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Zhou Q, Yu M, Jin M, Zhang P, Qin G, Yao Y. Impact of free hypertension pharmacy program and social distancing policy on stroke: A longitudinal study. Front Public Health 2023; 11:1142299. [PMID: 37143973 PMCID: PMC10151749 DOI: 10.3389/fpubh.2023.1142299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
Background The estimated lifetime risk of stroke was the highest in East Asia worldwide, especially in China. Antihypertensive therapy can significantly reduce stroke mortality. However, blood pressure control is poor. Medication adherence is a barrier as patients' out-of-pocket costs have risen. We aimed to take advantage of a free hypertension pharmacy intervention and quantified the impact on stroke mortality. Methods A free pharmaceutical intervention program was implemented in Deqing, Zhejiang province in April 2018. Another non-pharmaceutical intervention, social distancing due to the pandemic of Coronavirus disease 2019 (COVID-19), was also key to affecting stroke mortality. We retrospectively collected the routine surveillance data of stroke deaths from Huzhou Municipal Center for Disease Prevention and Control in 2013-2020 and obtained within-city mobility data from Baidu Migration in 2019-2020, then we quantified the effects of both pharmaceutical intervention and social distancing using Serfling regression model. Results Compared to the predicted number, the actual number of stroke deaths was significantly lower by 10% (95% CI, 6-15%; p < 0.001) from April 2018 to December 2020 in Deqing. Specifically, there was a reduction of 19% (95% CI, 10-28%; p < 0.001) in 2018. Moreover, we observed a 5% (95% CI, -4 - 14%; p = 0.28) increase in stroke mortality due to the adverse effect of COVID-19 but it wasn't statistically significant. Conclusion Free hypertension pharmacy program has great potential to prevent considerable stroke deaths. In the future, the free supply of low-cost, essential medications that target patients with hypertension at increased risk of stroke could be taken into account in formulating public health policies and guiding allocations of health care resources.
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Affiliation(s)
- Qi Zhou
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Meihua Yu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Meihua Jin
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
- *Correspondence: Meihua Jin,
| | - Peng Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Ye Yao,
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Kifle ZD, Adugna M, Chanie GS, Mohammed A. Prevalence and associated factors of hypertension complications among hypertensive patients at University of Gondar Comprehensive Specialized Referral Hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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3
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Cabral AC, Lavrador M, Fernandez-Llimos F, Castel-Branco M, Figueiredo IV. Evaluation of a sample of Portuguese hypertensive patients’ knowledge about hypertension and its influence on their beliefs and adherence to therapy. Rev Port Cardiol 2021; 41:361-367. [DOI: 10.1016/j.repc.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 10/19/2022] Open
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Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl) 2021; 134:292-301. [PMID: 33470655 PMCID: PMC7846498 DOI: 10.1097/cm9.0000000000001360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs. METHODS In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs. RESULTS There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was -7.9 mmHg (95% CI, -9.9 to -5.9) in the brand-name drug group and -7.1 mmHg (95% CI, -9.1 to -5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2-2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment. CONCLUSIONS Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
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Weldegebreal AS, Tezeta F, Mehari AT, Gashaw W, Dessale KT, Legesse NY. Assessment of drug therapy problem and associated factors among adult hypertensive patients at Ayder comprehensive specialized hospital, Northern Ethiopia. Afr Health Sci 2019; 19:2571-2579. [PMID: 32127830 PMCID: PMC7040299 DOI: 10.4314/ahs.v19i3.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Drug-therapy problems(DTPs) among hypertensive patients can result in patient's morbidity and mortality. The main aim of this study was to assess drug therapy problem and associated factors among hypertensive patients. METHODS A hospital based cross sectional study was conducted. The data was collected from patients' medical charts and through interview. Drug therapy problem was categorized according to Cipolle methods of DTP classification. Thedata was analyzed using the Statistical Package for the Social Sciences (SPSS), version 21. RESULTS A total of 241 patients were studied. The mean number of antihypertensive medications prescribed were 1.41±0.53. A total of 357 drug therapy problems(DTPs) were identified. From the patients studied,134(55.6%) had at least one evidence of drug therapy problem. Non adherence was the most commonly identified drug therapy problem occurred in (143(59.3%)) patients. Substance use (AOR=0.445, 95% CI= 0.227-0.870, p=0.018) and comorbidity (AOR= 2.099, 95% CI= 1.192-3.694, p=0.010) werethe predictors of DTP. CONCLUSION More than half of the participants had evidence of onset drug therapy problem. Thus efforts that could boost antihypertensive compliance and minimizes substance use should be adopted to reduce patients's drug therapy problems.
