Possibilities of Using the National Electronic Data Syetstem in Assessing the Control of Arterial Hypertension at The Primary Health Care Level in the Kyrgyz Republic Using the Example of a Single Family Medicine Center.

AIM: To determine the capabilities of the National Electronic System for collecting quantitative data necessary to assess the quality of management and effectiveness of arterial hypertension (AH) control at the primary health care (PHC) level and to develop indicators and possibilities of their use for a standardized report on the quality of AH management and control at the PHC level in the Kyrgyz Republic. MATERIAL AND METHODS: Data from electronic outpatient records were processed for all registered patients of a pilot family medicine center (FMC) that was selected randomly. The registered patient group consisted of 91,226 people older than 18 years, including 37,740 men and 53,486 women. The data obtained during contact with a patient was entered by the family doctor into the electronic outpatient record and automatically forwarded to the center that collected and aggregated the data. To monitor AH control, 11 indicators were developed and evaluated. The indicators were divided into 3 groups: indicators for identifying AH, indicators for the quality of AH patient management, and indicators for the effectiveness of AH control. RESULTS: In total, 26,206 patients (7,933 men and 18,273 women) visited the FMC during a year, and blood pressure (BP) was measured in 71.4% of them. In 2022, 5,072 patients (5.6% of the registered group) visited the FMC for AH, including 1,539 men and 3,533 women (4.1 and 6.6% of the registered patient group, respectively; p<0.001). The proportion of patients with AH who, according to the clinical protocol, had their BP measured 2 times a year or more, was 81.4% and was slightly higher for women than for men (82.3% and 79.1%, respectively; p<0.01). 38.7% of AH patients received antihypertensive drugs. Lipid-lowering therapy was prescribed to 23.5% of AH patients. The proportion of AH patients taking acetylsalicylic acid was higher, 36.3% for the whole group, including 34.1% for men and 37.2% for women (p<0.05). The efficacy of AH treatment was 62.8%. CONCLUSION: Any monitoring system has limitations for the amount of useful data that can be obtained ensuring their proper quality. Taking this into account, two major indicators are suggested to use for evaluating the effectiveness of AH control at the PHC level: 1) the number of AH patients who have achieved the BP goal; 2) the number of AH patients who visited a medical institution (health care facility) during a calendar year relative to the number of registered patients (AH detectability).

[Lipoprotein-associated phospholipase A2: relation to development of ischemic stroke in patients with essential hypertension].

AIM: to investigate association of lipoprotein-associated phospholipase A2 (Lp-PLA2) level (mass) with ischemic stroke in patients with essential hypertension (EH) with or without dyslipidemia. MATERIAL AND METHODS: We examined 60 patients with EH without complications and 90patients with EH and history of ischemic stroke. Examination included measurement of height, weight, waist, blood pressure and heart rate, determination of glucose, creatinine, lipid profile, Lp-PLA2 mass, and duplex scanning of carotid arteries. All patients were divided into 2groups: A) with high (n=70), and B) normal or mildly elevated (n=80) levels of low density lipoprotein cholesterol (LDLC). RESULTS: In group A (LDLC <3.4 mmol/L) Lp-PLA2 mass in patients with stroke was higher than in patients with uncomplicated EH; age and elevated Lp-PLA2 mass were independently associated with history of stroke. In group B (LDLC >3.4 mmol/L) Lp-PLA2 mass did not differ between patients with EH with or without stroke while low level of high density lipoprotein cholesterol was most significantly associated with history of stroke. INTERPRETATION: These results suggest that the role of LP-PLA2 in the development of ischemic stroke is reduced in the presence of evident dyslipidemia and high level of traditional cardiovascular risk factors. However, in the presence of low level of traditional metabolic risk factors proinflammatory substances and LP-PLA2 in particular acquire dominant role in the processes of atherogenesis and plaque destabilization.