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Heizhati M, Li N, Shi Q, Yao X, Zhang D, Zhou K, Wang M, Hu J, Duiyimuhan G, Jiang W, Hong J, Sun L. Effects of Simplified Antihypertensive Treatment Algorithm on Hypertension Management and Hypertension-Related Death in Resource-Constricted Primary Care Setting between 1997 and 2017. Int J Hypertens 2021; 2021:9920031. [PMID: 34336267 PMCID: PMC8294957 DOI: 10.1155/2021/9920031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Hypertension management is poor in primary care settings of developing countries, where 75% of hypertensives are living. Exploring better ways to improve hypertension management and to decrease stroke and CVD death is needed such as introducing treatment algorithm. Therefore, we selected intervention counties from Xinjiang, an underdeveloped region in China, and introduced antihypertensive treatment algorithm, comprising locally available and affordable agents, to primary health providers since 1998. Program effects were evaluated using the data collected in various ways including cross-sectional screenings to population ≥30 years between 1998 and 2015 by comparing treatment and control rates of hypertension, changes in blood pressure (BP) levels and distribution, and proportion of case/total and NCD death for CVD and stroke. Compared to 1998-2000, treatment rate was improved by 2.78 fold (11.2% vs. 32.1%, P < 0.001), and the overall and treated control rate were improved by 53.5 fold (0.2% vs. 10.7%, P < 0.001) and by 16.8 fold (2.0% vs. 33.5%, P < 0.001), respectively, in 2015. Mean SBP and DBP showed a net reduction by 33.7 mmHg (181.3 vs. 147.6 mmHg) and 21.3 mmHg (106.3 vs. 85.0 mmHg), respectively, in 2015, compared to 1998-2000 (P < 0.001), and stage III hypertension was reduced by 75.2% (33.5 vs. 8.3%, P < 0.001). Compared to 1997-1999, stroke/NCD death was reduced by 34.1% in 2015-2017 (31.7 vs. 20.9%, P = 0.006) in the intervention counties whereas by 7.5% in control county. Introduction of treatment algorithm helps improve hypertension management and reduce stroke death in resource-constricted primary settings.
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Affiliation(s)
- Mulalibieke Heizhati
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Nanfang Li
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Qiaoyan Shi
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Xiaoguang Yao
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Delian Zhang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Keming Zhou
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Menghui Wang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Junli Hu
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Gulinuer Duiyimuhan
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Wen Jiang
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Jing Hong
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
| | - Le Sun
- National Health Committee Key Laboratory of Hypertension Clinical Research, Hypertension Institute of Xinjiang, Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region China, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang, China
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Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work? JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:48. [PMID: 28567067 PMCID: PMC5426097 DOI: 10.4103/jrms.jrms_205_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/09/2016] [Accepted: 01/23/2017] [Indexed: 11/06/2022]
Abstract
Background: It is assumed that doctor-patient relationship plays an effective role in patients’ satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients’ satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Materials and Methods: This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1) patients’ satisfaction derived from the relationship with doctors and (2) medication adherence named “Morisky Medication Adherence Scale” with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR) of patients’ satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. Results: A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06–0.71 and OR = 0.20) and empathy subscales (CI = 0.95, 13–0.80 and OR = 0.33) was associated with nonadherence to treatment after controlling the physicians’ gender and patients’ age, gender, education, and duration of disease. Conclusion: Patients’ satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.
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Affiliation(s)
- Ahmad Mahmoudian
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Zamani
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Tavakoli
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Fathollahi-Dehkordi
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Tsai DS, Chang YS, Li TC, Peng WH. Prescription pattern of Chinese herbal products for hypertension in Taiwan: a population-based study. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:1534-1540. [PMID: 25091464 DOI: 10.1016/j.jep.2014.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/17/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese medicine (TCM) has been commonly used in Asia country. The aim of this study is to analyze the utilization of TCM among hypertensive patients in Taiwan. MATERIALS AND METHODS The use of TCM for primary hypertensive patients was evaluated using a randomly sampled cohort of 1,000,0s recruited from the National Health Insurance Research Database in 5-year period from 2006 to 2010. RESULTS Overall, 49.7% (n=42,586) of primary hypertension utilized TCM and 12.1% (n=5132) of them used TCM for the treatment of hypertension. Among the top 10 most frequently prescribed herbal formulae, Tian-Ma-Gou-Teng-Yin, Gout-Teng-San, Liu-Wei-Di-Huang-Wang and its derivatives were found to be the most common herbal formulae prescribed by TCM doctors for the treatment of hypertension in Taiwan. CONCLUSION This study showed the utilization pattern of Chinese herbal product in patients with hypertension. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese formulae or its ingredients in treating hypertension.