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Affiliation(s)
| | - Fekadu Tezeta
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Ethiopia
| | - Atey Tesfay Mehari
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Ethiopia
| | - Wubetu Gashaw
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Ethiopia
| | - Kassa Tesfaye Dessale
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Ethiopia
| | - Niriayo Yirga Legesse
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Ethiopia
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Essayagh T, Essayagh M, El Rhaffouli A, Khouchoua M, Bukassa Kazadi G, Khattabi A, Essayagh S. Prevalence of uncontrolled blood pressure in Meknes, Morocco, and its associated risk factors in 2017. PLoS One 2019; 14:e0220710. [PMID: 31398197 PMCID: PMC6688818 DOI: 10.1371/journal.pone.0220710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022] Open
Abstract
Background Uncontrolled high blood pressure (UBP) can lead to various cardiovascular complications causing an estimated nine million deaths per year worldwide. In Meknes, epidemiologic data on UBP are scarce, depriving programs from evidence-based information that would allow a better management of hypertension. Hence, we aimed to assess UBP prevalence in hypertensive patients treated in Meknes and identify UBP-associated risk factors. Methods Between November and December 2017, we conducted a cross-sectional study enrolling 922 hypertensive patients managed at Meknes’s primary health care facilities using the multistage sampling method. We interviewed patients face to face to collect their socio-demographic-characteristics, lifestyle behaviours, clinical parameters and the triad care system-patient-physician. Another questionnaire was self-administered by physicians to characterize therapeutic inertia. A multivariate logistic regression analysis highlighted the risk factors associated with UBP. Results UBP prevalence was 73% with a mean age of 61±11 years (mean±standard deviation) and a male/female ratio of 1/3. Risk factors associated with UBP were: therapeutic inertia (adjusted odds ratio to other variables (AOR) = 18.2, 95% CI [8.35–39.84]), drug non-adherence (AOR = 1.8, 95% CI [1.07–3.04]), obesity/overweight (AOR = 1.6, 95% CI [1.03–2.58]), unemployment (AOR = 1.9, 95% CI [1.09–3.01]), low income (AOR = 2.6, 95% CI [1.01–6.86]), family history of hypertension (AOR = 1.5, 95% CI [1.07–2.08]) and male sex (AOR = 1.6, 95% CI [1.04–2.58]). Conclusion UBP prevalence is high in Meknes. Prevention should firstly focus on raised awareness of hypertensive patients’ self-care management. Secondly, health professionals should better comply to the guidelines of anti-hypertensive treatments. Lastly, health professionals should frequently be reminded to reach therapeutic goals to overcome therapeutic inertia.
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Affiliation(s)
- Touria Essayagh
- Laboratoire Sciences et Technologies de la Santé, Institut Supérieur des Sciences de la Santé, Université Hassan 1, Settat, Morocco
- Ecole Nationale de Santé Publique, Rabat, Morocco
- * E-mail:
| | - Meriem Essayagh
- Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | | | | | - Germain Bukassa Kazadi
- Department of Indigenous Services Canada/Government of Canada, Health Surveillance and Assessment Unit, First Nations and Inuit Health, Saskatchewan Region, Regina, Sk Canada
| | | | - Sanah Essayagh
- Laboratoire Agroalimentaire et Santé, Faculté des Sciences et Techniques, Université Hassan 1, Settat, Morocco
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Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013-Evidence from Two Provinces in South of China. Curr Med Sci 2018; 38:741-748. [PMID: 30128887 DOI: 10.1007/s11596-018-1939-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/20/2018] [Indexed: 02/04/2023]
Abstract
Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P>0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.
