Blood Pressure Control Program Research Articles

Self-Care Behavior and Associated Factors in the Elderly with Hypertension

Hypertension is one of the main risk factors for life-threatening cardiovascular disease and is often called the silent killer The results of basic health research in 2018 suffered from hypertension were the most in the elderly aged 55 to 64 years (55.2%). Hypertension in the elderly is a chronic disease that requires disease care management including regular blood pressure control and self-care behavior programs to prevent further complications. This study aims to determine the factors related to self-care behavior in hypertensive elderly in the Integrated Health Care Center of elderly, Srikandi, Turi Sub District, Community Health Centers of Sukorejo, Sukorejo district, Blitar. The method used in this study was an analytical descriptive study with a cross-sectional approach conducted on 38 hypertensive elderly people. The study was conducted from January to February 2022. Analysis data using multiple linear regression analysis to ascertain the possible factors that influence self-care behavior. Based on this study, the Rank Spearman correlation test results, the factor that correlated with self-care behavior was level of education and time living with diagnosed hypertension with a Sig (2-tailed) value of 0.008; 0,000 with a correlation coefficient is positive, the value of 0.427; 0.605. so that the relationship between the two variables is unidirectional. This study recommends that community nurses must understand the factors that influence self-care behavior in hypertensive clients in the community so that they are able to provide appropriate nursing care.

Building Your Peripheral Artery Disease Toolkit: Medical Management of Peripheral Artery Disease in 2022.

Peripheral artery disease (PAD) is associated with substantial morbidity, including a high risk of cardiovascular and limb events and death. A growing body of evidence has demonstrated the benefits of antithrombotic therapy, lipid lowering, blood pressure control, diabetes management, smoking cessation, and exercise programs on improving symptoms and reducing these complications. Guidelines make specific recommendations on how to use these strategies to prevent adverse cardiovascular and limb outcomes in patients with PAD. Unfortunately, antithrombotic therapies, statins, optimal antihypertensives, smoking cessation counselling and therapies, and exercise programs have all been consistently shown to be underutilised in PAD patients both in Canada and globally. A variety of barriers to optimal utilisation of evidence-based medical therapies have been described at the patient, health care provider, and system levels. These include lack of knowledge among patients and health care providers, and lack of access to secondary prevention programs. We review the evidence for preventive therapies in PAD, evidence for underutilisation of these therapies, and barriers to their use. Core elements of PAD secondary prevention clinics are proposed, and a summary of optimal medical therapies and relevant tools is provided. This review may help clinicians who treat patients with PAD to develop a toolkit to overcome these barriers in order to improve utilisation of medical therapies, with the ultimate goal of improving outcomes for PAD patients.

Trend of ischemic heart disease mortality attributable to metabolic, behavioral, and environmental risk factors in the past two decades