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Affiliation(s)
- Der-Shiang Tsai
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Yuan-Shiun Chang
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan; Department of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Wen-Huang Peng
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Pharmacy, China Medical University, Taichung, Taiwan.
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Theodorou M, Stafylas P, Kourlaba G, Kaitelidou D, Maniadakis N, Papademetriou V. Physicians' perceptions and adherence to guidelines for the management of hypertension: a national, multicentre, prospective study. Int J Hypertens 2012; 2012:503821. [PMID: 23251788 PMCID: PMC3515898 DOI: 10.1155/2012/503821] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/15/2012] [Accepted: 10/17/2012] [Indexed: 12/20/2022] Open
Abstract
Background. The aim of the current study was to investigate physicians' perceptions and adherence to the European guidelines for the management of hypertension. Methods. This is a national, multicentre, prospective, observational study, conducted between November 2007 and June 2008, in Cyprus. Consecutive hypertensive patients have been recruited by a random sample of physicians. The physicians' recommendations for every single patient have been recorded and compared with the 2007 ESH/ESC guidelines. Results. Of the total of 654 patients, 477 (72.9%) were correctly advised by their physician to receive antihypertensive treatment to control their blood pressure, while 396 (60.5%) correctly got advices to adopt only lifestyle changes. The overall adherence of physicians to the European guidelines (overall agreement rate) was 70.4% (k = 0.258, P < 0.001). Of the total of 68 physicians, 65 (95.6%) reported that they were aware of some guidelines. There was no statistically significant effect of specific physicians' characteristics on the overall adherence to guidelines, but there was in the percentage of patients achieving medication guidelines. Conclusions. The study demonstrated that although Cypriot physicians declared that they were aware of the clinical guidelines for the management of hypertension, more than one-fourth of high risk hypertensive patients remained untreated and 40% of low risk patients received inappropriate medication.
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Affiliation(s)
- Mamas Theodorou
- Faculty of Economic Sciences and Management, Open University of Cyprus, 1304 Nicosia, Cyprus
| | - Panagiotis Stafylas
- Hypertension Unit, 1st Department of Internal Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Georgia Kourlaba
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11522 Athens, Greece
| | - Daphne Kaitelidou
- Centre for Health Services Management and Evaluation, Department of Nursing, University of Athens, 11527 Athens, Greece
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11522 Athens, Greece
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Meaney E, Lara-Esqueda A, Ceballos-Reyes GM, Asbun J, Vela A, Martínez-Marroquín Y, López V, Meaney A, de la Cabada-Tamez E, Velázquez-Monroy O, Tapia-Conyer R. Cardiovascular risk factors in the urban Mexican population: The FRIMEX study. Public Health 2007; 121:378-84. [PMID: 17292427 DOI: 10.1016/j.puhe.2006.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 09/18/2006] [Accepted: 11/20/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atherosclerotic ischaemic heart disease is the second leading cause of general mortality in Mexico due to the growing prevalence of atherosclerotic risk factors in our society. The data of the FRIMEX study (Factores de Riesgo en México, Risk Factors in Mexico), considered together with those of other contemporary epidemiological surveys, will aid in our comprehension of the current state of cardiovascular epidemics in Mexico. METHODS Frequencies of obesity, hypertension and smoking, and total cholesterol and glucose in capillary blood were estimated in a non-probabilistic sample comprised of 140017 individuals (aged 44+/-13 years; 42% men and 58% women), from six Mexican cities (Mexico City, Guadalajara, Monterrey, Puebla, Leon and Tijuana). RESULTS Obesity or overweight status was found in 71.9% of participants. Hypertension was found in 26.5%, and the proportions of awareness, treatment and control for this disease were 49.3, 73 and 36%, respectively. Prevalence of hypertension increased with age; while it was higher in men under 60 years of age, in the more aged individuals it was higher in women. Hypercholesterolaemia was found in 40% of the individuals and cholesterolaemia > or =240 mg/dl was significantly higher in women. Thirty-five and a half percent of men and 18.1% of women were smokers. Type 2 diabetes mellitus was found in 10.4% of participants. There was significant Pearson's correlation between body mass index and blood pressure, between hypertension and glucose levels, and between hypertension and total cholesterol concentrations. CONCLUSIONS We conclude that this population has a high cardiovascular risk profile and a high probability of the occurrence of metabolic syndrome.
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Affiliation(s)
- E Meaney
- Cardiovascular Unit, Hospital Regional 1o de Octubre, ISSSTE, Ave. Politécnico 1669, Col. Magdalena de las Salinas, Delegación Gustavo A. Madero, Mexico City DF 07300, Mexico.
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