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Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study. Int J Hypertens 2017; 2017:2637051. [PMID: 28695006 PMCID: PMC5485479 DOI: 10.1155/2017/2637051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 (p = 0.01)]. Conclusion More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.
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Li J, Shi L, Li S, Xu L, Qin W, Wang H. Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011. Int J Equity Health 2017; 16:50. [PMID: 28288635 PMCID: PMC5348878 DOI: 10.1186/s12939-017-0545-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/02/2017] [Indexed: 01/16/2023] Open
Abstract
Background China has experienced a rapid increase in hypertension over the past decade, especially in rural. Therefore, the aim of this research is to examine the dynamic trends in urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese adults from 1993 to 2011. Methods Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in hypertension prevalence, detection and medication use. Multiple logistic regressions were used to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011, after controlling for health-related behaviors, BMI, demographic variables and socioeconomic characteristics. Blinder-Oaxaca decomposition technique was also used to calculate the extent to which urban-rural disparities reflect an endowments effect or a coefficients effect. Results Hypertension prevalence, detection, and medication use among rural adults were significantly lower than urban adults, with the significant level at p < 0.001. The urban-rural gaps in hypertension prevalence and medication use gradually narrowed during the period 1993–2011, whereas the gaps in hypertension detection grew wider. After controlling for confounding variables, urban adults were about 24.5, 49.4, and 89.5% more likely to be hypertensive, detected, and medicated than their rural counterparts (p < 0.01), respectively. The Blinder-Oaxaca decomposition suggested that approximately 22 and 26% of the urban-rural gap in hypertension detection and medication use could be attributed to coefficient difference, respectively. Conclusions Although hypertension prevalence among rural adults was comparable to that of urban adults, hypertension detection and medication use of rural adults were still suboptimal. Unusually large urban-rural gaps and an expanding trend in hypertension detection deserve the attention of health policymakers and researchers.
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Affiliation(s)
- Jiajia Li
- Shandong University, Jinan, People's Republic of China
| | - Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Shixue Li
- Shandong University, Jinan, People's Republic of China
| | - Lingzhong Xu
- Shandong University, Jinan, People's Republic of China
| | - Wen Qin
- Infirmary of Shandong University, Jinan, People's Republic of China
| | - Heng Wang
- The Second Hospital of Shandong University, Jinan, People's Republic of China
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Lee BH, Yang AR, Kim MY, McCurdy S, Boisvert WA. Natural sea salt consumption confers protection against hypertension and kidney damage in Dahl salt-sensitive rats. Food Nutr Res 2016; 61:1264713. [PMID: 28325999 PMCID: PMC5328355 DOI: 10.1080/16546628.2017.1264713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/20/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022] Open
Abstract
Although sea salts are widely available to consumers nowadays, whether its consumption over refined salt has any real health benefits is largely unknown. This study was conducted to compare hypertension-inducing propensity of natural sea salt (SS) to refined salt (RS) in a well-established animal model of hypertension. Five groups of male Dahl salt-sensitive rats were fed rat chow diet supplemented with various amounts of salt for 15 weeks. The groups were: control (CON, n = 10), 4% RS (RS4), 4% SS (SS4), 8% RS (RS8), 8% SS (SS8) (n = 12 for each group). After 15 weeks, both SS4 and SS8 groups had significantly lower systolic (SBP) and diastolic blood pressure (DBP) compared to RS4 and RS8 rats, respectively. RS8 rats had markedly higher SBP and DBP compared to all other groups. Echocardiography just prior to sacrifice showed abnormalities in RS4, SS8 and RS8 hearts, while CON and SS4 hearts displayed normal measurements. Plasma renin and aldosterone levels of high salt groups were lower than those of CON, and serum electrolytes were similar amongst all groups. Abnormal kidney pathology and high glomerulosclerosis index scores were seen in RS4 and RS8 rats, but SS4 and SS8 kidneys showed relatively normal morphology similar to CON kidneys. Our findings show that consumption of natural sea salt induces less hypertension compared to refined salt in the Dahl salt-sensitive rat.
