Clinician response after receipt of abnormal pediatric ambulatory blood pressure monitoring - characteristics associated with inertia and action.

BACKGROUND: Ambulatory Blood Pressure Monitoring (ABPM) is recommended for diagnosis and management of hypertension. We aimed to identify characteristics associated with physician action after receipt of abnormal findings. METHODS: This was a retrospective cross-sectional analysis of patients 5-22 years old who underwent 24-h ABPM between 2003-2022, met criteria for masked or ambulatory hypertension, and had a pediatric nephrology clinic visit within 2 weeks of ABPM. "Action" was defined as medication change/initiation, lifestyle or adherence counseling, evaluation ordered, or interpretation with no change. Characteristics of children with/without 1 or more actions were compared using Student t-tests and Chi-square. Regression analyses explored the independent association of patient characteristics with physician action. RESULTS: 115 patients with masked (n = 53) and ambulatory (n = 62) hypertension were included: mean age 13.0 years, 48% female, 38% Black race, 21% with chronic kidney disease, and 25% overweight/obesity. 97 (84%) encounters had a documented physician action. Medication change (52%), evaluation ordered (40%), and prescribed lifestyle change (35%) were the most common actions. Adherence counseling for medication and lifestyle recommendations were documented in 3% of encounters. 24-h, wake SBP load, and sleep DBP load were significantly higher among those with physician action. Patients with > 1 action had greater adiposity, SBP, and dipping. Neither age, obesity, nor kidney disease were independently associated with physician action. CONCLUSIONS: While most abnormal ABPMs were acted upon, 16% did not have a documented action. Greater BP load was one of the few characteristics associated with physician action. Of potential actions, adherence counseling was underutilized.

A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth.

CONTEXT: Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES: To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN: A prospective case series study. SETTING: Five FQHCs. PARTICIPANTS: The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION: SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE: Systolic blood pressure and diastolic blood pressure. RESULTS: Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS: Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.

Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center.

CONTEXT: Uncontrolled hypertension can lead to an increased risk of cardiovascular disease, myocardial infarction, stroke, or death. Self-monitoring blood pressure (SMBP) programs have been associated with blood pressure (BP) reduction, particularly among rural, minority, and low-income individuals. There is limited literature about nonphysician SMBP programs. OBJECTIVES: To evaluate the effectiveness of an SMBP program designed to engage nonphysician team members in hypertension management within a federally qualified health center (FQHC). DESIGN: Self-monitoring blood pressure program activities were implemented using a Plan, Do, Study, Act model. The University of Washington Health Promotion Research Center evaluated processes and patient-level outcomes in a mixed-methods design. Quantitative analysis examined clinical outcomes related to hypertension, and qualitative analysis relied on interviews with clinical staff examining program implementation, adoption, and sustainability. SETTING: Family Health Centers (FHCs), a FQHC located in rural Washington, serving medically underserved populations. PARTICIPANTS: Two hundred five active SMBP patients out of 2600 adult patients (over 18 years old) who had a diagnosis of hypertension within the last 12 months. INTERVENTION: Patients with uncontrolled hypertension were given a BP cuff to log their daily BP. Patients met with community health workers (CHWs) and medical staff to review logs and set self-management goals over 3 to 4 months. MAIN OUTCOME MEASURE: Controlled BP measurements and factors to implementation and sustainment. RESULTS: Facilitators to implementation included expanded telehealth reimbursement during the COVID-19 pandemic, integration of CHWs, and linguistically adapted resources. Barriers included a lack of reimbursement for nonphysician time and BP monitors. Quantitative results demonstrated an effort to reach minoritized populations but did not show an improvement in BP outcomes. CONCLUSIONS: Family Health Center implemented an SMBP program adapted to meet the linguistic and social needs of their patients. The successful integration of CHWs and the need for reimbursement policies to support SMBP programs were key factors for implementation and sustainability.

Virtual Expansion of the YMCA's Blood Pressure Self-Monitoring (BPSM) Program: Using Telehealth to Adapt an Evidence-Based Program to Reach Rural Communities in South Carolina.

