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Myanganbayar M, Baatarsuren U, Chen G, Campbell NRC, Bosurgi R, So G, Unurjargal T, Dashtseren M, Tserengombo N, Batsukh B, Bungert A, Dashdorj N, Dashdorj N. Hypertension knowledge, attitudes, and practices of nurses and physicians in primary care in Ulaanbaatar Mongolia. J Clin Hypertens (Greenwich) 2019; 21:1202-1209. [PMID: 31268239 DOI: 10.1111/jch.13592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
Abstract
Increased blood pressure is a leading risk for death globally, and interventions to enhance hypertension control have become a high priority. An important aspect of clinical interventions is understanding the knowledge, attitudes, and practices (KAP) of differing primary healthcare practitioners. We examined KAP surveys from 803 primary care practitioners in Ulaanbaatar, Mongolia (response rate 80%), using a comprehensive KAP survey developed by the World Hypertension League (WHL). The WHL KAP survey uniquely includes an assessment of key World Health Organization recommended interventions to enhance hypertension control. There were few substantive differences between healthcare professional disciplines. Primary care practitioners mostly had a positive attitude toward hypertension management. However, confidence and practice in performing specific tasks to control hypertension were suboptimal. A low proportion indicated they systematically screened adults for hypertension and many were not aware of the need to or were confident in prescribing more than two antihypertensive medications. It was the practice of a high proportion of doctors to not pharmacologically treat most people with hypertension who were at high cardiovascular risk. There was a reluctance by physicians to task share hypertension diagnosis, drug prescribing and assessing cardiovascular risk to nurses. The minority of health care professions use a hypertension management algorithm, and few have patient registries with performance reporting functions. There were few substantive differences based on the age, gender, and years of clinical practice of the practitioners. The study findings support the need for standardized education and training of primary care practitioners in Ulaanbaatar to enhance hypertension control.
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Affiliation(s)
| | | | - Guanmin Chen
- Research Facilitation, Analytics, Alberta Health Services 1101, Foothills Medical Centre, Calgary, AB, Canada
| | - Norm R C Campbell
- Departments of Medicine, Physiology and Pharmacology, Community Health Sciences Libin Cardiovascular Institute of Alberta, O'Brien Institute for Public Health, University of Calgary, Calgary, AL, Canada
| | | | | | - Tsolmon Unurjargal
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Batbold Batsukh
- The First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Andreas Bungert
- Onom Foundation: Onom Foundation Central Office, Ulaanbaatar, Mongolia
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Colgrove P, Connell KL, Lackland DT, Ordunez P, DiPette DJ. Controlling hypertension and reducing its associated morbidity and mortality in the Caribbean: implications of race and ethnicity. J Clin Hypertens (Greenwich) 2017; 19:1010-1014. [PMID: 28752658 DOI: 10.1111/jch.13056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 02/05/2023]
Abstract
Cardiovascular diseases and stroke, especially hypertension, represent a significant global disease burden for both morbidity and mortality, with a disproportionately higher impact in vulnerable low- to middle-income countries. International initiatives such as the Centers for Disease and Prevention and the Pan American Health Organization Standardized Hypertension Treatment Project have been developed to address this burden on the Caribbean and Latin America populations. The disparity in disease burden observed in low- to middle-income countries is explained, in part, by differences in disease risks for different racial and ethnic groups with high blood pressure more prevalent and hypertension-related morbidity significantly higher in men and women of African heritage. In addition to the race and ethnic differences in indicators of socioeconomic status, access to care and health service delivery, the physiologic mechanism of high blood pressure including salt-sensitivity, may also play a significant role in the disparities in hypertension and hypertension-related outcomes. This article focuses on potential racial and ethnic differences in influences on the pathophysiology of hypertension in the Caribbean region of the world. The identification of such differences may be used in the development of population hypertension control strategies and treatment approach that address the excess disease burden in these populations. The consideration of strategies, such as salt reduction and hypertension awareness and treatment, are particularly relevant to the high-risk Caribbean region.
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Affiliation(s)
- Paige Colgrove
- University of South Carolina, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | | | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Donald J DiPette
- University of South Carolina, University of South Carolina School of Medicine, Columbia, SC, USA
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Campbell NR. Volunteerism, and alignment, are needed for a major paradigm shift in approaches to hypertension control: 2016 World Hypertension League Excellence Award in Hypertension Prevention and Control and the Distinguished Service Award. J Clin Hypertens (Greenwich) 2017; 19:740-742. [DOI: 10.1111/jch.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Norm R.C. Campbell
- Department of Medicine; Physiology and Pharmacology and Community Health Sciences; O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
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Lackland DT. Controlling Hypertension to Prevent Target Organ Damage: Perspectives from the World Hypertension League President. Ethn Dis 2016; 26:267-70. [PMID: 27440963 DOI: 10.18865/ed.26.3.267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The evidence from epidemiological and observational studies over the past five decades consistently identify a significant association of blood pressure level and disease risks for both sexes, all races and cultures, as well as all age groups. The evidence is strong such that clinical guidelines and intervention programs focus on blood pressure management and lower blood pressure levels for primary and secondary stroke prevention supported and promoted by numerous organizations including the World Hypertension League. These comprehensive components of population risk reduction are ideal models for the clinical medicine and population health partnership, and timely for global implementation. The accelerated decline in blood pressure-related outcomes (eg, stroke mortality), which began in the 1970s in the US and Western countries, included models for aggressive detection, treatment and control strategies for hypertension. These strategies can be implemented on a global scale to respond to the global risks from blood pressure, which is developing in the most vulnerable populations.
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Affiliation(s)
- Daniel T Lackland
- Division of Translational Neurosciences and Population Studies; Department of Neurology, Medical University of South Carolina
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Khalsa TK, Campbell NR, Redburn KA, Lemogoum D, Niebylski ML. A Needs Assessment of Sub-Sahara African National Hypertension Organizations for Hypertension Prevention and Control Programs. J Clin Hypertens (Greenwich) 2015. [DOI: 10.1111/jch.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Tej K. Khalsa
- Department of Internal Medicine; The University of Calgary; Calgary AB Canada
| | - Norm R.C. Campbell
- Departments of Medicine, Community Health Sciences and of Physiology and Pharmacology; Libin Cardiovascular Institute; University of Calgary; Calgary AB Canada
| | | | - Daniel Lemogoum
- Cardiovascular Medicine; School of Medicine and Pharmaceutical Sciences; University of Douala; Douala Cameroon
- Cameroon Heart Foundation; Douala Cameroon
- Erasme Hospital; Free Brussels University; Brussels Belgium
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Campbell NRC, Lemogoum D. Hypertension in sub-Saharan Africa: a massive and increasing health disaster awaiting solution. Cardiovasc J Afr 2015; 26:152-4. [PMID: 26407216 PMCID: PMC4683293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Norm RC Campbell
- Departments of Medicine, Physiology and Pharmacology, and Community Health Sciences, O’Brien Institute for Public Health, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Daniel Lemogoum
- Douala School of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon, and Erasme Hospital, Free Brussels University, Belgium President of the International Forum for Hypertension Control and Prevention in Africa (IFHA), President of the Cameroon Heart Foundation, and Director of the Cameroon Heart Institute
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