Compliance with medication among outpatients with uncontrolled hypertension in the Seychelles.

Owing to increasing rates of hypertension and cardiovascular-related diseases in developing countries, compliance with antihypertensive medication is major public health importance. Few studies have reported on compliance in developing countries. We determined the compliance of 187 patients with uncontrolled hypertension in the Seychelles (Indian Ocean), by assessing the presence of a biologic marker (riboflavin) in the urine. The urine tested positive in 56% of the cases. Compliance varied from one physician to another (highest 72% versus lowest 33%, P = 0.003), improved with the level of literacy (62% versus 45%, P = 0.024), and depended on the presence absence of diuretics in the medication (respectively, 45% versus 66%, P = 0.005). The ability of patients to report correctly the number of antihypertensive pills to be taken daily was a predictor of compliance (62% of the patients who gave appropriate answers had positive urine for the marker versus 31% for those giving inappropriate answers).

Systematic difference between blood pressure readings caused by cuff type.

In this study we determine whether blood pressure readings using a cuff of fixed size systematically differed from readings made with a triple-bladder cuff (Tricuff) that automatically adjusts bladder width to arm circumference and assessed subsequent clinical and epidemiological effects. Blood pressure was measured with a standard cuff or a Tricuff in 454 patients visiting an outpatient clinic in the Seychelles (Indian Ocean). Overall means of within-individual standard cuff-Tricuff differences in systolic and diastolic blood pressures were examined in relation to arm circumference and sex. The standard cuff-Tricuff difference in systolic and diastolic blood pressures increased monotonically with circumference (from 4.7 +/- 0.8/3.2 +/- 0.7 mm Hg for arm circumference of 30 to 31 cm to 10.0 +/- 1.1/8.0 +/- 0.9 mm Hg for arm circumference > or = 36 cm) and was larger in women than men. Multivariate linear regression indicated independent effects of arm circumference and sex. Forty percent of subjects with a diastolic blood pressure of > or = 95 mm Hg measured with a standard cuff had values less than 95 mm Hg measured with a Tricuff. Extrapolation to the entire population of the Seychelles decreased the prevalence of blood pressure greater than or equal to 160/95 mm Hg by 11.5% and 24.0% in men and women, respectively, aged 35 to 64 years. The age-adjusted effect of body mass index on systolic and diastolic blood pressures decreased twofold using blood pressure readings made with a Tricuff instead of a standard cuff.(ABSTRACT TRUNCATED AT 250 WORDS)

The cardiovascular disease situation in Seychelles.

A rising frequency of cardiovascular diseases and related risk factors has been documented in Seychelles. This epidemiological transition to chronic diseases is believed to result from the aging of the population and from changes in lifestyle associated with a rapidly improving standard of living. Since 1990 a long-term national collaborative programme has been established for the prevention and control of cardiovascular diseases. It has been designed with a view to implementing a combination of population-based and specific, high-risk target-group strategies. Objectives have been formulated, and culturally acceptable multisectoral activities have been devised, along with plans for the monitoring of cardiovascular diseases and risk factors and for the evaluation of the programme as it proceeds.

[Developments in the treatment of myocardial infarction in Switzerland 1986-1990: results of a population survey]. / Evolution du traitement de l'infarctus du myocarde en Suisse de 1986 à 1990: les résultats d'une étude de population.

The Swiss cantons of Vaud and Fribourg participate in the international MONICA project (MONI-toring of trends and determinants in CArdiovascular disease). Within this context, drug therapies and procedures were recorded during two separate years (1986 and 1990) for all hospitalizations of men aged 25 to 64 with the diagnosis of myocardial infarction. The medical files were reviewed to classify this diagnosis as possible or definite on the basis of the symptoms, the ECG results and the enzymatic tests. The two study populations (n = 318 in 1986 and n = 332 in 1990) are comparable with respect to age, history of ischemic heart disease and initial care. In 1990, half of the patients arrived at hospital in less than 3 hours, the median time delay being 4 hours for those first attending a general practitioner and 2 hours for those transferred directly. The frequency of treatments between 1986 and 1990 is compared only for cases with a definite diagnosis of myocardial infarction (respectively n = 217 and n = 223). The proportion of patients given thrombolytic therapy rose from 9% to 44% (p < 0.005) and from 51% to 95% (p < 0.005) for those treated with antiplatelet drugs, whereas the proportion fell from 72% to 55% (p < 0.005) for calcium blockers and from 33% to 24% (p < 0.05) for inotropic drugs. The use of anticoagulants (in 98% of patients) and of beta blockers (in 57%) remained stable across time.(ABSTRACT TRUNCATED AT 250 WORDS)