CONTEXT: Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large. PROGRAM: The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions. IMPLEMENTATION: The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program. EVALUATION: A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure. DISCUSSION: Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.

Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study.

Unlabelled: User engagement with remote blood pressure monitoring during pregnancy is critical to optimize the associated benefits of blood pressure control and early detection of hypertensive disorders of pregnancy. In our study population of pregnant individuals, we found that connected blood pressure cuffs, which automatically sync measures to a monitoring platform or health record, increase engagement (2.13 [95% CI 1.36-3.35] times more measures per day) with remote blood pressure monitoring compared to unconnected cuffs that require manual entry of measures.

How many blood pressure measurements should we take in the office?

No consensus has emerged among different guidelines concerning how many blood pressure (BP) measurements should be performed at office visits in the diagnosis of hypertension. The purpose of this study was to examine the compatibility of various multiple average office BP measurements and 24-h BP monitoring (ABPM) in patients followed up in the posthoc analysis of the Cappadocia hypertension cohort. A total 1158 office BP measurements by 207 patients were examined. The results were then classified as G1 (average of the 1st and 2nd BP), G2 (average of the 2nd and 3rd), G3 (average of the 2nd, 3rd, and 4th), G4 (average of the 2nd, 3rd, 4th, and 5th), and G5 (average of all five measurements). Compatibility between the average values in the groups and concomitant 24-h ABPM data was examined. While a significant difference was observed between daytime 24-h ABPM SBP and G1 (p = .002), no difference was found in the other groups. Office DBP approached the daytime 24-h ABPM values as the number of measurements in the five groups increased, although average office DBP data in all groups were higher than daytime 24-h ABPM DBP (p = .000 for all). In light of our study results, we recommend that three office BP measurements be performed and that the average of the 2nd and 3rd measurements be used for SBP, while in terms of DBP, we recommend that as many measurements as possible be taken without the 1st value being included in the average.

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. LOCAL PROBLEM: At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. INTERVENTIONS: A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. RESULTS: A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). CONCLUSION: Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.

Status of home blood pressure measurement in treated hypertensive patients. Results of a survey from two cities in Korea.

Knowledge of the status of real-world home blood pressure (BP) measurements is crucial for establishing policies promoting hypertension treatment through home BP monitoring. However, only a few studies have investigated the status of home BP measurements in real-world settings. This study investigated the practice of Korean patients in measuring BP at home. This study recruited participants aged ≥20 years who were taking antihypertensives and conducted a questionnaire-based survey on home BP measurements. Of 701 participants recruited between August 2018 and April 2020, 673 were included in the analysis. Of these, 359 (53.3%) possessed home BP measurement devices. The devices used by 184 (51.3%) participants were validated, 110 (30.6%) were nonvalidated, and 65 (18.1%) had an unknown validation status. Only 18 patients (5.0%) with home BP devices were aware of the validation tests for home BP measurement devices. Of the 673 participants, 278 (41.3%) measured BP at home (77.4% of the patients owned home BP measurement devices). Among them, at least 74 (26.6%) performed proper measurements (at least once a month, at least twice a day or twice at a time, after at least 1 minute of rest, with at least a 1-min interval between each measurement, and 30 min after drinking coffee, exercising, or smoking). In conclusion, our community-based survey in the nonpresentive Korean population revealed a low rate of home BP measurement, a high rate of using nonvalidated devices, and a high rate of inappropriate measurements, suggesting that more efforts toward patient education regarding home BP measurements are needed.

Relationship between morning blood pressure variability and cerebral microbleed burden in patients with hypertension.