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Affiliation(s)
- Bog-Hieu Lee
- Department of Food and Nutrition, School of Food Science and Technology, Chung-Ang University , Seoul , Korea
| | - Ae-Ri Yang
- Department of Food and Nutrition, School of Food Science and Technology, Chung-Ang University , Seoul , Korea
| | - Mi Young Kim
- Department of Food and Nutrition, School of Food Science and Technology, Chung-Ang University , Seoul , Korea
| | - Sara McCurdy
- Center for Cardiovascular Research, University of Hawaii John A. Burns School of Medicine , Honolulu , Hawaii
| | - William A Boisvert
- Center for Cardiovascular Research, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii; Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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Asgedom SW, Gudina EK, Desse TA. Assessment of Blood Pressure Control among Hypertensive Patients in Southwest Ethiopia. PLoS One 2016; 11:e0166432. [PMID: 27880781 PMCID: PMC5120816 DOI: 10.1371/journal.pone.0166432] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The rate of blood pressure control among hypertensive patients is poor and the reasons for poor control of blood pressure remain poorly understood globally. OBJECTIVE To assess the rate of blood pressure control among adult hypertensive patients at Jimma University Specialized Hospital. MATERIALS AND METHODS We conducted a hospital based cross sectional study among adult hypertensive patients at Jimma University Specialized Hospital hypertension clinic from March 4, 2015 to April 3, 2015. Data on sociodemographic characteristics of the participants and adherence to antihypertensive medication(s) were collected from patients by face to face interview using a pretested structured questionnaire. Comorbidities, antihypertensive medication(s) and blood pressure measurements were collected retrospectively from medical records. Medication adherence was assessed using Morisky's Medication Adherence Scale-8 score. We did the statistical analysis using chi-square test and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p<0.05. RESULTS Out of 311 participants, 286 patients were eligible and were studied. More than half, 154 (53.8%), of the participants were males. The mean age of the participants was 54.8± 12.6 years (range 26 to 94). The majority, 196 (68.53%), of the participants were taking more than one antihypertensive medication. More than one third (39.5%) of the participants were non adherent to their medication(s). The rate of blood pressure control was 50.3%. In a univariate logistic regression analyses, age ≥65 years old (P = 0.008), physical inactivity (p<0.001), chat chewing (P<0.001), adding salt to food (P<0.001), and coffee use (P<0.001) are significantly associated with uncontrolled blood pressure. CONCLUSION Almost half of the hypertensive patients on follow up had uncontrolled blood pressure. We recommend better health education and care of patients to improve the rate of blood pressure control at the hospital.
