Outpatient Hypertension Clinic Research Articles

Treatment of hypertension at an outpatient hypertension clinic. Blood pressure control, dropout rate, and side effects

Long-term results from an outpatient hypertension clinic concerning blood pressure (BP) control, dropout rate, and adverse effects of treatment in a random population sample are presented. Six hundred eighty-six men, aged 47–54 years, and recruited from a screening examination with casual systolic BP > 175 mm Hg or diastolic BP > 115 mm Hg on two occasions or already on antihypertensive therapy, were treated and followed for 5 years. The 5-year dropout rate of patients refusing to participate or lost for unknown reasons was low (4.2%), with the highest incidence during the first year (2.2%). The most commonly used drugs were beta-adrenoceptor blocking agents (69%), thiazide diuretics (62%), and hydralazine (34%). After 5 years' follow-up 58% of the patients had BP below 160 mm Hg systolic and 95 mm Hg diastolic, 33% had BP between 160–170 mm Hg systolic or 95–105 mm Hg diastolic, and 9% remained above 170 mm Hg systolic and/or 105 mm Hg diastolic. This blood pressure control was in many cases achieved first after several years of treatment and with the frequent use of combination drug therapy (66%). Patients who remained above 170 mm Hg systolic and/or 105 mm Hg diastolic after 5 years were characterized by higher initial BPs, more frequent eye—ground changes, heart enlargement, and more frequent alcohol problems, but also by being on more aggressive treatment. After the initial treatment phase, the frequency of adverse effects necessitating drug withdrawal was low, approximately 3% per year. These promising results are attributed to the clinical routine used and thus point to a potential benefit of structured care for the management of large patient populations.

Random one-hour urine catecholamine and 4-hydroxy-3-methoxymandelic acid assays for diagnosis of pheochromocytoma.

Using randomly voided 1-h urine samples, levels of excretion of catecholamines (CA) and 4-hydroxy-3-methoxymandelic acid (vanillylmandelic acid; VMA) were determined in order to save time in and simplify the diagnostic work-up of pheochromocytoma, particularly in out-patient hypertension clinics. Twenty-nine patients with surgically verified pheochromocytoma (15 paroxysmal and 14 sustained type), 56 patients with essential hypertension (26 labile and 30 fixed type) and 14 normal volunteers were studied. Abnormally high excretion of CA and VMA was found in all patients with pheochromocytoma when compared to those with essential hypertension or to normal controls after duly considering the influence of external factors such as food and exercise. From these results, we concluded that assays of CA and VMA even in random 1-h urine samples are useful in separating patients with pheochromocytoma from those with other types of hypertension.

A screening program for hypertension in outpatient clinics: Julia A. Thole, Miami University, Oxford, Ohio 45056

A screening program for hypertension in outpatient clinics: Julia A. Thole, Miami University, Oxford, Ohio 45056

Medication adherence and patient satisfaction among hypertensive patients attending outpatient clinic in Lagos University Teaching Hospital, Nigeria.

Low adherence is an essential element responsible for impaired effectiveness and efficiency in the pharmacological treatment of hypertension. Patient satisfaction is an important measure of healthcare quality and is a crucial determinant of patients' perspective on behavioural intention. This study determined the association between medication adherence and treatment satisfaction among hypertensive patients attending hypertension outpatient clinic in Lagos University Teaching Hospital (LUTH), Nigeria. Setting - The study setting was LUTH; a descriptive cross-sectional study was conducted. Study design - Hypertensive patients were consecutively recruited from the outpatient clinic. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale and treatment satisfaction was assessed using the 14-item Treatment Satisfaction Questionnaire for Medication. Univariate and linear regression analyses were conducted using STATA software version 14.1 (StataCorp LP, College Station, TX, USA). Statistical significance was set at P ≤ 0.05. A total of 500 respondents with a mean age of 58.9 ± 13.3 years participated in the study. Overall, majority (446 [89.2%]) of the respondents in this study had 'moderate' adherence to antihypertensive medication. However, only five (1.0%) respondents reported 'high' adherence. Mean scores were highest in the moderate adherence category for all satisfaction domains and overall domain. Treatment satisfaction was associated with medication adherence, and was statistically significant (P = 0.000). One in every hundred patients had high adherence to hypertensive medication in this study, and there was a positive association between treatment satisfaction and medication adherence. Continuous patient-specific and tailored adherence education and counselling for hypertensive patients is recommended.