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Martins RDS, Santiago LM, Reis MT, Roque AC, Pinto M, Simões JA, Rosendo I. Implications for medical activity of differences between individuals with controlled and uncontrolled hypertension. Rev Port Cardiol 2020; 38:745-753. [PMID: 32019713 DOI: 10.1016/j.repc.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/10/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare clinical characteristics, medical activity, and family and social characteristics of individuals with controlled and uncontrolled hypertension. METHODS This was an observational study on an alphabetically organized randomized sample of individuals suffering from hypertension in a primary care setting followed by 25 general practitioners at three clinics in the Central region of Portugal in mid-2018. Electronic medical records of individuals with an ICPC-2 classification of hypertension were analyzed. Epidemiologic, family, social and therapeutic data were gathered for descriptive and inferential analysis. RESULTS From a total population of 8750 patients classified as having hypertension, a representative sample of 387 individuals (n=369 required for a 95% confidence interval and 5% error margin) was studied. The incidence of uncontrolled hypertension was 56.1%, significantly higher among those living alone (p=00.24) or in a nuclear family (p=0.011), in lower socioeconomic classes (p=0.018), and prescribed anti-inflammatory drugs (p=0.018). The calculated cardiovascular risk was no higher for uncontrolled hypertension (p=0.116). Therapeutic inertia was not found either in number of medicines or in their association (p=0.274). No other studied variables showed a significant difference. Binary logistic regression revealed that living alone or in a nuclear family, and in a family with low socioeconomic level, were associated with uncontrolled hypertension, this model representing 9.6% of the likelihood of having uncontrolled hypertension. CONCLUSIONS Medical activity in general practice and other settings should, in the light of these findings, ally therapeutic competencies with knowledge gained from studying individual, family and social characteristics in order to improve blood pressure control.
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Affiliation(s)
| | - Luiz Miguel Santiago
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | | | | | - José Augusto Simões
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
| | - Inês Rosendo
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Rodrigues AP, Gaio V, Kislaya I, Graff-Iversen S, Cordeiro E, Silva AC, Namorado S, Barreto M, Gil AP, Antunes L, Santos A, Miguel JP, Nunes B, Dias CM. Sociodemographic disparities in hypertension prevalence: Results from the first Portuguese National Health Examination Survey. Rev Port Cardiol 2019; 38:547-555. [PMID: 31708247 DOI: 10.1016/j.repc.2018.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/29/2018] [Accepted: 10/28/2018] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is an important cause of death and disability worldwide, and hypertension is responsible for at least 45% of all deaths due to heart disease and 51% of deaths due to stroke. This study aimed to estimate and describe the distribution of prevalence, awareness, treatment and control of hypertension in the Portuguese population in 2015. METHODS A national survey using a representative sample of 4911 individuals residing in Portugal and aged between 25 and 74 years was implemented. Trained nurses performed a health interview and a physical examination, including blood pressure measurement (right arm, three measurements at 1-min intervals). The prevalence of hypertension was stratified by gender, age group, marital status, education, occupation and type of residential area. Associations between hypertension prevalence and sociodemographic factors were assessed using bivariate and multivariate Poisson regression. RESULTS The overall hypertension prevalence was 36.0%. The highest rates were observed in males (39.6%), in individuals aged between 65 and 74 years (71.3%), and in those with low levels of education (62.6%) and with no formal occupation (64.5%). Among hypertensive individuals, 69.8% were aware of their condition and 69.4% were under treatment, of whom 71.3% were controlled. Rates of awareness and medical treatment were significantly higher among women and older individuals. CONCLUSIONS A large majority of the adult Portuguese population are likely to reach blood pressure levels defined as hypertension in adulthood. Significant differences in hypertension prevalence were found according to gender, age and socioeconomic status, which highlights the importance of population strategies in public health policies.