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Affiliation(s)
- Solomon Woldegebriel Asgedom
- Department of Pharmacy, Clinical Pharmacy Unit, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, School of Medicine, Jimma University, Jimma, Ethiopia
| | - Tigestu Alemu Desse
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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Jiang Q, Jiang Z, Xin Z, Cherry N. Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study. BMC Public Health 2016; 16:980. [PMID: 27628183 PMCID: PMC5024510 DOI: 10.1186/s12889-016-3643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although many studies have investigated the relationship between the introduction of the New Cooperative Medical Scheme (NCMS) in rural China in 2003 and increased use of medical services, the effect on health status, objectively measured, is seldom reported. In Anhui Province a chronic disease scheme (CDS) for reimbursing part of the cost of outpatient care is designed to improve management of those with chronic conditions, including diabetes. Methods A follow-up study was designed in which patients with diabetes aged 40–70 years who had recently (in 2010) been granted a chronic disease card were individually matched on age, sex and village with a patient with diabetes not yet in the scheme. Each subject gave a fingertip sample of blood to give the concentration of glycosylated hemoglobin (HbA1c), a measure indicating blood glucose control during the previous 3 months. This measure was made on recruitment and at 12 month follow-up: information on use of health services, quality of life and financial burden was also collected at the two contacts. Results Of 602 pairs initially recruited, 528 pairs were contacted at follow-up and are the subject of this report. To distinguish between outcomes associated with application and those of membership of the scheme, the primary analysis was of 256 pairs in which one had been a member of the CDS throughout and the other never applied. No difference between pairs on HbA1c was found either at recruitment or follow-up but those in the CDS reported more hospital visits, more tests and more use of high level hospitals. However they had poorer scores on quality of life scales (SF-12, EQ-5D) and were more likely to report that the financial costs were very burdensome. Those recently applying for the scheme, or being accepted since recruitment, had lower HbA1c scores. Conclusions On-going membership of the CDS was associated with increased use of services but this did not appear to result in better management of blood glucose or improved quality of life. Those who had recently joined the scheme had signs of improvement, suggesting a need for active follow-up to maintain and reinforce early gains.
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Affiliation(s)
- Qicheng Jiang
- School of Public Health, Anhui Medical University, Anhui, China.,School of Health Management, Anhui Medical University, Anhui, China
| | - Zhen Jiang
- School of Health Management, Anhui Medical University, Anhui, China.,National HIV/AIDS Center, Anhui, China
| | - Zhang Xin
- Anhui Provincial Hospital, Anhui, China
| | - Nicola Cherry
- Division of Preventive Medicine, University of Alberta, 5-22 University Terrace, 8303-112 St, Edmonton, AB, T6G 2 T4, Canada.
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Hypertension prevalence, awareness, treatment, and control in 115 rural and urban communities involving 47 000 people from China. J Hypertens 2016; 34:39-46. [DOI: 10.1097/hjh.0000000000000745] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Prevalence, awareness, treatment and control of high blood pressure among Chinese rural population in Haimen, Jiangsu. J Hum Hypertens 2015; 30:225-30. [DOI: 10.1038/jhh.2015.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
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Gu D, He J, Coxson PG, Rasmussen PW, Huang C, Thanataveerat A, Tzong KY, Xiong J, Wang M, Zhao D, Goldman L, Moran AE. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study. PLoS Med 2015; 12:e1001860. [PMID: 26241895 PMCID: PMC4524696 DOI: 10.1371/journal.pmed.1001860] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 06/25/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs. METHODS AND FINDINGS The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China. CONCLUSIONS Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.
