Standardized Management Of Hypertension Research Articles

The Effect of Zikr Meditation on Anxiety, Stress Levels and Blood Pressure in Hypertensive Patients

Background: Hypertension, a prevalent chronic condition, poses significant health risks when left untreated. Psychological factors like stress and anxiety are known contributors to high blood pressure. Effective management of hypertension may benefit from non-pharmacological interventions that address these psychological elements. Purpose: This study aims to evaluate the impact of Zikr meditation, a spiritual mindfulness practice, on reducing anxiety, stress, and blood pressure in individuals with hypertension. Methods: A double-blind randomized controlled trial was conducted with 60 hypertensive patients, randomized into intervention and control groups. The intervention group participated in 20-minute Zikr meditation sessions for four weeks daily, while the control group engaged in a placebo activity. Anxiety and stress levels were measured using the Hamilton Anxiety Rating Scale (HAM-A) and the Perceived Stress Scale (PSS), respectively. Blood pressure readings were taken before and after the intervention. Results: Participants in the Zikr meditation group showed a significant reduction in anxiety and stress levels compared to the control group. Additionally, there was a notable decrease in systolic and diastolic blood pressure among those practicing Zikr meditation. Conclusions: Zikr meditation effectively reduces anxiety and stress, leading to lower blood pressure in hypertensive patients. These findings suggest that incorporating Zikr meditation into standard hypertension management could offer a valuable, non-pharmacological approach to improving cardiovascular health. Further research is recommended to examine Zikr meditation's long-term effects and broader applicability in hypertension care.

Outcomes of a hypertension care program based on task-sharing with private pharmacies: a retrospective study from two blocks in rural India

Low density of formal care providers in rural India results in restricted and delayed access to standardized management of hypertension. Task-sharing with pharmacies, typically the first point of contact for rural populations, can bridge the gap in access to formal care and improve health outcomes. In this study, we implemented a hypertension care program involving task-sharing with twenty private pharmacies between November 2020 and April 2021 in two blocks of Bihar, India. Pharmacists conducted free hypertension screening, and a trained physician offered free consultations at the pharmacy. We calculated the number of subjects screened, initiated on treatment (enrolled) and the change in blood pressure using the data collected through the program application. Of the 3403 subjects screened at pharmacies, 1415 either reported having a history of hypertension or had elevated blood pressure during screening. Of these, 371 (26.22%) were enrolled in the program. Of these, 129 (34.8%) made at least one follow-up visit. For these subjects, the adjusted average difference in systolic and diastolic blood pressure between the screening and follow-up visits was −11.53 (−16.95 to −6.11, 95% CI) and −4.68 (−8.53 to −0.82, 95% CI) mmHg, respectively. The adjusted odds of blood pressure being under control in this group during follow-up visits compared to screening visit was 7.07 (1.29 to 12.85, 95% CI). Task-sharing with private pharmacies can lead to early detection and improved control of blood pressure in a resource-constrained setting. Additional strategies to increase patient screening and retention rates are needed to ensure sustained health benefits.

The Early Impact of the People-centred Integrated Care on the Hypertension Management in Shenzhen.

