Algorithm of Screening and Monitoring of Hypertension in Rural Outpatient Clinics: the Realities of Practice Through the Prism of the Recommendations

Abstract

The objective: of the study was a comparative analysis and identify the informativeness of diagnostic methods available in conditions of rural outpatient clinic and formulate the algorithm of screening and monitoring of hypertension in the practice of family doctors.
 Patients and methods: The study involved 62 patients with hypertension of the second-degree severity. In the first group diagnosis of AH was performed by the methods available in conditions of rural outpatient clinic, in the second group the reference methods were used. The clinical laboratory tests and instrumental examination were made. Informativeness of the methods available in conditions of rural outpatient clinic was defined on base of data of sensitivity, specificity and positive predictive value.
 Results. Home blood pressure measurement in terms of rural family medicine is the most justified because of the low cost of the survey, the possibility of continuous control of hypertension, the relative autonomy of the patient and results with data DMAT is approximate, high rates of sensitivity and specificity. Use ECG criteria for their relatively high sensitivity and specificity of the method proves informative and justifies its use in the village for early diagnosis of heart damage in patients with hypertension. Definition of ankle brachial index is informative, non-invasive, affordable method to detect the presence of vascular pathology, to evaluate dynamics during treatment.
 Determination of MAU is an affordable quality marker of kidney damage in hypertension, with high sensitivity and specificity. For a more accurate diagnosis be to calculate glomerular filtration rate. Lipid metabolism at clinic should be determined by the level of total cholesterol. Carbohydrate metabolism enough to carry on fasting glucose and glucose1tolerant test.
 Conclusion. It is proved the simple in performance, the cheap and routine methods that are used widely can to inform about cardiovascular risk and to determine the prognosis of illness in patients with hypertension.