Cerebral microbleeds (CMBs) can be understood as a type of target organ damage caused by hypertension. We aimed to explore the association of the CMB burden with morning blood pressure (BP) variability in patients with hypertension. We divided patients with hypertension into two groups: a group with 1-10 CMBs and a group with more than 10 CMBs. The duration, grade, medication, and control of hypertension were recorded in all patients. Morning home BP measurements were performed every 3 days for a month. A total of 791 patients were recruited. Full factor model analysis showed that higher morning home diastolic BP variability (standard deviation [SD], OR = 1.080, 95% CI: 1.024-1.140, P = .005; coefficient of variation [CV], OR = 1.076, 95% CI: 1.028-1.128, P = .002) was associated with more than 10 CMBs. Morning home systolic and diastolic blood pressure variability (SD, CV, average real variability) in more than 10 non-lobar CMBs group was significantly higher than that in 1-10 non-lobar CMBs group (P < .05).The multivariate analysis showed higher morning home diastolic blood pressure variability (SD, OR = 1.124, 95% CI: 1.031-1.224, P = .008; CV, OR = 1.099, 95% CI: 1.019-1.186, P = .015; average real variability, OR = 1.055, 95% CI: 0.995-1.120, P = .075) was associated with more than 10 non-lobar CMBs. There was no significant relationship between morning home systolic blood pressure variability and more than 10 non-lobar CMBs (P > .05). Higher morning home diastolic blood pressure variability was associated with more than 10 CMBs and more than 10 non-lobar CMBs.

Controle dos níveis pressóricos em hipertensos / Pressure level control in hypertensive patients

Objetivos: Identificar o controle pressórico em hipertensos acompanhados por uma equipe da Saúde da Família. Métodos: Trata-se de um estudo longitudinal, realizado por meio da análise de prontuários de 134 indivíduos hipertensos maiores de 18 anos com, no mínimo, três aferições de pressão arterial ao longo do período citado, em uma Unidade Básica da Saúde da Família, durante o ano de 2017, no município de Itajaí (SC). Resultados: Da amostra total, 60,5% eram do sexo feminino. A faixa etária predominante foi dos 60 aos 69 anos (33,6%), e 80,7% tinham até 8 anos de escolaridade. Em relação ao número de medicações utilizadas, 34,3% estavam em monoterapia, 41,8% em terapia dupla, 17,9% em terapia tripla e 6% em terapia quádrupla. A taxa de controle pressórico foi de 28,4%. Apenas 9% da amostra apresentava índice de massa corporal dentro do ideal. No grupo compensado, 52,7% dos indivíduos apresentavam sobrepeso, enquanto 65,6% do grupo descompensado apresentavam obesidade (p<0,05). Da amostra total, 47,8% dos indivíduos eram portadores de diabetes mellitus, correspondendo a 53,1% do grupo descompensado (p<0,05). Ainda nesse grupo, 46,9% apresentavam níveis inadequados de LDL-colesterol (p<0,05), bem como 35,4% dos hipertensos descompensados apresentavam alto risco cardiovascular (p<0,05). Conclusão: Menos de um terço dos hipertensos apresentou níveis pressóricos adequados, sendo que os fatores que mostraram associação significativa com o controle da pressão arterial foram diabetes mellitus, dislipidemia, elevado índice de massa corporal e risco cardiovascular intermediário e alto.

Objectives: To identify pressure control in hypertensive patients followed by a Family Health Team. Methods: This is a longitudinal study carried out through the analysis of medical records of 134 hypertensive patients over 18 years of age, with at least three blood pressure measurements during the period mentioned, in a Primary Family Health Unit, during 2017 in the municipality of Itajaí (SC). Results: Of the total sample, 60.5% were women. The predominant age group was between 60 and 69 years (33.6%) and 80.7% had up to 8 years of schooling. Regarding the number of medications used, 34.3% were in monotherapy, 41.8% in double therapy, 17.9% in triple therapy, and 6% in quadruple therapy. The pressure control rate was 28.4%. Only 9% of the sample had optimal body mass index. In the compensated group, 52.7% of the individuals were overweight, while 65.6% of the decompensated group were obese (p<0.05). Of the total sample, 47.8% of the individuals had diabetes mellitus, corresponding to 53.1% of the decompensated group (p<0.05). Still in this group, 46.9% had inadequate LDL levels (p<0.05), as well as 35.4% of the decompensated hypertensive patients presented high cardiovascular risk (p<0.05). Conclusion: Less than one-third of hypertensive patients presented adequate blood pressure levels, and the factors showing a significant association with blood pressure control were diabetes mellitus, dyslipidemia, high body mass index, and intermediate and high cardiovascular risk