To evaluate the impact of the integrated care in Luohu, China on the hypertension management. Hypertensive patients aged 35-74 years were recruited by the cluster-randomized sampling method from Luohu district which adopted integrated care and another district that remained original routine care during October 2018~January 2020, with 1353 and 583 patients from integrated and routine care communities, respectively. Health information, knowledge, attitude, and practice (KAP) towards cardiovascular diseases, pharmaceutical expenditure on hypertension and its comorbidities, and healthcare-related satisfaction were collected by questionnaires, with the expenditure additionally verified by hospitals' billing records database. Continuous and categorical variables were compared by Wilcoxon test and Chi-square test, respectively. The age-standardized hypertension control rate was calculated by direct standardization. The standardized hypertension management rate in the integrated care communities (45.75%) was significantly higher than that in routine care communities (14.07%) (P < 0.0001), while the age-standardized hypertension control rates were similar (integrated care: 50.3%, routine care: 52.65%, P = 0.518). The pharmaceutical expenditure on hypertension and its comorbidities in the integrated care communities was Ұ264.23 ± 357.38/month/person, lower than that in the routine care communities (Ұ354.56 ± 430.59/month/person). Patients in the integrated care had higher KAP scores (73.48 ± 11.54), compared with routine care (68.89 ± 15.51) (P < 0.0001). Moreover, the integrated care communities had higher satisfaction rates towards the convenience of dual referral (90.15% vs. 77.99%) and service quality (95.18% vs. 87.81%) than routine care communities (P < 0.0001). The practice of the integrated care in Luohu has substantially improved the hypertension management and the healthcare-related satisfaction while with relatively low pharmaceutical expenditure. The investigation of long-term impact of the integrated care on hypertension control and management is warranted.

Delivering hypertension care in private-sector clinics of urban slum areas of India: the Mumbai Hypertension Project

In India, the private sector provides 70% of the total outpatient medical care. This study describes the Mumbai Hypertension Project, which aimed to deliver a standard hypertension management package in private sector clinics situated in urban slums. The project was conducted in two wards (one “lean” and one “intensive”) with 82 private providers in each. All hypertensive patients received free drug vouchers, baseline serum creatinine, adherence support, self-management counseling and follow-up calls. In the intensive-ward, project supported hub agents facilitated uptake of services. A total of 13,184 hypertensive patients were registered from January 2019 to February 2020. Baseline blood pressure (BP) control rates were higher in the intensive-ward (30%) compared with the lean-ward (13%). During the 14-month project period, 6752 (51%) patients followed-up, with participants in the intensive-ward more likely to follow-up (aOR: 2.31; p < 0.001). By project end, the 3–6-month cohort control rate changed little from baseline—29% for intensive ward and 14% for lean ward. Among those who followed up, proportion with controlled BP increased 13 percentage points in the intensive ward and 16 percentage points in the lean ward; median time to BP control was 97 days in the intensive-ward and 153 days in lean-ward (p < 0.001). Despite multiple quality-improvement interventions in Mumbai private sector clinics, loss to follow-up remained high, and BP control rates only improved in patients who followed up; but did not improve overall. Only with new systems to organize and incentivize patient follow-up will the Indian private sector contribute to achieving national hypertension control goals.

Effectiveness of a pathway-driven eHealth-based integrated care model (PEICM) for community-based hypertension management in China: study protocol for a randomized controlled trial

BackgroundThe prevalence of hypertension is high and increasing in China in recent years. The treatment and control of hypertension calls for long-term management beyond hospital, which is hard to implement in traditional care settings. Integrated care combined with information technology can promote high-quality healthcare services across the life-course. However, few studies have applied a customized integrated care model in community-based hypertension management in China, catering to the emerging “three-manager” mode. This study aims to identify the effectiveness of a pathway-driven eHealth-based integrated model that implemented as a full-featured telehealth system to facilitate standardized management of hypertension in China.MethodsThe trial has been designed as a 1-year, non-blinded superiority trial with two parallel groups. A total of 402 hypertensive patients who meet the eligibility criteria will be recruited and randomized with a 1:1 allocation. All the participants will receive a mobile device for self-management, which is a part of our telehealth system. Participants in the control group will only use the device for BP measurement and receive regular follow-ups from care providers according to the guidelines. Participants in the intervention group will gain full access to the system and receive intervention based on the proposed model (a well-designed coordinated care pathway consisting of 9 tasks). Outcomes will be measured mainly on three occasions (at inclusion, at 6 months, and at 12 months). The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes include changes in diastolic blood pressure, biochemical indexes related to hypertension, lifestyles, self-management adherence, and hypertension awareness, as well as work efficiency of care providers.DiscussionThis study aims to investigate whether a pathway-driven eHealth-based integrated care model based on the “three-manager” mode will improve hypertension control in China. Success of the model would help improve the quality of present community-based management procedures and benefit more patients with uncontrolled hypertension.Trial registrationChinese Clinical Trial Registry ChiCTR1900027645. Registered on November 22, 2019.