Abstract Background Ischemic heart diseases (IHD) is the leading cause of mortality, worldwide. Understanding of the status of risk factors contributing to IHD and mortality helps control this public health issue. Purpose This study aims to provide global, regional, and national estimates of the trend of IHD burden and deaths attributable to the modifiable risk factors, from 1990 to 2019. Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the IHD incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). IHD deaths attributable to the different metabolic, behavioral and environmental risk factors were estimated based on risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on 2010 to 2019. Results Globally, there were 21·2 million (95% uncertainty interval [UI] 18·8–23·7) new cases, 9·1 million (8.4–9·7) deaths, and 182·0 million (170·2–193·5) DALYs due to IHD, in 2019. From 1990 to 2019, IHD incident cases, deaths and DALYs increased globally by 29.1·9% (27.0–31·3), 32·4% (25.3–37·8), and 53.9% (42·7–64·3), respectively. Although high SDI regions succeeded to reduce DLAYs due to IHDs by −36.7% (−33.8 to −39.2), low SDI regions faced an increase in DALYs due to IHDs by +104.4% (+75.0 to +135.3). In 2019, the five leading risk factors of deaths due to IHDs were; high systolic blood pressure [2.2 million deaths (1.7–2.7)], high LDL cholesterol [1.7 million deaths (1.2–2.3)], high fasting plasma glucose [1.1 million deaths (0.6–1.8)], high body-mass index [0.8 million deaths (0.5–1.1)], and diet low in whole grains [0.6 million deaths (0.2–0.8)]. From 1990 to 2019, high SDI regions succeeded to reduce the age standardized death rate of IHDs attributable to metabolic risk factors by −60.1% (−61.9 to −57.7), behavioral risk factors by −61.2% (−62.8 to −59.2) and environmental risk factors by −65.8% (−71.4 to −59.3). During the same period, the age standardized IHD death rate attributable to environmental risk factors decreased by −16.0% (−30.4 to −1.6), while the age standardized IHD death rate attributable to metabolic and behavioral risk factors didn't change significantly, in low SDI regions. Conclusions During the past two decades despite steadily increase in incident cases of IHDs, the age standardized burden of IHDs has decreased in high SDI regions most probably due to control of attributable risk factors. However, burden of IHDs has increased dramatically in low SDI regions. Preventive measures such as “polypills” for high blood pressure control programs and life-style modification should be prioritized in these settings. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Bill & Melinda Gates Foundation Age-standardized DALY rates of IHD

Effectiveness of a comprehensive blood pressure control program in primary health care in Peru

ABSTRACTObjective.To assess the effectiveness of a comprehensive blood pressure (BP) control program on improving lifestyle indicators, BP levels, and laboratory examination results among people living in low-income urban areas of Peru.Methods.A prospective before-and-after study design was applied to 1 271 participants with hypertension or pre-hypertension. The intervention was implemented for 2 years, from May 2015 – April 2017, in three health centers in Lima (2 in Comas and 1 in Callao). The changes in participants over the study period were compared. All participants were provided with individualized consultations, group health education sessions, regular group meetings to improve self-management, and text messages providing health education. Paired t- and chi-square tests were used to determine the significance of the changes in indicators before and after the intervention.Results.Lifestyle behaviors, such as weight and blood pressure monitoring, reduced salt consumption, increased fruit and vegetable consumption, and stress control improved during the intervention (P < 0.001). The EuroQol-Five Dimension Scale showed improvement (P < 0.001) and body mass index, waist circumference, and systolic and diastolic BPs of the participants significantly decreased (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) and triglyceride decreased (P < 0.01) and high-density lipoprotein cholesterol (HDL-C) increased. The estimated glomerular filtration rate (eGFR) increased after the program (P < 0.001).Conclusions.This comprehensive BP control program was effective in improving lifestyle indicators, BP levels, and laboratory results among people living in a low-income urban area of Peru. Increasing opportunities for BP measurement, systematic management of hypertensive patients, and community-based prevention and education programs are paramount to hypertension detection, prevention, and control.

Development of an entirely remote, non-physician led hypertension management program.

BackgroundHypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximize efficiency of care delivery and optimize control.HypothesisWe aimed to develop a remote, navigator‐led hypertension innovation program that would leverage algorithmic care pathways, home BP measurements and patient coaching to allow rapid and complete medication titration.MethodsA multidisciplinary group of clinical experts from subspecialties and primary care collaborated to develop an evidence‐based clinical algorithm, designed to be automated and administered by non‐licensed patient navigators. In the development stage, a prospective pilot cohort of 130 patients was managed by nurse practitioners and pharmacists to ensure efficacy and safety. Patients with clinic BP ≥ 140/90 mm Hg were enrolled and given a Bluetooth‐enabled BP device. Home BPs were transmitted automatically into the electronic medical record. Medication titrations were performed by phone at biweekly intervals, based upon weekly average BP, until home BP was controlled at <135/85 mm Hg.ResultsEighty‐one percent of all enrolled, and 91% of those patients who regularly measured home BP achieved goal, in an average of 7 weeks. Control was reached similarly across races, genders, and ages.ConclusionsA home‐based BP control program run by non‐physicians can provide efficient, effective and rapid control, suggesting an innovative paradigm for hypertension management. This program is effective, sustainable, adaptable, and scalable to fit current and emerging national systems of healthcare.