Acurácia da hipertensão arterial sistêmica autorreferida em adultos de Rio Branco, Acre / Precisión de la hipertensión arterial sistémica autorreferida en adultos de Rio Branco, Acre, Brasil / Accuracy of self-reported systemic arterial hypertension in adults, Rio Branco, Acre, Brazil

Objetivo: analisar a validade da hipertensão arterial sistêmica (HAS) autorreferida na população adulta de Rio Branco, Acre, Brasil. Métodos: estudo de acurácia diagnóstica com 576 adultos (18-59 anos); foram calculados acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo para construção da curva de Receiver Operating Characteristic (ROC). Resultados: as prevalências de HAS aferida (padrão ouro) e autorreferida foram de 19,6% e 16,6%, respectivamente; a HAS autorreferida apresentou 53,7% de sensibilidade e 92,4% de especificidade; a sensibilidade variou de 29,9%, nos indivíduos abaixo de 40 anos, a valores superiores a 70,0% entre os obesos e os que autorrelataram dislipidemia; a especificidade apresentou uma variação de 70,0%, nos que referiram diabetes mellitus, a 95,3% nos eutróficos; a curva ROC para análise da hipertensão apresentou área sob a curva de 0,77 (IC95% 0,72;0,81). Conclusão: o autorrelato de HAS em adultos a partir dos 40 anos apresenta acurácia para utilização em pesquisas no município.

Objetivo: analizar la validez de la hipertensión arterial sistémica (HAS) autorreferida en adultos de Rio Branco, Acre, Brasil. Métodos: estudio de la exactitud diagnóstica con 576 adultos de 18 a 59 años; se calculó precisión , especificidad, valores predictivos positivo y negativo para la construcción de la curva de Receiver Operating Characteristic (ROC). Resultados: la prevalencia de la HAS comparada (patrón-oro) fue del 19,6% y de la HAS autorreferida del 16,6%; la HAS autorreferida presentó 53,7% de sensibilidad y 92,4% de especificidad; la sensibilidad varió del 29,9%, en los individuos con menos de 40 años, a niveles del 70,0% entre los obesos y los que relataron dislipidemia; la especificidad varió de 70,0%, entre los que refirieron diabetes mellitus, a 95,3% en los eutróficos; la curva ROC para análisis de la hipertensión presentó área bajo la curva de 0,77 (IC95% 0,72;0,81). Conclusión: el autorrelato de HAS en adultos a partir de los 40 años tiene precisión para uso en investigaciones poblacionales en Rio Branco, Acre.

Objective: to analyze the validity of self-reported systemic arterial hypertension (SAH) in the adult population of Rio Branco, Acre, Brazil. Methods: this was a study of diagnostic accuracy with 576 adults aged 18 to 59 years; accuracy, sensitivity, specificity and positive and negative predictive values were calculated in order to build the Receiver Operating Characteristic (ROC) curve. Results: the prevalence rates of measured SAH (gold standard) and self-reported SAH were 19.6% and 16.6%, respectively; self-reported SAH showed 53.7% sensitivity and 92.4% specificity; sensitivity ranged from 29.9% in individuals under 40 years of age, to levels above 70.0% among obese individuals and those who reported having dyslipidemia; specificity varied from 70.0% in those who self-reported diabetes mellitus, to 95.3% in underweight patients; the area under the ROC hypertension analysis curve was 0.77 (95%CI 0.72;0.81). Conclusion: self-reported SAH in adults 40 years old and over was found to be accurate for use in studies in Rio Branco.

