Number Of Follow-up Examinations Research Articles

Effect of guideline revisions by the Swiss Society of Hypertension on blood pressure control in hypertensive patients from primary care.

We used longitudinal data from the Swiss Hypertension Cohort Study, which was a prospective, observational study conducted by the Centre for Primary Health Care of the University of Basel from 2006 to 2013. General practitioners (GPs) enrolled 1003 patients attending their practice with a pre-existing diagnosis of arterial hypertension or office blood pressure measurement ≥140/90 mm Hg and assessed office blood pressure, cardiovascular risk factors, subclinical organ damage, diabetes mellitus, and established cardiovascular and renal disease. Mixed-effects regression models were used to estimate the associations of (1) the change in hypertension guidelines in 2009 with blood pressure and antihypertensive therapy in high-risk patients, and (2) cardiovascular risk factors with blood pressure target achievement in patients with complicated and uncomplicated hypertension. Models were adjusted for sociodemographic and health-related covariates. Missing data were imputed using a “multiple imputation by chained equation” approach. At baseline, hypertensive patients were on average 65.9 ± 12.5 years old and 55% were male. Blood pressure targets were achieved in 47% of patients with uncomplicated hypertension and in 13% of high-risk patients at baseline. In multivariable analyses adjusted for potential confounding factors, a visit by high-risk patients after 2009 was associated with decreased systolic office blood pressure (−5.40 mm Hg, 95% confidence interval [CI] −8.08 to 2.73) and a trend towards an increased use of pharmacological combination therapy (odds ratio [OR] 1.85, 95% CI 0.94 to 3.63; p = 0.073) compared with a visit before 2009. Neither a reduction of diastolic blood pressure nor an increase of blood pressure target achievement in high-risk patients was observed after 2009. High-risk patients were slightly more likely to achieve blood pressure targets at later follow-up visits than at baseline (OR 1.35, 95% CI 0.98 to 1.86; p = 0.068). In patients with uncomplicated hypertension, factors associated with the likelihood to achieve blood pressure goals were the increased use of pharmacological combination therapy (OR 1.19 per combination increase: e.g., dual therapy vs monotherapy, 95% CI 1.02 to 1.40), left ventricular hypertrophy (OR 0.58, 95% CI 0.36 to 0.93), older age (OR 1.19 per 10 years, 95% CI 1.02 to 1.40) and the number of follow-up examinations (OR 1.44 per follow-up visit, 95% CI 1.21 to 1.72). Overall, blood pressure goal attainment remains low for treated hypertensive patients followed up by primary care physicians in Switzerland. Independent of known confounding factors for blood pressure, the 2009 guideline change in high-risk patients was associated with a reduction in systolic office blood pressure together with an increase in pharmacological combination therapy. These results highlight primary care physicians’ efforts to implement blood pressure guidelines. Further, blood pressure goal attainment was more likely to be achieved in later follow-up visits, indicating that it takes time and regular follow-up visits with the GP to meet blood pressure goals. &nbsp.

AGE-RELATED TRENDS IN BLOOD PRESSURE BASED ON LARGE-SCALE HEALTH CHECKUP DATA USING LONGITUDINAL ANALYSIS

Objective: Information on the change in blood pressure (BP) during the life course is essential from both clinical and public health standpoints. Most studies demonstrating age-related trends in BP were based on cross-sectional data. Since an elevated BP at a younger age results in fatal cardiovascular events in later life, the cross-sectional study design contributes to an underestimation of BP in elderly individuals. The present study involved longitudinal analysis to assess age-related trends in BP, using large-scale data. Design and method: We received data of health check-up conducted between 2008–2017 and used a total of 2,235,055 observations from 386,760 individuals aged between 30–74 years in the JMDC database, which contains multiple health checkup data from the Japanese health insurance societies. The age-related trends in BP were estimated using a repeated-measures mixed linear model including age, sex, and an interaction between age and sex. We cross-sectionally summarized the prevalence rate of hypertension and antihypertensive treatment rate among hypertensives in each age group. Results: The number of follow-up examinations without baseline visit was < 2, 3, 4, or > = 5 in 14,453 (3.8%), 33,468 (8.7%), 139,961 (36.2%), and 198,878 (51.4%), respectively. Systolic BP increased consistently from 121.1 mmHg at 36 years to 129.7 mmHg at 66 years in men and from 109.7 mmHg at 33 year to 131.9 mmHg at 74 years in women. The diastolic BP increased from 72.1 mmHg mmHg at 30 years to 80 mmHg at 56 years in men and from 64.7 mmHg at 30 years to 74.6 mmHg at 64 years but decreased after the peak. The prevalence rate of hypertension increased linearly with age; the rates at the age of 60 years were 51.8% for men and 39.5% for women. The antihypertensive treatment rate increased with age but was less than 50% before 50 years.Conclusions: Systolic BP increased linearly with age. There was an inverse-U shaped age-related trend in diastolic BP and the time of the peak in women was approximately ten years later than that in men. The present findings also suggest that the antihypertensive treatment rate in young adults should be enhanced.