Epidemiology of Hypertension in a Typical State-Level Poverty-Stricken County in China and Evaluation of a Whole Population Health Prevention Project Intervention.

Background In China, there were 584 state-level, poverty-stricken counties until January 2019. The central government has invested a large amount of funds and preferential policies to alleviate poverty in these areas. The Whole Population Preventive Healthcare Pilot Project (WPPHCPP) aims to explore the use of limited funds to achieve healthy poverty alleviation through free regular physical examinations and comprehensive health management for the entire population in impoverished regions. Objective By demonstrating the prevalence of hypertension in populations of poverty-stricken counties in Western China and evaluating health management outcomes after implementing the WPPHCPP, we can provide a foundation for the future development and promotion of improved public health. Subjects and Methods Through the WPPHCPP, the entire population in the pilot area was required to undergo free physical examinations. The examinations screened for hypertension revealed the epidemiology of adult hypertension. Based on blood pressure levels and risk factor exposures, risk classifications for hypertensive patients were performed. Corresponding intervention and management strategies for different risk levels were provided by a joint management team consisting of family physicians from three different levels of local medical institutions (village, town, and county). Healthcare management outcomes including awareness, treatment, and hypertension disease rates were compared between the period before and after the intervention and management. Results By the end of 2017, among the 452,200 permanent residents in the region, 285,458 adults had completed the physical examination. The prevalence of hypertension was 18.5%, which was lower than the national average of rural areas (28.8%). The prevalence of hypertension in men (18.7%) was slightly higher than that of women (18.3%). The prevalence of hypertension increases with age; for people aged >65 years, it was 39.2%. There were 15,074 newly discovered hypertensive patients in the WPPHCPP, accounting for 29.6% of the total hypertensive population in the region. Regarding the management outcomes, the rates of management and standardized management of hypertension increased each year between 2015 and 2017. Although the rate of disease control management decreased slightly, the overall level of management remained significant. The awareness and treatment rates of hypertension also increased over the years and peaked at 95.0% and 94.9%, respectively, in 2017. The disease control rate was 45.6% in 2016, which was the highest among the years assessed. All the above parameters were better than the national average of rural areas. From 2015 to 2017, the number of people with high-risk factors for hypertension and percentage of high-risk patients decreased from 33,064 to 26,982 and 27.4% to 24.6%, respectively. The percentage of the population exposed to cigarettes and alcohol decreased from 30.6% to 27.2% and 25.1% to 22.0%, respectively. The number of deaths due to hypertensive cardiovascular or cerebrovascular diseases decreased each year and was 275 (39.55/100,000 people) in 2017, which was the lowest rate measured. The annual growth of cardiovascular or cerebrovascular diseases remained negative. Conclusions The overall prevalence of hypertension in the studied area was lower than the national average of rural areas. The health management model of “government-led joint efforts of three levels of medical institutions (village, town, and county) with active participation of local village communities” improved the management outcomes of hypertensive patients and fulfilled the latest advocacy of the prevention and control of chronic diseases by the United Nations. This model can be considered an effective model for healthcare management practice in similar situations.

