A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study.

INTRODUCTION: Non-adherence to medication severely affects chronic disease control. AIM: To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. METHODS: A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period. RESULTS: The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (± 8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (± 13.6)/97.7 (± 8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg). CONCLUSIONS: The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

Blood Pressure Association with the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults from Low-Resource Primary Care Settings: Results from a Prospective Cohort Nested within a Randomised Controlled Trial.

INTRODUCTION: One of the self-report adherence scales most widely used is the 8-item Morisky Medication Adherence Scale (MMAS-8). AIM: To evaluate construct validity and reliability of the MMAS-8 in hypertensive adults from low-resource settings within the public primary care level in Argentina. METHODS: Prospective data from hypertensive adults under antihypertensive pharmacological treatment that participated in the "Hypertension Control Program in Argentina" study was analyzed. Participants were followed at baseline, 6, 12 and 18 months. Based on MMAS-8, adherence was defined as low (score < 6), medium (score 6 to < 8) and high (score of 8). RESULTS: 1214 participants were included in the analysis. In comparison to low adherence, high adherence category was associated with a reduction of - 5.6 mmHg (CI 95%: - 7.2; - 4.0) in systolic blood pressure (BP) and - 3.2 mmHg (CI 95%: - 4.2; - 2.2) in diastolic BP; and with a 56% higher likelihood to have controlled BP (p < .0001). Among those participants with baseline score ≤ 6, two points increase in MMAS-8 along follow-up showed a tendency to reduce BP in almost all-time points and a 34% higher likelihood of having controlled BP at the end of the follow-up (p = 0.0039). Cronbach's alpha total-item values in all time-points were higher than 0.70. CONCLUSIONS: Higher MMAS-8 categories were positively associated with BP reduction and higher likelihood of BP control over time. Internal consistency was acceptable and in line with previous studies.

Bases académicas en la enseñanza de la hipertensión arterial en una facultad pública de Medicina: diseño del estudio / Academic bases in the teaching of high blood pressure in a public medical school: study design

La hipertensión arterial (HTA) es uno de los principales factores de riesgo para la enfermedad cardio-cerebrovascular. Actualmente, coexisten múltiples guías y consensos de práctica clínica, lo que puede conducir a una variabilidad exagerada en el proceso de aprendizaje de esta patología. El presente estudio busca evaluar la variabilidad existente en la enseñanza de la HTA de la Facultad de Ciencias Médicas de la Plata, estimar la percepción sobre la necesidad de elaborar un consenso interno y evaluar la implementación de un consenso propio de la facultad. El estudio se realizará en cuatro fases: armado de la encuesta, implementación de la encuesta, armado de un documento-consenso e implementación del documento consenso. Durante la primera fase del estudio se elaboró la encuesta, incluyendo la referencia a ocho documentos científico-académicos relacionados con la problemática de la HTA. Se realizó la implementación de la encuesta en el último trimestre de 2019. Se espera que el desarrollo del presente proyecto de investigación y sus productos ayude no solamente a perfeccionar los procesos de enseñanza de los alumnos en el manejo de la HTA, sino también a sentar las bases para iniciar procesos similares en otras patologías asociadas con alta carga de enfermedad para la población. (AU)

High blood pressure (HT) is one of the main risk factors for cardio-cerebrovascular disease. Currently, multiple clinical practice guidelines and consensus co-exist that can lead to exaggerated variability in the learning process of this pathology. The present study seeks to evaluate the variability existing in the teaching of the HTA of the Faculty of Medical Sciences of La Plata, to estimate the perception of the need to elaborate an internal consensus and to evaluate the implementation of a consensus of the faculty. The study will be carried out in four phases: assembling the survey, implementing the survey, assembling a consensus document and implementing the consensus document. During the first phase of the study, the survey was prepared including a reference to eight scientific-academic documents related to the problem of HT. The implementation of the survey was carried out in the last quarter of 2019. The development of this research project and its products is expected to help not only to improve the teaching processes of the students in the management of the HTA, but also will lay the foundations to initiate similar processes in other pathologies associated with a high disease burden for the population. (AU)

Epidemiology of early repolarization pattern in an adult general population.