Trends in prevalence, awareness, treatment and control of high blood pressure in the Seychelles between 1989 and 2013.

Limited data are available in the African region on trends in blood pressure (BP) and awareness, treatment and control rates. We examined trends in these indicators for a 25-year period in the Seychelles, a rapidly developing small island state in the African region. Population-based surveys of adults aged 25-64 years were performed in 1989, 1994, 2004 and 2013 using nearly identical methods for all surveys. BP was based on the average of the second and third readings. Data were age-standardized. Between 1989 and 2013, mean SBP decreased in older adults (but increased in younger adults) and mean DBP decreased in all age categories, despite a marked secular increase in mean BMI. At age 25-64 years, the proportions with BP at least 140/90 mmHg decreased from 44%/33% (men/women) in 1989 to 37%/22% in 2013. The proportions of persons aware of having high BP (among those with BP ≥ 140/90 or treatment) increased from 40%/63% (men/women) in 1989 to 65%/80% in 2013; the proportions under treatment (among aware) increased from 37%/49% to 64%/78%; and the proportions with controlled BP (among treated) increased from 10%/16% to 34%/61%. Awareness was associated with female sex, age, obesity and diabetes; treatment with age, obesity, low alcohol consumption and diabetes; and control with female sex, age and high socio-economic status. In 2013, the main classes of antihypertensive medications were used in similar proportions, and 64.5% received at least two medications. The prevalence of high BP (≥140/90 mmHg) decreased over time, which paralleled improved detection and control of hypertension. The identified associated factors should be considered when strengthening BP control programs.

PHS114 - Knowledge of Blood Pressure Control Programs In University Students

PHS114 - Knowledge of Blood Pressure Control Programs In University Students

PP.01.29] ASSESSMENT OF UNCOMPLICATED HYPERTENSION THERAPY EFFECTIVENESS IN REAL LIFE SETTING

Objective: Our aim was to compare the home blood pressure (BP) monitoring (HBPM) results with those obtained by ambulatory BP monitoring (ABPM) and office BP measurements before and after 6 month (M) algorithmic antihypertensive treatment of uncomplicated hypertension (UH) in longitudinal real-life BP control program. Design and method: We analyzed BP measurement results of 76 consecutively recruited patients (pts) 55,7 ± 9,8 years, with new diagnosed (13,1%) or treated but uncontrolled UH, participants of PERFECT-BP prospective observational study (ISRCTN75706523). Pts were prescribed or switched to perindopril/amlodipine FDC with successively adding, if needed, indapamid-SR, spironolactone, moxonidine or doxasosine. ABPM was performed within 2 days after visit 1 and before visit at M6. A validated oscillometric device Microlife BP3AG1 with individually selected cuff were used for HBPM (three times in the morning and evening for 7 consecutive days after visit 1 and before visit at M6). Office BP measurements were performed with standardized automatic Microlife BPW200 with universal cuff. Pearson's linear correlation was used for analysis. Results: By M6 office systolic BP (SBP) lowered from 164,9 ± 1,6 to 134,2 ± 1,3 mmHg; diastolic BP (DBP) – from 98,1 ± 0,9 to 83,2 ± 0,9 mmHg; home SBP – from 146,2 ± 1,6 to 131,6 ± 1,0 mmHg; DBP – from 91,3 ± 1,1 to 82,7 ± 0,8 mmHg; 24-hour SBP – from 150 ± 1,8 to 129,7 ± 1,2 mmHg; DBP - from 91,2 ± 1,2 to 81,4 ± 1,2 mmHg; daytime SBP – from 154,9 ± 2,3 to 134,0 ± 1,7 mmHg; DBP– from 95,3 ± 1,5 to 84,3 ± 1,2 mmHg; (all p < 0,001). HBPM showed a good correlation with office BP measurements and ABPM results at baseline and by M6 both for SBP and DBP (see in table). Masked hypertension at M6 was identified by ABPM in 17 (22,4%) and by HBPM in 19 (25%) pts (p > 0,05).Conclusions: HBPM is an acceptable tool for assessment of antihypertensive treatment efficacy for UH in real life setting.