Night-time blood pressure is associated with the development of chronic kidney disease in a general population

Ambulatory blood pressure (BP) is reportedly associated with target organ damage. However, whether ambulatory BP carries prognostic significance for the development of chronic kidney disease (CKD) has not been confirmed. We measured ambulatory BP in 843 participants without CKD at baseline from a general Japanese population and examined the incidence of CKD defined as positive proteinuria or an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m at health checks. The association between baseline ambulatory BP and CKD incidence was examined using the Cox proportional hazard regression model adjusted for sex, age, BMI, habitual smoking, habitual alcohol consumption, diabetes mellitus, hypercholesterolemia, a history of cardiovascular disease, antihypertensive medication, eGFR at baseline, the number of follow-up examinations, and the year of the baseline examination. The mean age of the participants averaged 62.9 ± 8.1 years, 71.3% were women and 23.7% were under antihypertensive medication. During a median follow-up of 8.3 years, 220 participants developed CKD events. The adjusted hazard ratios for CKD in a 1-standard deviation increase in daytime and night-time SBP were 1.13 [95% confidence interval (CI) 0.97-1.30] and 1.21 (95% CI 1.04-1.39), respectively. When night-time and daytime BP was mutually adjusted into the same model, only night-time BP persisted as an independent predictor of CKD. Night-time BP is a better predictor of CKD development than daytime BP in the general population. Ambulatory BP measurement is considered useful for evaluating the risk of progression to CKD.

Pre-hypertension as a significant predictor of chronic kidney disease in a general population: the Ohasama Study

Hypertension is associated with an increased risk of development of chronic kidney disease (CKD). However, it is unclear whether pre-hypertension is related to the incidence of CKD. The incidence of CKD defined as positive proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) was examined in 2150 inhabitants without pre-existing CKD from the general Japanese population. The association of blood pressure and CKD incidence was examined using a Cox regression model adjusted for age, sex, habitual smoking and drinking, obesity, history of cardiovascular disease, diabetes mellitus or hypercholesterolemia, eGFR at baseline, number of follow-up examinations and year of baseline examination. Participants were categorized according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Participants were categorized into normotension (n = 586, 27.3 % ), pre-hypertension (n = 815, 37.9 % ), Stage 1 hypertension (n = 386, 18.0 % ) and Stage 2 hypertension (n = 363, 16.9 % ). During a mean follow-up of 6.5 years (14 023 person-years), 461 incidences of CKD were recorded. Compared to normotension, adjusted hazard ratios of CKD were significantly higher for pre-hypertension (1.49, P < 0.003), Stage 1 (1.83, P < 0.001) and Stage 2 (2.55, P < 0.001) hypertension. The population-attributable fraction of pre-hypertension (12.1 % ) was considered to be compatible to that of Stage 1 (8.6 % ) and Stage 2 (14.9 % ) hypertension. This was the first study to demonstrate that pre-hypertension was significantly associated with an increased risk of CKD and was one of the considerable causes of CKD in the general population.