Background: Early repolarization pattern (ERP) is a frequent finding in asymptomatic subjects with controversial implications regarding to its prognosis. This study aims to estimate the prevalence of ERP and its association with sociodemographic characteristics and cardiovascular risk factors among the adult population in the Southern Cone of Latin America.Methods: A sub-sample of 5398 participants of the CESCAS I study was included in the present analysis. ERP was defined as a J peak ≥0.1 mV in two or more contiguous leads with an end-QRS notch or slur on the downslope of a prominent R-wave.Results: The global prevalence of ERP was 8.1%; 11.1% in men and 5.6% in women. The prevalence in women increased with age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.2, at >65 years, p < 0.001), current cigarette smoking (OR 1.4, 95%CI 1.0-2.0, p = 0.045) and hypercholesterolaemia (OR 1.4, 95%CI 1.0-2.0, 0 p = 0.036). Conversely, in men, ERP prevalence decreased with age (OR 0.5, 95%CI 0.3-0.9, at >65 years, p = 0.01) and obesity (OR 0.6, 95%CI 0.4-0.8, p = 0.006). We found an increasing ERP prevalence with a higher Sokolow-Lyon index in both sexes (p < 0.001). Inferior location was found in 67.9% of cases, and the most common ERP type was a "slurring" appearance without ST elevation (76.3%).Conclusions: We found an overall prevalence of ERP of 8.1% and a robust association of ERP with normal BMI and higher Sokolow-Lyon index in men and with hypercholesterolaemia, current cigarette smoking and higher Sokolow-Lyon index in women.

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America.

BACKGROUND: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.

Efectividad de una intervención multi-componente para el mejoramiento de la adherencia terapéutica en hipertensión arterial / Effectiveness of a multicomponent intervention to improve therapeutic adherence in arterial hypertension

INTRODUCCIÓN Las enfermedades crónicas no trasmisibles son la primera causa de morbimortalidad a nivel mundial, dentro de ellas la enfermedad cardiovascular en cabeza la lista. La hipertensión arterial es uno de los principales factores de riesgo de la enfermedad cardiovascular, con una alta prevalencia a nivel poblacional y bajos niveles de control asociados. El modelo de atención de personas con enfermedades crónicas plantea a la adherencia terapéutica como uno de los principales pilares para el control de las enfermedades crónicas. El presente estudio evaluó el efecto de una intervención multi-componente implementada a través del equipo de atención primaria de la salud para el mejoramiento de la adherencia terapéutica y el control de la presión arterial. MÉTODOS se implementó un estudio tipo antes-después en 5 CAPS del sistema de atención primaria público de la localidad de Almirante Brown, provincia de Buenos Aires. Se reclutaron 125 personas hipertensas no controladas bajo tratamiento para la hipertensión arterial. Se evaluó la tasa de posesión de la medicación (TPM) pre-intervención y post-intervención y se evaluó la tensión arterial en una visita basal y 6 meses después de la implementación de la intervención. Se consideró TPM adecuada a aquellos valores ≥ 80%. El componente principal de la intervención se basó en el monitoreo activo de la TPM de los participantes y una intervención telefónica basada en el modelo de las 5 A en quienes tuvieron durante el seguimiento una TPM insuficiente. RESULTADOS 96.8% de los participantes completaron el seguimiento. 47.2% de la muestra era de sexo masculino, promedio de edad de 57.1 años (DE 8.1), 83.5% declaró tener cobertura en salud pública exclusiva y 64.8% poseía nivel educativo con primaria completa o menor. Se observó un incremento de la TPM adecuada del 16.8% al 47.2%., p<0.001 y una reducción promedio de la tensión arterial sistólica (TAS) de 16.4 mmHg (DE 18.3) y de la diastólica (TAD) de 12 mmHg (DE 12.1); p<0.001. Al final del estudio se observó un 52.2% de control de la HTA. DISCUSIÓN la intervención del estudio fue exitosa para incrementar la TPM luego de 6 meses de seguimiento y lograr una reducción significativa de los valores de TA asociándose con más de la mitad de la población con hipertensión controlada.