Effect of comprehensive intervention on hypertension control program in workplaces in China

Objective: To evaluate the effect of comprehensive intervention program on hypertension control in workplaces in China. Methods: The study design was a non-randomized controlled trial. First, 20 sub-centers were selected across China, then hypertension patients in 2-4 workplaces were selected as the intervention group, and hypertension patients in 1 comparable workplace selected, as the control group in each sub-center. The comprehensive intervention strategy which integrating workplace primary prevention of cardiovascular diseases and standardized management of hypertension was adopted in the intervention group for at least 2 years. Patients in the control group continued their usual health care, and only baseline data and 2-year data was collected. Analyses were conducted for hypertension patients in 30 stated-owned enterprises (SOEs), including 20 for the intervention group and 10 for the control group. The primary outcome was the control rate ofhypertension while the intervention effect (IE) was estimated by using the formula: differential value of intervention group[rate (mean)]-differential value of control group[rate (mean)]. Results: Overall, 2 622 patients completed the 2-year follow-up, of which 2 055 were in the intervention group and 567 in the control group, respectively. After 2 years of intervention, the IE on the level of SBP and DBP for intervention group and control group were-7.5 and-3.9 mmHg, respectively (P<0.05). BMI decreased by 0.4 kg/m(2), with the regular exercise rate as 36.4% and alcohol consumption rate decreased by 14.0%, respectively (P<0.05). The smoking rate decreased by 6.1% (P>0.05). The overall hypertension control rate was 25.0%, and further subgroup analysis showed that our intervention program was particularly effective for those with high education level (27.6%), white-collar employees (41.9%), and those from SOEs whose affiliated hospital had been separated away (41.9%). Conclusion: The comprehensive intervention program could greatly improve the hypertension control in the workplaces in China.

Efficacy of evidence-based medicine training for primary healthcare professionals: a non-randomized controlled trial

BackgroundThe impact of evidence-based medicine (EBM) training techniques in primary healthcare professionals remains to be determined.MethodsA non-randomized controlled trial (NRCT) was performed aiming to assess the two methods of evidence-based medicine training for primary healthcare professionals by assessing evidence based practice (EBP) related knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), anticipated future use (EBP-F), and community management of hypertension. Participants were recruited and assigned to either an EBM training group that receiving a weekly face-to-face EBM training course, or an EBM self-instruction course for eight weeks. A validated instrument was applied to evaluate the four aspects of EBP. Additionally, community management of hypertension was assessed by comparing the the rate of detection, blood pressure control, standard management, grading management and patient satisfaction between 2015 and 2016 to measure training efficacy. The difference between the impact of these two interventions was assessed statistically.ResultsOne hundred fifty-one participants (69 in the face-to-face EBM training group and 82 in the self-instruction group) were included. Compared to self-instruction, the face-to-face EBM training was associated with significantly improved EBP-Knowledge (26.14 ± 4.22 vs. 22.44 ± 4.47, P < 0.05), EBP-Personal application (22.52 ± 6.18 vs. 16.89 ± 5.99, P < 0.05), and EBP-Future use (44.04 ± 8.97 vs. 37.71 ± 8.39, P < 0.05). EBP-Attitude scores (10.89 ± 4.52 vs.14.93 ± 5.92, P < 0.000) were lower in the EBM training group. Stratified analyses showed that the results were consistent regardless of the participants’ gender, professional role (doctors & apothecaries or nurses), rank (junior or senior doctors & apothecaries), or specialty (Traditional Chinese or Western Medicine). Assessment of community hypertension management revealed that the rate of blood pressure control, standardized hypertension management and patient satisfaction was significantly better in group A than group B (1.14% vs.0.69, 2.85% vs.1.68 and 2.41% vs.0.84%).ConclusionsA face-to-face EBM training course improved primary healthcare professionals’ EBP knowledge, attitudes, personal application, and anticipated future use. Effective EBM training may improve the efficacy of primary health care services.Trial registrationNon-Randomized Controlled Trial ChiCTR1800017498, August 1, 2018.

Standardized Hypertension Management to Reduce Cardiovascular Disease Morbidity and Mortality Worldwide.

Standardized Hypertension Management to Reduce Cardiovascular Disease Morbidity and Mortality Worldwide.

