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Jardim TV, Souza ALL, Barroso WKS, Jardim PCBV. Blood Pressure Control and Associated Factors in a Real-World Team-Based Care Center. Arq Bras Cardiol 2020; 115:174-181. [PMID: 32876180 PMCID: PMC8384292 DOI: 10.36660/abc.20180384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although team-based care is recommended for patients with hypertension, results of this intervention in a real-world setting are missing in the literature. OBJECTIVE To report the results of a real-world long-term team-based care for hypertensive patients we conducted this study. METHODS Data of hypertensive patients attending a multidisciplinary treatment center located in the Midwest region of Brazil in June 2017 with at least two follow-up visits were retrospectively assessed. Anthropometric, blood pressure (BP), follow-up time, pharmacological treatment, diabetes and lifestyle data were collected from the last visit to the service. BP values < 140 x 90 mmHg in non-diabetics and < 130 x 80 mmHg in diabetics were considered controlled. A logistic regression model was built to identify variables independently associated to BP control. Significance level adopted p < 0.05. RESULTS A total of 1,548 patients were included, with a mean follow-up time of 7.6 ± 7.1 years. Most patients were female (73.6%; n=1,139) with a mean age of 61.8 ±12.8 years. BP control rates in all the sample, and in non-diabetics and diabetics were 68%, 79%, and 37.9%, respectively. Diabetes was inversely associated with BP control (OR 0.16; 95%CI 0.12-0.20; p<0.001) while age ≥ 60 years (OR 1.48; 95%CI 1.15-1.91; p=0.003) and female sex (OR 1.38; 95%CI 1.05-1.82; p=0.020) were directly associated. CONCLUSIONS A BP control rate around 70% was found in patients attending a multidisciplinary team care center for hypertension. Focus on patients with diabetes, younger than 60 years and males should be given to further improve these results. (Arq Bras Cardiol. 2020; 115(2):174-181).
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Affiliation(s)
- Thiago Veiga Jardim
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Ana Luiza Lima Souza
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
| | - Paulo Cesar B Veiga Jardim
- Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde , Goiânia , GO - Brasil.,Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia , GO - Brasil
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Jardim TV, Inuzuka S, Galvão L, Negretto LAF, de Oliveira RO, Sá WF, de Souza HS, Sousa AC, Carneiro PS, Barroso WKS, Sousa ALL, Jardim PCV. Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center. Diabetol Metab Syndr 2018; 10:3. [PMID: 29339974 PMCID: PMC5759874 DOI: 10.1186/s13098-017-0305-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/29/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although multidisciplinary treatment is recommended for type 2 diabetes mellitus and hypertension (HTN), there is a lack of scientific literature supporting the hypothesis of extending this treatment strategy to patients with both diabetes and HTN. Aiming to report results of long-term multidisciplinary treatment for these patients and identify strategies to improve their management, we conducted this study. METHODS Data of patients with diabetes and HTN with regular follow-up visits in a multidisciplinary HTN treatment center from Brazil's Midwest were retrospectively assessed. Patients ≥ 18 years enrolled in the service by June 2017 with a minimum of three visits were included. Anthropometric, blood pressure (BP), laboratory, pharmacological treatment, lifestyle, and cardiovascular events data were collected from first (V1), intermediate (V2) and most recent (V3) visits to the service. BP < 130 × 80 mmHg, LDL-cholesterol (LDL-C) < 70 mg/dL and HbA1C < 7.0% were defined as treatment targets. Wilcoxon signed-rank test was used to compare variables along study visits. A linear regression model was built to identify variables associated with better overall patient control. RESULTS A total of 162 patients were included (mean age of 56.5 ± 10.8 years). Median follow-up time was 60 (IQR 40-109) months, 80.2% of the sample was female and 83.3% had no cardiovascular event history. BP, total cholesterol, LDL-C, triglycerides and HbA1C values showed a significant trend to improve along the study visits (p < 0.001). Growing trend in aspirin (p = 0.045) and statins (p < 0.001) use was found, in addition to treatment compliance increase (p < 0.001). Significant improvement trends in BP (p < 0.001), LDL-C (p = 0.004) and HbA1C (p = 0.002) control were also found across visits. Control rates of BP, LDL-C and HbA1C in combination were low in V1, V2 and V3 (1.2, 1.9 and 6.8%, respectively), but showed significant improvement trend (p < 0.001). Treatment compliance (β-coefficient = 1.20; 95% CI 1.07-1.34; p < 0.001) was positively associated with better overall patients control. CONCLUSIONS Multidisciplinary treatment of patients with diabetes and HTN significantly improved clinical and laboratory parameters, despite ageing of population evaluated. Although combined control of HbA1C, BP and LDL-cholesterol increased along follow-up, management of all these three conditions needs to improve, and focus on treatment compliance should be given to attain this goal.
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Affiliation(s)
- Thiago Veiga Jardim
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
- Division of Cardiovascular Medicine, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Center for Health Decision Science, Harvard TH Chan School of Public Health-Department of Health Policy and Management, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115 USA
| | - Sayuri Inuzuka
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Luan Galvão
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | | | - Rogério Orlow de Oliveira
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Wanessa Faria Sá
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Haroldo Silva de Souza
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Andrea Crisitina Sousa
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Patricia Silva Carneiro
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Weimar Kunz Sebba Barroso
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Ana Luiza Lima Sousa
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
| | - Paulo César Veiga Jardim
- Hypertension League, Federal University of Goias, 1ª Avenida, S/N.-Setor Universitário, Goiânia, GO CEP 74085-300 Brazil
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