Abstract P168: Evaluation of the American Heart Association’s “Check Change ControlTM”- Blood Pressure Control Program

Background: Blood pressure (BP) awareness, treatment and control remains suboptimal among US adults with hypertension. In response, the AHA has developed the “Check. Change. Control. TM” (CCC) BP program to reduce BP in those with elevated BP. We evaluated the efficacy of this program as implemented in a sample of Asian and Hispanic senior citizens in Southern California. Methods: We studied 122 participants aged &gt;62 years (93% Chinese and 7% Hispanic) who participated in the CCC program in Los Angeles and Orange Counties, California. Systolic (SBP) and diastolic blood pressure (DBP) was recorded over the CCC program resulting in 8 readings over 4 months during which participants learned self-monitoring, tracking BP, the use of the Heart360 TM digital tool, and self-management skills. Participants in this analysis were required to have baseline, final, and at least two interim BP measures. BP changes from baseline to mid-study and final visit were examined by the paired t-test among the whole cohort and in those with elevated BP (&gt;=140 SBP and/or &gt;=90 DBP) at baseline. Results: Average baseline SBP was 136.8 (19.4) mm Hg and DBP was 76.0 (12.0) mm Hg. At baseline, 46.7% of the participants had elevated BP, which was reduced to 41% by the final visit. The figure depicts the change in SBP and DBP from baseline to mid visit and final visit for the overall cohort and those with elevated BP at baseline. There were significant reductions in both SBP and DBP overall and especially among those with elevated BP at baseline. Further, 36.1% of participants had a SBP drop of &gt;10 mm Hg from baseline to final visit. Conclusion: In conclusion, the AHA’s CCC program had a significant impact in reducing BP in our AHA CCC participants, especially among those with elevated BP at baseline. Further study should investigate the specific program and patient factors that best predict blood pressure reduction.

PP.19.28

Objective: To compare target office (<140/90mmHg) and normal home (<135/85mmHg) blood pressure (BP) attainment after 6 month (M) standardized algorithmic treatment and home BP monitoring (HBPM) of normal weight, overweight and obese uncomplicated hypertensives (UH) in longitudinal real-life BP control program. Design and method: Per protocol cohort of PERFECT-BP prospective observational study (ISRCTN75706523) included 430 patients (pts) < 75 years (57.6 ± 0.5years) newly diagnosed (18,3%) or treated but uncontrolled (BP < 200/120 mmHg) UH. Pts and MDs (54 ambulatory cardiologists) were provided with standardized precalibrated automatic BP measurement devices with individually selected and universal cuff correspondingly. At visit 1, pts were given training and written instructions for HBPM and recording (twice per day for 7 consecutive days before each visit at day 7, M1, 2, 3, 6) and were prescribed or switched to perindopril/amlodipine fixed-dose combination (FDC) (doses at discretion of MDs). Step 2 was FDC uptitration, step 3 – plus indapamid-SR, step 4 – spironolactone, step 5 – moxonidine or doxasosine. Results: Of participants, 33(7,7%) were normal weight, 190(44,2%) overweight and 195(45,3%) obese, data of 12(2,8%) pts were missed. Normal weight, overweight and obese pts did not differ in age, office systolic and diastolic BP level at baseline (165,4 ± 2,8; 165 ± 1,0; 166,7 ± 1,0mmHg and 97,9 ± 1,9; 96,8 ± 0,7; 97,6 ± 0,6mmHg respectively, all p > 0,05), but obese group compared to overweight had more females (118(60,5%) vs 90(47,4%), p < 0,05) and diabetics (47(24,1%) vs 13(6,8%), p < 0,01). At 6 M target office BP was attained in 25(75,8%), 159(83,7%), 157(80,5%) pts, normal home BP – in 21(63,6%), 131(68,9%), 118(60,5%) pts, both target office and normal home BP – in 21(63,6%), 123(64,7%), 110(56,4%) pts respectively (all p > 0,05). Among obese 76(39%) pts needed 3 or more drugs vs 5(15,1%) normal weight and 51(26,9%) overweight ones (all p < 0,05). Obese pts had higher office (132,5 ± 0,6 vs 129,2 ± 0,7mmHg, p < 0,05) and home (130,5 ± 0,6 vs 128,1 ± 0,6mmHg, p < 0,05) systolic BP at 6 M then overweight ones. Conclusions: Weight status of UH didn’t influence on 6 M results of standardized algorithmic treatment with HBPM for both office and home BP control, but obese pts required more antihypertensive medications compared to normal weight and overweight ones with similar baseline BP levels.

