RESUMEN
Hypertension is present in almost a third of Türkiye's adult population. The Ministry of Health of the Republic of Türkiye in conjunction with the World Health Organization, rolled out a pilot primary health care model from February 2019 to 2020 to improve hypertension screening, management, and follow-up across the provinces of Erzincan, Çankiri and Usak. The model was conducted in selected family health centers for one year and included multiple interventions - training of multidisciplinary primary care teams, implementation of evidence-based, standardised clinical guidelines related to monitoring and treatment of hypertension, clinical supervision and performance monitoring, and provision of health education to hypertensive individuals. Repeat surveys of population-based random samples of 975 patients were taken before (December 2018) and after (February 2020) model implementation to evaluate its effect on care delivery. There was an almost 6.5-fold increase in the measurement and subsequent recording of blood pressure compared to before model implementation (from 50 to 323). Blood pressure control improved to 58 % of measured individuals compared to 46 % of those measured at initial evaluation. The frequency of measuring risk factors and outcomes related to hypertension at least once a year increased for creatinine from 71 % to 79 %, fasting blood glucose from 70 % to 78 %, and tobacco use from 22 % to 31 %. Prescription of antihypertensive drugs increased from 49 % to 61 %. With improvements in hypertension-related care in all measures and across all regions, this primary healthcare model represents a potential paradigm for nationwide implementation.
RESUMEN
Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.