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Affiliation(s)
- Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for Cardiovascular Diseases, Beijing, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Pamela G. Coxson
- Division of General Medicine, University of California at San Francisco, San Francisco, California, United States of America
| | - Petra W. Rasmussen
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Chen Huang
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for Cardiovascular Diseases, Beijing, China
| | - Anusorn Thanataveerat
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Keane Y. Tzong
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Miao Wang
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Lee Goldman
- Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | - Andrew E. Moran
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
- Columbia University College of Physicians and Surgeons, New York, New York, United States of America
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Hypertension prevalence, awareness, treatment and control among Han and four ethnic minorities (Uygur, Hui, Mongolian and Dai) in China. J Hum Hypertens 2015; 29:555-60. [PMID: 25589212 DOI: 10.1038/jhh.2014.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/02/2014] [Accepted: 11/18/2014] [Indexed: 11/09/2022]
Abstract
In the previous study, hypertension prevalence, awareness, treatment and control for Han and others four ethnic minorities (Uygur, Hui, Mongolian and Dai) has not been clearly documented in China. Therefore we used the baseline data of Prospective Urban and Rural Epidemiology (PURE) for further detailed study. Adjusted rate were estimated and compared through logistic regression after adjustment of age, sex, location and education. Among the total of 7137 participants (Han: 1626, ethnic minorities: 5511), hypertension prevalence, awareness, treatment and control were 2922(40.9%), 1199(41.0%), 873(29.9%) and 147(5.0%), respectively. The most commonly used antihypertensive drugs are traditional compound drugs (6.2%) and calcium channel blockers (5.2%). Hypertension prevalence in ethnic minorities was significantly higher than in Han (42.4% vs 34.4%, P<0.0001), while control rate (1.6% vs 9.8%, P=0.0198) and treated control rate (8.0% vs 25.0%, P=0.0200) were lower. Compared with Han counterparts, Dai had a higher prevalence (50.8% vs 29.9%, P<0.0001). Uygur had a lower treatment rate (33.2% vs 20.6%, P=0.0110). Mongolian had a lower control (5.1% vs 16.1%, P=0.0046) and treated control rate (14.1% vs 50.3%, P=0.0013). In conclusions, our study showed ethnic minorities had higher hypertension prevalence, especially for Dai and lower control and treated control rate for Mongolian. Hence, we need more attention with respect to hypertension in ethnic minorities.
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Goverwa TP, Masuka N, Tshimanga M, Gombe NT, Takundwa L, Bangure D, Wellington M. Uncontrolled hypertension among hypertensive patients on treatment in Lupane District, Zimbabwe, 2012. BMC Res Notes 2014; 7:703. [PMID: 25297796 PMCID: PMC4197296 DOI: 10.1186/1756-0500-7-703] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/02/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More than half of hypertensive patients reviewed at Lupane District Hospital during the first half of 2011 had uncontrolled hypertension. This prompted an investigation on the prevalence of uncontrolled hypertension and associated factors among hypertensives on treatment. METHODS Analytical cross-sectional study was conducted. Three hundred fifty-four consenting participants were consecutively selected from eligible hypertensive patients on treatment attending the outpatients department at Lupane District Hospital for their reviews. An interviewer administered questionnaire adapted from the World Health Organization was used to collect data on risk factors. Blood pressure and anthropometric measurements were taken as per World Health Organization guidelines. Uncontrolled hypertension was defined as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg in a patient taking anti-hypertensive medication. RESULTS Mean systolic BP was 151.0 mmHg and mean diastolic BP was 92.6 mmHg. Prevalence of uncontrolled hypertension was (238) 67.2%. Independent risk factors for uncontrolled hypertension were obesity (AOR 3.28, 95% CI 1.39-7.75) and adding salt to food at the table (AOR 2.77, 95% CI 1.41-5.43) whilst being compliant with the drug treatment regimen (AOR 0.34, 95% CI 0.16-0.72) and having received health education on hypertension (AOR 0.49, 95% CI 0.25- 0.97) were protective against uncontrolled hypertension. CONCLUSION There prevalence of uncontrolled hypertension is high despite all the participants being on treatment. The findings suggest that interventions at the patient, the provider and the health delivery system are needed to improve hypertension control in Lupane, Zimbabwe.
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Affiliation(s)
| | - Nyasha Masuka
- />Provincial Medical Directorate, Matabeleland North Province (MoHCC), Matabeleland, Zimbabwe
| | - Mufuta Tshimanga
- />Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Notion Tafara Gombe
- />Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Lucia Takundwa
- />Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Donewell Bangure
- />Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Maureen Wellington
- />Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Prevalence rates of self-care behaviors and related factors in a rural hypertension population: a questionnaire survey. Int J Hypertens 2013; 2013:526949. [PMID: 23819042 PMCID: PMC3683479 DOI: 10.1155/2013/526949] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.
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Current world literature. Curr Opin Cardiol 2012; 27:441-54. [PMID: 22678411 DOI: 10.1097/hco.0b013e3283558773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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