Oscillometric casual blood pressure normative standards for Swedish children using ABPM to exclude casual hypertension.

Casual blood pressure (CBP) is considered a reliable proxy for cardiovascular health. Although the auscultatory technique is the reference standard method for measuring CBP, oscillometric devices are increasingly being used in children. We sought to establish oscillometric CBP normative standards for Swedish children. Cross-sectional oscillometric CBP readings were obtained by the Welch Allyn Spot Vital Signs 420 monitor and measured according to the International Guidelines' recommendations. Participants with elevated oscillometric CBP levels underwent verification by the auscultatory method. Ambulatory blood pressure monitoring (ABPM) was used to exclude casual hypertension. Data on 1,470 (772 males) apparently healthy Swedish schoolchildren aged 6-16 years were analyzed and sex-specific reference charts normalized to age or height were constructed. Systolic and diastolic CBP values were significantly higher with age, height, height standard deviation score (SDS), body mass index (BMI), and BMI SDS. Gender differences for systolic CBP were present starting from age of 15 years and revealed significantly higher values in boys than in girls, whereas for diastolic CBP, the differences were apparent at the age of 12 years, with higher values in girls. Increased BMI and BMI SDS were positively associated with CBP levels. Positive parental history of hypertension turned out to be a risk factor for higher systolic and diastolic CBP across all ages. Our normative standard for CBP can be used for blood pressure screening and control programs in Swedish children. The use of ABPM should be considered to confirm the diagnosis of casual hypertension.

Check it, change it: a community-based, multifaceted intervention to improve blood pressure control.

Although home blood pressure (BP) monitoring interventions have shown potential in selected populations, it is unclear whether such strategies can be generalized. We sought to determine whether a multifaceted BP control program that uses a web-based health portal (Heart360), community health coaches, and physician assistant guidance could improve hypertension control in a diverse community setting. Between September 12, 2010, and November 11, 2011 Check It, Change It, a community-based hypertension quality improvement program, enrolled 1756 patients with hypertension from 8 clinics in Durham County, NC. The Check It, Change It community intervention was evaluated using a prepost study design without a concurrent control. Participants were stratified into 3 tiers according to their initial BP: tier 0 (BP <140/90 mm Hg)=51% of population, tier 1 (BP=140/90-159/99 mm Hg)=30% of total, and tier 2 (BP ≥159/99 mm Hg)=19% of total. Overall, median age was 59 years (interquartile range, 49-69), 67% were female, and 76% black. After 6 months, the mean overall systolic BP declined 4.7 mm Hg. Rates of achieving target BP control (<140/90) increased overall from 51% at baseline to 63% by 6 months, and 69% had either reached their BP target or had reduced their baseline systolic BP by 10 mm Hg or more. A multicomponent-tiered hypertension program was associated with improved BP control in a diverse community-based population.

