ప్రాథమిక సంరక్షణలో నాణ్యత అందరికి ప్రవేశం

నైరూప్య

Quality management of hypertension in primary care: do physicians treat patients’ blood pressure level or cardiovascular risk?

Nora E Gimpel , Veronica Schoj , Adolfo Rubinstein

Background The risk of cardiovascular disease in patients with hypertension is determined not only by the level of blood pressure but also by the presence of target organ damage and other risk factors. Numerous guidelines for management of hypertension emphasise the importance of using stratification for total cardiovascular risk in clinical decision making.Aim We investigated if primary care physicians consider individual cardiovascular risk, in addition to blood pressure level, when they select a treatment strategy. Secondarily, we evaluated physicians’ performance  in clinical management and pharmacologicaltreatment of hypertension, to determine predictors of control and intensity of treatment.Methods Acro ss-sectional study was conducted in an academic health maintenance organisation (HMO). Asample of 1200 records of patients with hypertension was examined to evaluate potential predictors of poorly controlled hypertension (
160– 95mmHg) as well as predictors of change in the systolic and diastolic blood pressure (SBP and DBP respectively). Stages and groups risk stratificationwas used as reported by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI).Results Atotal of 922 hypertensive patients were included. Patient mean ( standard deviation (SD)) age was 59.5 (15.6) years, 56.8% women, and average follow-up was 42.86 (22.7) months, with 3.42 (4.7) visits per year. The percentage of patients with well-controlled hypertension (