Blood pressure control among stroke patients in Thailand--the i-STROKE study

The Modifiable Risk Factors of Uncontrolled Hypertension in Stroke: A Systematic Review and Meta-Analysis

OBJECTIVE

This review aimed at figuring out the risk factors of uncontrolled hypertension in stroke.

METHOD

This study systematically analyzed the hypertension risk factors available in the ProQuest, EBSCO, and PubMed databases published between 2010 and December 2019. The risk factors' pooled odds ratio (POR) included in this research was calculated using both fixed and random-effect models. The meta-data analysis was processed using the Review Manager 5.3 (Rev Man 5.3).

RESULT

Of 1868 articles, seven studies were included in this review searched using specific keywords. Based on the analysis results, there were 7 risk factors of uncontrolled hypertension in stroke: medication nonadherence (POR = 2.23 [95% CI 1.71-2.89], p = 0.342; I 2 = 6.7%), use of antihypertensive drugs (POR = 1.13 [95% CI 1.19-1.59, p = 0.001; I 2 = 90.9%), stage of hypertension (POR = 1.14 [95% CI 1.02-1.27], p = <0.001; I 2 = 97.1%), diabetes mellitus (POR = 0.71 [95% CI 0.52-0.99], p = <0.001; I 2 = 96.5%), atrial fibrillation (POR = 1.74 [95% CI 1.48-2.04)], p = <0.001; I 2 = 93.1%), triglycerides (POR = 1.47 [95% CI 1.23-1.75], p = 0.879; I 2 = 0%), and age (POR = 1.03 [95% CI 0.89-1.18], p = <0.001; I 2 = 97.5%]. There were no bias publications among studies. Medication nonadherence and triglycerides had homogeneous variations, while the others had heterogeneous variations.

CONCLUSION

Medication nonadherence, triglycerides, stage of hypertension, atrial fibrillation, and use of antihypertensive drugs significantly affect the uncontrolled hypertension in stroke.

Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study

Purpose

Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand.

Patients and Methods

This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups.

Results

At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001).

Conclusion

These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.

Stroke epidemiology in Thailand

Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. Despite the improvement of healthcare system, the mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. Evolution from predominantly rural to urbanized industrial communities result in the increasing prevalence of these risk factors. Similar to other parts of the world, ischemic stroke is the most common stroke type but the proportion of hemorrhagic stroke is higher when compared to Caucasian populations. Among patients with ischemic stroke, lacunar stroke is most common, accounting for almost half followed by atherosclerotic disease. Intracranial atherosclerosis is also prevalent in Thai population. For acute treatment, intravenous thrombolysis has been used in Thailand for over 20 years. Its cost is reimbursed by the national health care system but its use is still limited. With the introduction of the stroke fast track system, prompt stroke treatment across the country is warranted. Stroke unit is now the standard of care in large regional and provincial hospitals.