Previous blood pressure measurement and associated factors in student adolescents / Medida prévia da pressão arterial e fatores associados em adolescentes estudantes

Objective To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents.Methods This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis.Results Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician’s office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97).Conclusion Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured.

Objetivo Identificar a prevalência de medida prévia da pressão arterial no último ano e analisar alguns fatores associados a essa medida em adolescentes estudantes.Métodos Estudo transversal realizado com 6.077 adolescentes entre 14 e 19 anos. Foram coletados os dados demográficos (sexo, faixa etária, turno de estudo, região de residência, trabalho, cor da pele e situação econômica) e históricos da medida da pressão arterial nos últimos 12 meses, além do local em que essa medida foi realizada e o valor de pressão arterial. Foi utilizada análise descritiva e de regressão logística para avaliar as associações entre a medida prévia da pressão arterial e os dados demográficos e a pressão arterial elevada.Resultados No presente estudo, 56,8% responderam não ter medido a pressão arterial nos últimos 12 meses. O posto de saúde e a consulta médica foram os lugares mais mencionados (28,3% e 36,9%, respectivamente) em que foi realizada a medida da pressão arterial. Ser do sexo masculino (odds ratio de 1,64; IC95%: 1,46-1,84), ter idade entre 14 e 16 anos (odds ratio de 1,12; IC95%:1,01-1,25) e apresentar situação econômica desfavorável (odds ratio de 1,48; IC95%: 1,32-1,67) foram associados positivamente a não medição da pressão arterial. Trabalhar foi fator de proteção para não medição da pressão arterial (odds ratio de 0,84; IC95%: 0,73-0,97).Conclusão Elevado número de adolescentes não mediu pressão arterial nos últimos 12 meses. Rapazes, adolescentes com idade entre 14 e 16 anos e com situação econômica desfavorável apresentaram maior chance de não medir a pressão arterial.

Adesão ao tratamento e controle da pressão arterial por meio da monitoração ambulatorial de 24 horas / Blood pressure treatment adherence and control through 24-hour ambulatory monitoring

FUNDAMENTO: A hipertensão arterial sistêmica (HAS) é um importante fator de risco cardiovascular, no entanto os níveis de controle pressórico persistem inadequados. A avaliação da adesão ao tratamento anti-hipertensivo com a utilização da monitoração ambulatorial da pressão arterial (MAPA) de 24 horas pode representar um importante auxílio na busca de metas de controle da HAS. OBJETIVO: Avaliar a adesão ao tratamento anti-hipertensivo e a sua relação com os valores de PA obtidos pela MAPA de 24 horas entre pacientes hipertensos de centros de atenção primária à saúde (APS). MÉTODOS: Estudo transversal com 143 pacientes hipertensos de amostra representativa de serviço de APS do município de Antônio Prado, RS. Foi realizada aplicação do teste de Morisky e Green para avaliar a aderência ao tratamento e a verificação do número de medicamentos utilizados, seguida pela aplicação da MAPA de 24 horas. RESULTADOS: Observou-se que 65,7% da amostra foram considerados aderentes ao tratamento proposto, 20,3% eram moderadamente aderentes, enquanto somente 14% foram classificados como não aderentes. Do total de 143 pacientes avaliados, 79 (55,2%) foram identificados como HAS controlada (<130/80 mmHg) pelas medidas da MAPA de 24 horas, 64 (44,8%) não estavam controlados (>130/80 mmHg), 103 (72%) apresentaram ausência de descenso noturno da PA e 60 (41,9%) não estavam controlados durante o período de vigília. CONCLUSÃO: Verificamos, no presente estudo, que não há um controle adequado da HAS, com consequente perda de oportunidade dos profissionais envolvidos na APS de ajuste adequado das metas de PA preconizados. Esse fato ocorre a despeito de apropriada adesão ao tratamento anti-hipertensivo dos pacientes vinculados ao ambulatório de APS.