Observation of the effect of community standardized management of hypertension and analysis of its influencing factors

Objective To study the blood pressure control and its influencing factors in community standardized management of hypertension patients, to provide basis for clinical diagnosis and treatment. Methods 120 hypertension patients with community standardized management were selected as study group, another 120 hypertension patients were selected as control group.The blood pressure control was compared between the two groups, and the influencing factors were analyzed. Results The systolic and diastolic blood pressur before treatment between the two groups had no statistically significant differences (all P>0.05). The systolic blood pressure, diastolic blood pressure after administration of the study group were (129.4±3.2)mmHg, (87.5±2.8)mmgHg, which in the control group were (138.3±10.1)mmHg, (95.7±4.3)mmHg, the differences were statistically significant compared with before treatment (t=9.478, 9.074, 8.278, 8.687, all P<0.05), the differences between the two groups were statistically significant (t=7.654, 7.061, all P<0.05). Logistic regression analysis showed that age, body mass index, obesity, smoking, blood pressure level, taste and triglyceride were the influencing factors of blood pressure control(OR=20.564, 0.995, 0.746, 1.092, 0.749, 1.153, 0.854, all P<0.05). Conclusion Community standardized management can enhance the effect of blood pressure control, age, body mass index, obesity, blood pressure level, smoking and so on are the influencing factors. Key words: Hypertension; Community Health Services; Blood pressure; Factor

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China: a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

An Update: Standardized Hypertension Management to Reduce Cardiovascular Disease Morbidity and Mortality Worldwide

An Update: Standardized Hypertension Management to Reduce Cardiovascular Disease Morbidity and Mortality Worldwide

Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project.

Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

Study on effects of community-based management of hypertension patients aged ≥35 years and influencing factors in urban and rural areas of China, 2010

To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors. The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects' demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ(2) test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension. A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area(44.56%)than in rural area(31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group(P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group(P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group(P<0.05). In urban area, the subjects receiving standardized management had lower SBP(142.79±17.39)mmHg, lower DBP(84.26±9.49)mmHg and higher blood pressure control rate(49.77%)than those receiving no standardized management(P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management(P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice. The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

Control of hypertension in China: Challenging

The most recent data shows that during the period of 2005–2009, about 42% of Chinese adults aged 35–70 years were hypertensive and only 8.2% of hypertensive patients were well controlled [1]. Compared with the data in 2000–2001, prevalence of hypertension has drastically increased while hypertension control rate maintained at low level as well as awareness and treatment rates in midlife Chinese adults (Fig. 1) [1,2]. It is estimated that in China, the number of premature death due to hypertension is more than 2 million, and the corresponding direct medical costs are more than 3.66 billion [3]. In addition, 70% of stroke and 50% of myocardial infarction are attributable to hypertension in China [3]. High salt intake and obesity are main risk factors for hypertension. Data from the China Health and Nutrition Survey showed that an average of 12 g salt per day are consumed by Chinese adults [4], twice more than the recommended salt intake (less than 5 g/d) by World Health Organization (WHO). In addition, approximately 11% of Chinese adults were generally obese and 37% of them were abdominally obese in 2009 and the prevalence of general and abdominal obesity increased greatly from 1993 to 2009 [5]. Besides, lack of physical activity and sedentary behavior (e.g., TV viewing and computer use) are common in Chinese adults, which are other important risk factors for hypertension, as well as smoking and alcohol consumption [3]. Based on the current situation, it is time for China to establish intervention programs to control hypertension and its related risk factors. Indeed, several national intervention programs, such as “National Action of Healthy Lifestyle” and “National Fitness Program (2012–2015)”, have been conducted to reduce hypertension related risk factors. Although there was still a gap on coverage of hypertensive patients in China, community-based standardized management of hypertension (launched by the China Ministry of Health in 2006) and “2010 Guidelines for Prevention and Control of Hypertension in China” played an important role in hypertension management and control. In addition, “China Hypertension Education and Management Action” was launched in August, 2013 in Beijing. The aim of this action was to improve discipline level and service ability of grassroots units of China by standardizing the procedure of diagnosis and treatment and implementing comprehensive management and control strategy. Given the high prevalence, and low awareness, treatment and control of hypertension, national strategies aimed at this disease is urgently needed. As for hypertension prevention, control and management, Chinese government should be the leader and should cooperate with other components, including experts, media, and grassroots units. We believe prevention and control of hypertension will make periodical success through the joint effort of the whole society. Funding: This work was supported by the National “Twelfth FiveYear” Plan for Science & Technology Support Program (2012BAI03B03), the Research Fund for the Doctoral Program of Higher Education of China (20120131120004) and the Foundation for Outstanding Young Scientist in Shandong Province (BS2011YY026).