Treatment adherence in bipolar disorder

Purpose: A high level of treatment adherence is essential in patients with bipolar disorder for effective treatment, due to chronic progressive nature of the illness requiring maintenance treatment. Treatment nonadherence in individuals with bipolar disorder is the main reason for relapse and recurrence. The purpose of this study is to investigate the relationship between treatment adherence and the level of medication treatment adherence in the last month, socio-demographic and clinic characteristics affecting adherence, and the number of follow-up examinations within the last year in euthymic bipolar patients who registered at a psychiatry outpatient clinic at least a year ago. Method: The sample group of this study comprised of 147 euthymic patients, aged over 18, who visited the Psychiatry Outpatient Clinic of Malatya State Hospital, and diagnosed with a Bipolar Disorder in accordance with DSM-IV, and had been monitored at the clinic for at least a year because of this diagnosis. The hospital records were examined simultaneously for patients attending their follow-up examinations between 02.01.2011 and 02.28.2011. The patients, who had computerized records as of February 01, 2010, were included in this study, and their number of follow-up examinations was obtained from hospital records. The information regarding participating patients’ demographic variables, clinical properties, and their attitude towards their illness and treatment were recorded in the Data Gathering Form. The patients were categorized in two groups; those that had taken their medication or taken it irregularly for less than seven days within the last month were categorized as “treatment adherent,” and those that had not taken their medication or taken it irregularly for more than seven days within the last month were categorized as “treatment nonadherent.” SPSS 16.0 was used for the statistical data analysis. The data of treatment adherent group was compared to the data of treatment nonadherent group. Results: 108 (73.5%) patients were treatment adherent, while 39 (26.5%) patients were treatment nonadherent. The level of education (based on 8 years) was higher in the treatment adherent group (pl0.001). The rate of hospitalization was lower in the treatment adherent group in comparison to the treatment nonadherent group (pl0.05). The rate of attending to follow-up examinations within the last year (t= -5.42) and the level of insight towards their illness was higher in the treatment adherent group (pl0.001). There was no difference between the two groups in terms of their present medication or drug combinations (pg0.05). The treatment adherent group believed that they were more informed about their illness and treatment in comparison to the nonadherent group (pl0.001). The treatment nonadherent group believed that treatment had no effect on their disorder more than the treatment adherent group (pl0.05); the rate of disregarding medication because they thought they had recovered was higher in the treatment nonadherent group in comparison to the treatment adherent group (pl0.001). The rate of abandoning treatment, because of thinking that they had recovered, was higher in comparison to the rate of not taking medication, because they thought the treatment was not effective (p=0.04, ?2=8.64). The number of patients, who were discontent about taking medication, was higher in the treatment nonadherent group (pl0.05). Conclusion: In this study, some characteristics such as a lower education level, thinking that they had inadequate information regarding their illness, lack of insight, and dissatisfaction with treatment, were significantly higher in the treatment nonadherent group. The most common reason behind discontinued treatment was that individuals believed that they had recovered from their disorder and discontinued their medication(s).

Clinical Experience with a Circular Stapled Hemorrhoidopexy without Circular Anal Dilator (CAD)

Purpose: The circular stapled hemorrhoidopexy (SH) reduces mucosal prolapse and interrupts the end branches of the upper hemorrhoidal artery through a suitable instrument, Procedure for Prolapse and Hemorrhoids (PPH). However, there are some technical difficulties in routine use of the circular anal dilator (CAD). The goal of this study was to evaluate the efficacy and the safety of a CSH without use of a CAD. Methods: Between April 2005 and November 2006, 250 patients with Grade III and IV prolapsed hemorrhoids who had undergone CSH with PPH without using a CAD were retrospectively analyzed. The sex and age, the operation time, the type of anesthesia, the number of excised hemorrhoid piles, the degree of hemorrhoids and postoperative pain (consumed analgesics), the hospital stay, the postoperative complications, and the number of follow-up examinations at the outpatient clinic were analyzed. Results: The operation time was 17.76 minutes (10∼35 minutes). Most patients (89%) experienced spinal anesthesia. The degrees of hemorrhoids were Grade III (45%) and Grade IV (55%). The numbers of excised piles were 3 (44%), 4 (43%), and more than 5 (13%). The number of consumed postoperative analgesics was 0.97 times (mean). The mean hospital stay was 2.83 days. The postoperative complications were pain, bleeding, and urinary retention. Conclusions: A CSH without use of a CAD was an effective and safe surgical modality compared with other procedures for treating hemorrhoids. This procedure is feasible and convenient. The procedure is a new alternative in the treatment of severe hemorrhoids.

VULVAR MALIGNANCIES TREATED AT SABBATSBERG HOSPITAL OVER 20 YEARS

The paper surveys all cases of malignant vulvar tumor treated at Sabbatsberg Hospital in Stockholm over a period of 20 years. The observations made during hospitalization have been supplemented with information gathered from clinical records, from personal Communications from doctors subsequently treating the patients and from a number of follow-up examinations and interviews with surviving patients. It has thus been possible to make a longitudinal study of several patients, some of which were followed for more than 15 years.In spite of the serious disease, the malignant character of which was confirmed histologically in all cases, a high frequency of concomitant serious diseases and a high average age at the onset of symptoms, many patients were found to be in good condition several years after operation. For squamous cell carcinoma of the vulva, the survival rate was higher than that for comparable published materials. Thus, for patients who had undergone primary operation at Sabbatsberg, the 5-years ex...