Organized Blood Pressure Control Programs to Prevent Stroke in Australia

High blood pressure (BP) is the most important modifiable stroke risk factor. Worldwide high BP in many people is uncontrolled or people are unaware of their BP status. We aimed to assess whether a program of organized multidisciplinary care and medication would be cost-effective for improving BP control for the prevention of stroke. A novel aspect was to simulate the intervention to match recent primary care initiatives (eg, new Medicare reimbursement items) to ensure policy relevance. Current practice and additional costs of each intervention were included using the best available evidence. The differences in the cost per quality-adjusted life year (QALY) gained for the interventions were compared against current practice. Cost-effectiveness was defined as cost per QALY gained was less than Australian dollars (AUD) 50 000 (societal perspective; reference year 2004). The robustness of estimates was assessed with probabilistic multivariable uncertainty analysis. For primary prevention, the median cost per QALY gained was AUD11 068 (95% uncertainty interval AUD5201 to AUD18 696) in those aged 75 years or older and was AUD17 359 (95% uncertainty interval AUD10 516 to AUD26 036) in those aged 55 to 84 years with ≥15% absolute risk of stroke. Primary prevention interventions were not cost-effective if aged younger than 50 years. The median cost per QALY gained for secondary prevention was AUD1811 and AUD4704, depending on which medications were modeled. Organized care for BP control targeted at specific populations offers excellent value over current practice. Organized care for secondary prevention provided the greatest benefits and strongest cost-effectiveness. Translation into clinical practice requires improved use of relevant Medicare policy in Australia.

OBESITY AND HIGH BLOOD PRESSURE OF 12-HOUR NIGHT SHIFT FEMALE CLEAN-ROOM WORKERS

The 12 h shift schedule is widely used in clean rooms for electronic semiconductor production in Taiwan. This study investigated the associations of obesity and metabolic syndrome (MetS) components among women working in a semiconductor manufacturing factory in North Taiwan. Workers were divided into four groups according to their work schedules and duties (i.e., office workers, day workers, fixed 12 h day shift, and fixed 12 h night shiftworkers). The subjects comprised 1838 women who voluntarily attended a health examination between August 2006 and November 2006. Their mean (±SD) age was 33.6 (±7.1) yrs and their mean duration of work was 7.4 (±5.2) yrs. Each subject's health-related behaviors, body mass index, and MetS components were measured and analyzed using multivariate logistic regression. Obesity and MetS were defined according to World Health Organization criteria for Asian populations and the National Cholesterol Educational Program and Adult Treatment Panel III Guidelines, respectively. The results showed that women working in the clean room on fixed 12 h night shifts had significantly elevated odds ratios for obesity (OR, 2.7; 95% CI, 1.6–4.5), central obesity (OR, 2.9; 95% CI, 1.7–5.1), and high blood pressure (OR, 2.3; 95% CI, 1.2–4.4) compared to female office workers; these results persisted after adjusting for age, smoking, drinking, education, and duration of work. We did not find any significant differences in triglyceride and high-density lipoprotein cholesterol among women working different schedules. We conclude that working fixed 12 h night shifts was associated with an increased odds ratio for obesity, central obesity, and high blood pressure among clean-room women workers. Weight reduction and blood pressure control programs should be implemented in the workplace for women working fixed 12 h night shifts. (Author correspondence: m006671@ms.skh.org.tw)

A prospective study on the association between control of blood pressure and incidence of type 2 diabetes mellitus.