Effect of standardized management of hypertension in the community on vascular function

This paper addresses the trajectory tracking problem of an autonomous tractor–trailer system by using a fast distributed nonlinear model predictive control algorithm in combination with nonlinear moving horizon estimation for the state and parameter estimation in which constraints on the inputs and the states can be incorporated. The proposed control algorithm is capable of driving the tractor–trailer system to any desired trajectory ensuring high control accuracy and robustness against environmental disturbances.

Knowledge, attitudes, belief and practices in elderly hypertensive patients and hypertensive patients complicated with diabetes

Objective To compare the knowledge, attitudes, belief and practices (KABP) in elderly patients and patients complicated with diabetes mellitus (DM) in communities of Shanghai. Methods A cross-sectional study with simple random sampling was undertaken in 5 communities of Shanghai Xuhui District during May 2011 to July 2011. The target population were 47 572 patients incorporated into standardized management of hypertension. Total 3800 questionaires containing the basic information of patiens and their knowledge, attitudes, belief and practices on were distributed and 3328 were retrieved with a response rate of 87.6%. The survey results of elderly (≥65 y) patients and patients with DM were analysed and compared. Results Total 1057 elderly patients aged (76.1±6.4)y had simple and 42.5%(449/1057)were males; while 360 elderly patients aged (75.9±6.4) y were complicated with DM and 41.7% (150/360) were males. The rates of awareness of hypertension is a chronic disease (99.4% vs. 96.5%, χ2=8.659, P=0.003) and hypertensive patients should persist in taking long-term medications (98.9% vs. 95.4%, χ2=8.898, P=0.003) was higher in patients with complicated DM than those in simple patients. Most of them received education on hypertension-related knowledge from community out-patient clinics, while the percentage of this resource was higher in patients with and DM (75.9% vs. 65.6%, χ2=12.913, P<0.05). There was no statistical difference in controlling dietary salt intake between two groups (88.3% vs. 88.8%, P=0.799). Patients with and DM had shorter excise time than patients with simple [(49±30)min vs. (53±31)min, t=3.362, P=0.001], they were more likely to visit clinics(12.0% vs. 6.3%, χ2 =12.144, P<0.05)and more frequently to seeking hypertension-related medical help from tertiary hospitals(20.2% vs. 13.8%, χ2=7.832, P=0.005). The control rate of in patients complicated with DM was significantly lower than that in simple patients (15.3% vs. 79.2%, χ2=470.264, P<0.05). Conclusions Community out-patient clinic is the main source of knowledge on for elderly patients; so general practitioners should carry out individulized health education for blood pressure control, especially for those complicated with diabetes. Key words: Hypertension; Diabetes mellitus; Health education; Aged

Investigation of pharmacotherapy in patients with hypertension in community of Shanghai and the factors related to blood pressure control

