived severity of hypertension as well as their depression levels. RESULTS The uncontrolled hypertension group showed lower scores for self-care behavior and self-efficacy than the controlled hypertension group. Only self-efficacy significantly affected self-care behavior in the latter group, whereas self-efficacy, education level, and family support affected self-care behavior in the former group. CONCLUSIONS The study results indicated that strategies for uncontrolled hypertension elderly patients should consider patients' educational, family support, and self-efficacy levels in order to improve their self-regulation.
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Affiliation(s)
- EunJu Lee
- a College of Nursing , Keimyung University , Dalgubeol-daero, Dalseo-gu , 704-701 , Daegu , South Korea
| | - Euna Park
- b Department of Nursing , Pukyong National University , 45, Yongso-ro, Namgu, Busan 608-737 , South Korea
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20
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Pijacka W, Clifford B, Walas D, Tilburgs C, Joles JA, McMullen S, Langley-Evans SC. Impact of gonadectomy on blood pressure regulation in ageing male and female rats. Biol Sex Differ 2016; 7:64. [PMID: 27980712 PMCID: PMC5135757 DOI: 10.1186/s13293-016-0111-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual dimorphism in blood pressure has been associated with differential expression of the angiotensin II (AII) receptors and with activity of the nervous system. It is generally accepted that ageing affects kidney function as well as autonomic nervous system and hormonal balance. Given that hypertension is more prevalent in men than women until women reach their seventh decade, we hypothesised that females would be relatively protected from adverse effects of ageing compared to males and that this would be mediated by the protective effect of ovarian steroids. METHODS Intact and gonadectomised male and female normotensive Wistar rats aged 6, 12 and 18 months were used to study renal function, blood pressure, heart rate, and blood pressure variability. RESULTS We observed that intact females had lower levels of proteinuria and higher (12.5%) creatinine clearance compared to intact males and that this difference was abolished by castration but not by ovariectomy. Ovariectomy resulted in a change by 9% in heart rate, resulting in similar cardiovascular parameters to those observed in males or gonadectomised males. Spectral analysis of systolic blood pressure revealed that high-frequency power spectra were significantly elevated in the females vs. males and were reduced by ovariectomy. CONCLUSIONS Taken altogether, the results show that females are protected from age-related declining renal function and to a lesser extent from rising blood pressure in comparison to males. Whilst ovariectomy had some deleterious effects in females, the strongest effects were associated with gonadectomy in males, suggesting a damaging effect of male hormones.
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Affiliation(s)
- Wioletta Pijacka
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK ; School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, BS8 1TD UK
| | - Bethan Clifford
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Dawid Walas
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, University Walk, Bristol, BS8 1TD UK
| | - Chantal Tilburgs
- Department of Nephrology & Hypertension, University Medical Centre, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology & Hypertension, University Medical Centre, Utrecht, The Netherlands
| | - Sarah McMullen
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Simon C Langley-Evans
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
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Tangkiatkumjai M, Walker DM, Praditpornsilpa K, Boardman H. Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study. Clin Exp Nephrol 2016; 21:504-512. [PMID: 27438073 DOI: 10.1007/s10157-016-1312-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 07/10/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is limited evidence of medication adherence related to progression of chronic kidney disease (CKD) worldwide. The aim of this study was to determine associations between medication adherence and the progression of CKD in outpatients with CKD. METHODS This cohort study recruited 339 Thai patients with stages 3-5 CKD. Patients with a glomerular disease or receiving renal replacement therapy before recruitment were excluded. 295 were followed up regarding their serum creatinine, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol over 12 months. Medication adherence was measured at baseline using the Thai version of the 8-Item Morisky Medication Adherence Scale®. The primary outcome was the progression of CKD. The progression of CKD was defined as either a decline in estimated glomerular filtration rate of at least 3 ml/min/1.73 m2/year or initiation of renal replacement therapy. Univariate and multivariate analyses were performed using Chi-squared tests and multiple logistic regressions. RESULTS Twenty-one percent had poor adherence. Younger patients were more likely to have poor adherence (adjusted OR 2.81, 95 % CI 1.45-5.43). Anti-hypertensive agents were the most frequently reported as not being taken (52 %). Patients with poor adherence were associated with the progression of CKD (adjusted OR 1.96, 95 % CI 1.02-3.76). Those with poor adherence were less likely to control their blood pressure, than moderate-to-high adherence group (p < 0.01). CONCLUSION The findings suggest that CKD patients with poor medication adherence are more likely to have progression of CKD. Health care providers should acknowledge these findings and provide effective strategies to deal with this issue.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- Division of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhonnayok, 26120, Thailand.
| | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Helen Boardman
- Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
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Abstract
Untreated and uncontrolled hypertension (HTN) presents a major public health burden in the USA and worldwide. Despite the known risk for increased cardiovascular (CV) morbidity and mortality, blood pressure remains untreated and uncontrolled at alarming rates of between 20 and 40 % in patients with known HTN. Further, while cumulative evidence indicates that early onset of antihypertensive effect improves CV outcomes, the time to blood pressure (BP) control remains long. The objective of hypertension management cannot be simply to achieve and maintain the goal BP, but to do so quickly to improve short-term and long-term CV outcomes. In this review, we will (1) describe the magnitude of uncontrolled HTN, (2) identify the factors that contribute to uncontrolled BP in patients with the diagnosis of HTN, and (3) explore the rationale for and benefits of aggressive and immediate control of HTN.
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Seow LSE, Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Hypertension and its associated risks among Singapore elderly residential population. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jcgg.2015.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Evaluation of patients diagnosed with essential arterial hypertension through network analysis. Ir J Med Sci 2015; 185:443-51. [PMID: 26318328 DOI: 10.1007/s11845-015-1342-1] [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] [Received: 03/03/2015] [Accepted: 07/19/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Essential hypertension is a chronic pathology that causes long-term complications due to late diagnosis of patients, the inability to control the disease through medication, or due to the complexity of associated risk factors. AIMS Our study sets out to identify specific patterns of response to arterial hypertension treatment, by taking into consideration the multiple connections between risk factors in a relevant population of hypertensive patients. METHODS Network science is an emerging paradigm, branching over multiple aspects of physical, biological and social phenomena. One such branch, which has brought significant contributions to medical science, is the field of network medicine. To apply this methodology, we create a complex network of hypertensive patients based on their common medical conditions. Consequently, we obtain a community-based representation which pinpoints specific-and previously uncharted-patterns of hypertension development. This approach creates incentives for evaluating patient's treatment efficacy, by considering its network topological position. RESULTS Distinct clusters of patients with common properties have emerged for each study group (group A-treated with nebivolol, group B-treated with perindopril and group C-treated with candesartan cilexetil). Therefore, our network-based clustering allows for a better treatment assessment.
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Low KJ, Pelter MA, Deamer RL, Burchette RJ. Identification and evaluation of risk factors in patients with continuously uncontrolled hypertension. J Clin Hypertens (Greenwich) 2015; 17:281-9. [PMID: 25664597 PMCID: PMC8032169 DOI: 10.1111/jch.12478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 12/01/2022]
Abstract
An aggressive strategy to manage hypertension in a large integrated healthcare organization achieved blood pressure control in 82% of hypertensive patients, as compared with 52% nationwide. It is unknown why the remaining 18% is uncontrolled. The objective of this study was to identify characteristics associated with patients whose blood pressure remains continuously uncontrolled. This nested case-control study included 1583 continuously uncontrolled cases and 7901 matched controls. Univariate analysis revealed patients who visited their primary care provider frequently (odds ratio, 0.42; 95% confidence interval, 0.39-0.46) were adherent to antihypertensive medications (odds ratio, 0.12; 95% confidence interval, 0.10-0.14), and dispensed more medications (odds ratio, 0.86; 95% confidence interval, 0.85-0.87) were less likely to be continuously uncontrolled. Patient characteristics that were associated with continuously uncontrolled hypertension were the Patient Health Questionnaire-9 score and higher body mass index. Since patients with controlled hypertension visited their provider more often, patients with continuously uncontrolled hypertension may benefit from more interaction with their healthcare system.
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Affiliation(s)
- Kimberly J. Low
- Department of PharmacyKaiser Permanente Woodland Hills Medical CenterWoodland HillsCA
| | - Mitchell A. Pelter
- Department of PharmacyKaiser Permanente Woodland Hills Medical CenterWoodland HillsCA
| | - Robert L. Deamer
- Kaiser Permanente Drug Education, Ventura CountyCA
- Department of Pharmacy AdministrationKaiser PermanenteWoodland HillsCA
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