To investigate the relationship on the effect of blood pressure (BP) control and the incidence of new diabetes mellitus (DM) in a follow-up study. In this prospective study, non-diabetic subjects (n = 3146, 41% men) were recruited from the program "Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province" (PMMJS) to evaluate the risk of DM in relation to BP control program on both healthy or hypertensive patients. During the follow-up period, 102 subjects developed diabetes. In both healthy or hypertensive patients groupes, the incidence rates of diabetes increased along with the increase of either systolic or diastolic BP and were significantly higher in subjects who had become hypertension (5.6%) or patients with uncontrolled (7.1%) BP at baseline survey than in those who had maintained normal BP (1.9%) or with controlled BP at baseline survey (2.2%). After adjusted for age, sex and other diabetes-related risk factors at baseline study, the aRR of diabetes incidence for subjects with normal BP at baseline who became hypertension (1.84, 95%CI: 1.00 - 3.63) was higher than who maintained normal BP (1.90, 95%CI: 1.03 - 3.74) after the follow-up program, and hypertensive patients with uncontrolled BP was higher than those with controlled BP. When adjusted for baseline MS, the aRR (95%CI) for subjects with normal BP at baseline who had developed hypertension was 1.70 (0.99 - 2.78) compared those remained normal BP levels after the follow-up program, and 1.90 (1.04 - 3.75) for hypertensive patients with uncontrolled BP when compared with those whose BP had been under control. When the BP level had been effectively under control, the risk of developing a type 2 diabetes could be reduced.

Cost-utility analysis of a national project to reduce hypertension in Israel

BackgroundThis study aims to calculate the health effects and costs of a proposed national hypertension prevention and control program.MethodsInterventions are based on experience from our two programs: 10-year period of Ashkelon Hypertension Detection and Control Program (AHDC Program) and the Israel Blood Pressure Control (IBPC) program. The costs of a nationwide program were calculated based on economic data, training staff levels, course frequency and unit costs.ResultsOver the next 20 years, the program should decrease the risk in one-half of the treated hypertensive cases of the following ailments: cardiovascular events such as Acute Myocardial Infarction (AMI) and Unstable Angina Pectoris (UAP) by 16.0%, stroke by 41.2%, End stage renal disease (ESRD) by 50.0% and peripheral vascular disease (PVD) by 42.6%. In total, around 2,242 lives, 35,117 years of life or 24,433 disability adjusted life years will be saved due to decreased mortality.Program costs amount to $352.7 million. However savings ($537.6 million), from reduced medical treatment ($444.3 million) and reduced pharmaceutical use ($93.3 million) as a result of morbidity decreases, exceed costs by $185.0 million.ConclusionThe project which saves both lives and resources should be extended nation-wide to reach as wide a population as possible.

One Month Behavioral Blood Pressure Control Program Assisted by Computer Tailored Advices (First Report)

One Month Behavioral Blood Pressure Control Program Assisted by Computer Tailored Advices (First Report)

Improvement of risk factor management amongst hypertensive patients by educating family practitioners: the israeli blood pressure control (IBPC) program

The IBPC program was designed to improve risk factor control amongst hypertensive patients, without allocating patient treatment to specialized risk factor clinics. The program started in August 2000, and it was headed by authoritative figures in risk factor control in Israel. Family practitioners, each caring for 1000 to 5000 patients, were asked to join the program and register data of hypertensive patients. Each physician was allocated a small budget for program related expenses. The organizing committee scheduled meetings every 2 months, to report on the progress of the program, and to review the treatment guidelines. Each physician received the data analysis concerning his clinic, and a comparison to the other centers. After one year, the participants filled the follow-up data regarding the same patients. A total of 4742 patients from 30 centers were recruited for the registry. After 1 year, systolic and diastolic BP dropped by 5.2% (from 142±16 mmHg to 135±14 mmHg, p<0.001, and from 85±11 to 80±8 mmHg p<0.001 respectively). 46.5% had controlled BP (according JNC VI) at follow-up compared to 31.6% at baseline (p<0.001). 88% of the clinics had more patients reach the JNC VI goals than they did at baseline, and 78% had more than 35% of their patients achieve the goals (compared to 30% at baseline, p<0.001). LDL-c reduced from 134±35 mg/dL at baseline to 126±49 mg/dL (p<0.001) at follow-up, and 42.6% had LDL-c levels below the ATP-III recommended goals(compared to 31.5% at baseline, p<0.001). 94% of the clinics had more patients reach the ATP III goals than they did at baseline, and 66.6% pf the clinics had more than 35% of their patients achieve the goals (compared to 33% at baseline, p<0.001). The changes in blood pressure and lipid levels were achieved by enhancing adherence to perscribed treatment, increasing the number and dosage of BP and lipid lowering medications and improving lifestyle. The estimated 10-year risk according to ATP 3 risk charts was reduced from 18.0 (6% 10-year risk) to 17.4 points (5% 10-year risk) in females (p<0.001) and from 16.9 points (25-30% 10-year risk) to 13.8 points (12-16% 10-year risk) in males (p<0.001). We demonstrated that a physician education program can improve the quality of treatment in high risk patients in the community.