Objective To investigate pharmacotherapy in patients with hypertension in community of Shanghai Xuhui District and the related factors related to blood pressure control. Methods A cross-sectional sampling survey was undertaken in 47 572 patients incorporated into standardized management of hypertension from 5 communities in Xuhui District of Shanghai during May 2011 to July 2011. Results Total 3800 questionnaires were distributed and 3328 (87.6%) were returned. Among all patients elderly cases accounted for 71.0%(2305/3247); special patients complicated with other diseases, including diabetes mellitus, coronary heart disease and stroke accounted for 72.5%(2158/2978). To make up a prescriptionwas the primary reason of encounter (2929, 90.9%) and 76.8% choose community health service center. Only 454(14.4%) patients knew the major adverse effects of their antihypertensive drugs. The blood pressure control rates in common, elderly and special patients were 62.5%(235/376), 75.9%(487/642) and 17.8%(328/1839), respectively. 65.4%(2176/3328) patients choose monotherapy, only 28.6%(952/3328) used more than 2 drugs and 2.3%(76/3328) patients adjusted drugs by themselves. Additional use Chinese medicine (571/3378,16.9%) was common in community. The blood pressure control rate in patients using monotherapy was higher than that in patients using more than 2 drugs (OR=0.664, OR=0.427, P<0.001, P=0.002). In monotherapy, the control rate of patients using additional Chinese medicine was higher than those used calcium channel blockers (OR=1.717, P<0.001). Conclusions The results indicate that the blood pressure control rate in patients complicated with other chronic diseases is very low in communities; which were associated with non-standard medication and inadequate attention on blood pressure control standards in different populations. Key words: Hypertension; Therapy; Community health services; Questionnaires

The cost-effectiveness analysis on standardized management of hypertension in community

Objective To discuss the effectiveness of standardized management of hypertension and its significance of economics.Methods Taking prospective,randomized and controlled trial design to screen hypertension in four communities of Changping Town.The patients in the four communities were randomly divided into an intervention group and a control group.The intervention group was taken the standardized management and the control group was taken conventional management.Results The treatment rate and control rate of the intervention group was higher than the control group.Necessary inputs of per capita administration costs for every 1％ increase of treatment or control rate in the intervention group were less than the control groups by 1.08 and 1.36 Yuan respectively.The per capita administrative costs of intervention group were higher than control group,while the per capita comprehensive costs of intervention group were lower than control group.Compared with the control group,every 1 Yuan of per capita administrative costs increases,the comprehensive costs would be reduced 7.58 Yuan in the intervention group.Conclusion Standardized management of hypertension in community can significantly improve the prevention and treatment effects.Moreover,it has good cost-effective value and saving social resources. Key words: Hypertension; standardized management in Community; Cost-effectiveness; Economics

Hypertension control in communities (HCC): Analysis of antihypertensive drug regimen in baseline

Objective: The project of Hypertension Control in Communities (HCC) aimed to determine the effect of community-based standardized management on control of hypertension. Analyzing the current pattern of antihypertensive drug regimen in baseline was helpful for focusing on the training key. Methods: The protocol of community-based standardized hypertension management was developed by an expert board being oriented by guidelines. Community health service centers across China were selected to implement the protocol. After being trained with the protocol, the grass-roots doctors from selected centers were asked to manage hypertensives in their communities according to the protocol. Patients who were serviced by the selected centers and with diagnosed hypertension were recruited. Data were collected by using questionnaire. Results: By the end of 2010, the program contained 255,168 patients with eligible baseline data, 93,953 (36.8%) of them under treatment with 47.7% male were used for this analysis. In baseline, patients with diuretic, β-blocker, CCB, ACEI, ARB, α-blocker and compound pill were 7.8%, 10.3%, 37.0%, 18.2%, 4.0%, 0.1%, 46.7%, respectively. In total, 84.1% patients took single antihypertensive drug in which 47.0% with compound pill and 28.8% with CCB; 16.6% were under combination drug therapy, out of them, 13.0% with two-drug, 2.6% with three-drug or more drugs. The used two-drug combinations are “CCB+ACEI” (38.0%), “β-blocker+CCB” (24.1%), and three-drug combinations are “β-blocker+CCB+ACEI” (15.8%), “diuretic+CCB+ACEI” (13.3%). Only 22.5% patients under treatment were controlled (<140/90 mmHg). Conclusion: The baseline status of medicine usage of HCC patients was subject to no standard in this article. It showed standardized management was necessary for the medicine usage and further improvement of hypertension control.