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Affiliation(s)
- Ana Paula Rodrigues
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
| | - Vânia Gaio
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | | | - Eugénio Cordeiro
- Departamento de Saúde Pública, Administração Regional de Saúde do Centro, Coimbra, Portugal
| | - Ana Clara Silva
- Instituto de Administração da Saúde e Assuntos Sociais, Secretaria Regional de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - Sónia Namorado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Marta Barreto
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Escola Nacional de Saúde Pública (ENSP), Centro de Investigação em Saúde Pública (CISP/NOVA), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana Paula Gil
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Centro Interdisciplinar de Ciências Sociais, Faculdade de Ciências Sociais e Humanas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Liliana Antunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Ana Santos
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - José Pereira Miguel
- Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Escola Nacional de Saúde Pública (ENSP), Centro de Investigação em Saúde Pública (CISP/NOVA), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Escola Nacional de Saúde Pública (ENSP), Centro de Investigação em Saúde Pública (CISP/NOVA), Universidade NOVA de Lisboa, Lisboa, Portugal
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Santiago LM, Pereira C, Botas P, Simões AR, Carvalho R, Pimenta G, Neto G. Hypertensive patients in a general practice setting: comparative analysis between controlled and uncontrolled hypertension. Rev Port Cardiol 2014; 33:419-24. [PMID: 25062612 DOI: 10.1016/j.repc.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To study the differences between controlled and uncontrolled hypertensive patients. METHODS This was a cross-sectional observational study of the hypertensive population on the lists of three general practitioners in the district of Coimbra in central Portugal in 2013, with a margin of error of 6% and 95% confidence interval in each sample, organized in ascending order of health care user numbers. Data were gathered electronically by the investigators after approval by the Regional Health Authority's ethics committee. RESULTS A sample of 201 individuals was studied, of whom 104 (51.7%) were male and 86 (42.8%) were aged under 65 (p=0.127 for gender and age-group). Hypertension was controlled in 130 (64.7%). We found significant differences in target organ damage, more frequent in those with controlled hypertension (33.1% vs. 19.7%, p=0.031), in hypertension control, better in those taking at least one anti-hypertensive drug at night (56.9% vs. 29.6%, p<0.001), and in prescription of non-steroidal anti-inflammatory drugs, more frequent in those with uncontrolled hypertension (11.3% vs. 3.8%, p=0.043). CONCLUSION Hypertension control is significantly associated with target organ damage, taking at least one anti-hypertensive drug at night and not taking non-steroidal anti-inflammatory drugs simultaneously.
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Affiliation(s)
- Luiz Miguel Santiago
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal; USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal.
| | - Carolina Pereira
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Philippe Botas
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Ana Rita Simões
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Rosa Carvalho
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Gonçalo Pimenta
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Glória Neto
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
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Pereira PR, Lopes C. A cross sectional assessment of allergic rhinitis and asthma control at an immunoallergology outpatient hospital setting using CARAT10 questionnaire. Rev Port Pneumol 2013; 19:163-7. [PMID: 23643637 DOI: 10.1016/j.rppneu.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The most recent guidelines on asthma and rhinitis management recommend the optimal control of both diseases as the primary goal of treatment. CARAT10 is a recently developed and validated Portuguese questionnaire, which permits the simultaneous assessment of allergic rhinitis and asthma (ARA) control. There is no published data about the use of this tool. AIMS To assess ARA control using CARAT10 in an Immunoallergology hospital setting; METHODS Patients with diagnosis of allergic rhinitis with or without asthma (positive aeroallergens prick-tests and/or positive specific IgE) were sequentially enrolled and asked to fill in CARAT10 questionnaire at their first appointment. RESULTS Two hundred patients were included, mostly female (n=142) with an average age of 33.6±12.3 years. ARA was present in 86 patients while 114 had isolated allergic rhinitis. In ARA group, 86% scored CARATtotal ≤ 24, meaning poor control. Subscores revealed that 83% had poorly controlled rhinitis (CARATr ≤ 8) and 74% had poorly controlled asthma (CARATa < 16). There were no age or gender related differences in ARA control. In allergic rhinitis group (n=114), 89% were poorly controlled. CONCLUSIONS Only 14% of patients presenting rhinitis and asthma had both diseases controlled.
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Affiliation(s)
- P Ricardo Pereira
- Serviço de Medicina Interna, Departamento de Medicina, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
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