Оценка качества обследования больных артериальной гипертонией в первичном звене здравоохранения (по данным российского Регистра артериальной гипертонии)

Abstract

Objective: to assess the quality of examination of patients with arterial hypertension in primary health care. Materials and methods. The study was carried out with the Arterial Hypertension Register method (a software with remote access, medical data inputs were made from medical records of patients with AH). The study included a selection of 29 126 patients with AH under care in primary health care in 22 regions of Russia in 2010-2014. 35% were males, females were older by 3.7 years (60.9±12.5 years and 64.6±12.0 years respectively, p<0.05). Results. 1 stage AH was observed in 43% of patients; 2 stage - in 12%; 3 stage - in 3%. BP<140/90 mm Hg was registered in 38% of patients. 80% of patients were under antihypertensive therapy. 4% of patients with AH lacked BP data in their medical records. Analysis of examinations of patients with AH showed that 63% of patients had data on family medical history of cardiovascular diseases in their medical cards; 78.1% - data on smoking status; 45% - on alcohol consumption; 83.8% - on physical activity level; 26.4% - on waist circumference; 46.5% - on height and bodyweight. Total cholesterol was identified in 86.4%, HDL cholesterol - in 25.5%, triglycerids - in 38.6%, glucose - in 85.3% and creatinine in 58.7% of patients with AH. ECG examination was done on 100% of patients, echo-cardiography - on 28.9%, duplex screening of brachiocephalic arteries - on 1% of patients with AH.Chronic heart failure (44.4%), coronary artery disease (45.6%) and Q-wave myocardial infarction in anamnesis (20.5%) were statistically more frequently observed in males. In females CHF was observed in 35.2% of patients, CAD - in 26.7% and Q-wave MI in anamnesis - in 5.5% of pts. II type diabetes mellitus was observed in 12.1% of males and in 17.8% of females with AH. Conclusion. The Register method study on a selection of patients with AH under care in primary health care in 2010-2014 shows that their examination with regard to medical history taking, cardiovascular risk factors and target organ damage assessment in patients with AH is nonoptimal. Further efforts are needed to educate physician primary care physician, family doctors and cardiologists on the methods of diagnostics and treatment of patients with AH according to the Russian guidelines on AH.