Risk factor profile and achievement of treatment goals among hypertensive patients from the Israeli Blood Pressure Control (IBPC) program - initial cost utility analysis

Aims: Blood pressure (BP) reduction is crucial in reducing cardiovascular morbidity and mortality. The IBPC (Israeli Blood Pressure Control) program was initiated in order to enhance the control of modifiable risk factors among high-risk hypertensive patients under follow-up by general practitioners in Israel. The cost effectiveness of an intervention program is an important factor in the decision-making process of its implementation and therefore was evaluated here. The objective of this evaluation is to estimate the costs, monetary savings and benefits in terms of QALYs (quality-adjusted life years) that would be expected if the program were to be expanded to 100 clinics nationwide, enabling around 14 800 persons to be treated. Methods: Hypertensive patients were screened in 30 general practice clinics, supervised by specialists in family medicine, each seeing 1000-5000 patients; 50-250 hypertensive patients were diagnosed at each participating clinic. BP levels, body mass index (BMI), lipid and glucose levels, as well as target organ damage and medications were recorded for all patients. Results: A total of 4948 (2079, 42% males) were registered. Mean age was 64.8 ± 12 years. After 1 year of follow-up versus baseline, the various parameters were as follows: BP control was achieved in 46.4% vs 29% of all hypertensive patients. LDL control (JNC VI criteria) was achieved in 41.7% vs 31.2% of all patients. Fasting plasma glucose control (glucose <126 mg/dl) was achieved in 22% vs 19% of diabetic patients and 5.2% vs 3.1% of the diabetics had fasting plasma glucose levels >200 mg/dl. Obesity (BMI >30 kg/m[Formula: See Text]) was noted in 36.7% vs 43.8% at baseline. The cost utility analysis of the reduction in risk factors was calculated based on the international dicta applied to the reduction in risk factors as a result of treatment. For 100 clinics nationwide and 14 800 persons to be treated the net saving to health services would be $977 993 and the increase in QALYs would be 602 years. Conclusions: Better risk factor control in hypertensive patients by general practitioners could reduce morbidity and mortality as well as be cost effective.

Hypertension awareness, treatment and control rates for an Asian population: results from a national survey in Korea.

This observational study was performed in order to determine the hypertension awareness, treatment, and control rates for the country of Korea. Rates were determined in conjunction with a national blood pressure survey in Korea in 1990. Through cluster sampling, individuals aged > 30 in 190/146,944 districts were selected for study. Among 25,567 eligible individuals, 21,242 had measurement of blood pressure (BP) and answered a standard questionnaire. BP was recorded as the mean of two measurements with a standard mercury manometer. Hypertension was defined either as BP > or = 160/95 mm Hg or on treatment (n = 2628), or as BP > or = 140/90 mm Hg or on treatment (n = 4219). Treatment was defined as any method of BP treatment, including dietary, traditional, or medication. Rates for BP > or = 160/95 mm Hg or on treatment: aware 1057 (40%), treated 696 (27%), controlled 367 (14%). Rates for BP > or = 140/90 mm Hg or on treatment: aware 1069 (25%), treated 696 (16%), controlled 221 (5%). Hypertension awareness, treatment, and control rates are relatively low in Korea. Blood-pressure control programs, including detection strategies, are needed here and worldwide.