BACKGROUND: Although systemic arterial hypertension (SAH) is an important cardiovascular risk factor, blood pressure level control often remains inadequate. Assessment of adherence to antihypertensive treatment through 24-hour ambulatory blood pressure monitoring (ABPM) may represent an important aid in the search for BP control targets. OBJECTIVE: To assess adherence to antihypertensive treatment and its association with BP values at 24-hour ABPM in hypertensive patients treated in primary health care (PHC) centers. METHODS: We carried out a cross-sectional study of 143 hypertensive patients, who constituted a representative sample of patients from PHC centers in the town of Antonio Prado, RS. The Morisky-Green test was used to evaluate adherence and verify the number of medications used by patients, followed by 24-hour ABPM. RESULTS: We observed that 65.7% of the sample was considered adherent to the proposed treatment, 20.3% were moderately adherent and only 14% were classified as non-adherent. Considering all the 143 patients evaluated, 79 (55.2%) were identified as having controlled hypertension (<130/80 mmHg) according to the 24-hour ABPM measurements, 64 (44.8%) were considered uncontrolled (>130/80 mmHg), 103 (72%) had absence of nocturnal BP dip and 60 (41.9%) were uncontrolled while awake. CONCLUSIONS: In this study, we observed a lack of adequate hypertension control with a consequent loss of opportunity for PHC professionals to adequately adjust the recommended BP control targets. This fact occurs in spite of proper adherence to antihypertensive treatment by patients in PHC centers.

Prevalência de hipertensão do avental branco na atenção primária de saúde / Prevalence of white coat hypertension in primary health care

OBJETIVO: Avaliar a prevalência de hipertensão do avental branco no município de Dumont, Estado de São Paulo, caracterizando os participantes da pesquisa em relação a fatores demográficos e a alterações tanto fisiológicas como metabólicas. MÉTODOS: Foram selecionados 109 usuários da Unidade de Saúde municipal, divididos em três grupos (normotensão, hipertensão essencial e hipertensão do avental branco), após medidas de pressão arterial com aparelho oscilométrico e exame de monitorização ambulatorial da pressão arterial. Foram realizadas entrevista, mensuração de dados e coleta de exames laboratoriais para comparação das variáveis encontradas entre os grupos. Para o tratamento estatístico, foram utilizados os testes ANOVA e Tukey. Os resultados foram expressos como médias ± erros padrão das médias. As diferenças foram consideradas estatisticamente significativas para p < 0,05. RESULTADOS: A prevalência de hipertensão do avental branco foi de 34,1 por cento, com predominância do sexo feminino, média de idade de 45,3 anos e aumento de índice de massa corporal, relação cintura-quadril, glicemia e creatinina plasmáticas, na comparação com hipertensos e/ou normotensos. Não foi encontrada relação entre hipertensão do avental branco e variáveis demográficas. CONCLUSÃO: As diferenças encontradas entre os grupos e a presença de variações clínicas e bioquímicas possibilitam inferir que a hipertensão do avental branco é uma condição que deve ser analisada de maneira distinta em relação a indivíduos normotensos e hipertensos.

OBJECTIVE: Assess the prevalence of white coat hypertension in the municipality of Dumont, in São Paulo State, and map study participants' demographics, and physiologic and metabolic changes. METHODS: One hundred and nine (109) users of the Municipal Health Service were selected and then divided into three groups: normotension, essential hypertension, and white coat hypertension after blood pressure was measured through oscilometry and blood pressure monitoring exam at outpatient unit. Variables found between the groups were compared based on interview, data measurements, and laboratory exams. ANOVA and Tukey tests were used for statistical data. Results were expressed as means ± standard error of means. p<0.05 was considered statistically significant. RESULTS: The prevalence of white coat hypertension was 34.1 percent. Females were predominant: mean age 45.3 years, increased body mass index, waist/hip ratio, plasma glucose level and creatinine when compared to hypertensives and/or normotensives. No correlation was found between white coat hypertension and demographic variables. CONCLUSION: The differences found between the groups and clinical and biochemical variations lead to the conclusion that white coat hypertension is a condition that should be investigated in normotensive and hypertensive individuals distinctively.