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1.
Rev. enferm. UERJ ; 27: e37193, jan.-dez. 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1005387

RESUMO

Objetivo: identificar os recursos utilizados pelo enfermeiro da estratégia saúde da família (ESF) para estimular a adesão do paciente ao tratamento da Hipertensão Arterial Sistêmica. Método: abordagem qualitativa. O projeto foi aprovado por Comitê de Ética em Pesquisa. A coleta de dados ocorreu no período de abril a agosto de 2017, por meio de entrevista semiestruturada com 10 enfermeiros atuantes em unidades de ESF localizadas no Estado do Rio de Janeiro. Os depoimentos dos sujeitos foram submetidos à análise de conteúdo de Bardin. Resultados: os enfermeiros realizam consultas de enfermagem garantindo a adesão dos participantes em atividades educativas de grupo, como palestras e orientações de enfermagem. Conclusão: o sistema utilizado na adesão ao tratamento é similar entre as unidades de ESF mantendo um padrão preconizado pela literatura.


Objective: to identify the resources used by Family Health Strategy (FHS) nurses to encourage patient adherence to treatment for Systemic Arterial Hypertension. Method: qualitative approach. The project was approved by the research ethics committee. Data were collected between April and August 2017, through semi-structured interviews of 10 nurses working in FHS units in Rio de Janeiro state. The transcriptions underwent Bardin content analysis. Results: the nurses held nursing appointments thus fostering participants' adherence in group educational activities, such as talks and nursing guidance sessions. Conclusion: the treatment adherence system used is similar among FHS units, maintaining a pattern recommended by the literature.


Objetivo: identificar los recursos utilizados por el enfermero de la estrategia de salud familiar (ESF) para estimular la adhesión del paciente al tratamiento de la hipertensión. Método: enfoque cualitativo. El proyecto fue aprobado por el Comité de Ética en Investigación. La recolección de datos ocurrió en el período entre abril y agosto de 2017, por medio de entrevista semiestructurada junto a 10 enfermeros que trabajan en unidades de ESF ubicadas en el estado de Río de Janeiro. Las declaraciones fueron sometidas al análisis de contenido de Bardin. Resultados: los enfermeros realizan consultas de enfermería garantizando la adhesión de los participantes en actividades educativas de grupo, como charlas y orientaciones de enfermería. Conclusión: el sistema utilizado en la adhesión al tratamiento es similar entre las unidades de ESF manteniendo un patrón preconizado por la literatura.


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde , Cooperação do Paciente , Estratégia Saúde da Família , Educação em Enfermagem , Hipertensão , Análise Qualitativa , Epidemiologia Descritiva , Hipertensão/enfermagem , Hipertensão/tratamento farmacológico , Enfermeiras e Enfermeiros
3.
Int J Older People Nurs ; 14(3): e12248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31173482

RESUMO

AIMS AND OBJECTIVES: This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence. BACKGROUND: Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand. DESIGN: An observational study of a community-based intervention. METHODS: The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups. RESULTS: Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables. CONCLUSION: This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand. IMPLICATIONS FOR PRACTICE: Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions.


Assuntos
Redes Comunitárias/organização & administração , Hipertensão/enfermagem , Cooperação do Paciente , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Tailândia
5.
Am J Nurs ; 119(2): 19, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30681472

RESUMO

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.


Assuntos
Determinação da Pressão Arterial/enfermagem , Hipertensão/enfermagem , Hipertensão/prevenção & controle , Doenças Cardiovasculares/enfermagem , Doenças Cardiovasculares/prevenção & controle , Humanos , Revisão Sistemática como Assunto
6.
J Nurs Res ; 27(3): e20, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30694222

RESUMO

BACKGROUND: Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone. PURPOSE: This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship. METHODS: The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support. RESULTS: The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support (r = -.27) and positively correlated with suicidal ideation (r = .21), whereas social support was negatively correlated with suicidal ideation (r = -.35). Social support mediated the relationship between depression and suicidal ideation (Z = 2.69). CONCLUSIONS: Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.


Assuntos
Transtorno Depressivo/epidemiologia , Hipertensão/epidemiologia , Apoio Social , Ideação Suicida , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo/enfermagem , Transtorno Depressivo/psicologia , Feminino , Serviços de Saúde para Idosos , Humanos , Hipertensão/enfermagem , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Pesquisa em Enfermagem , Análise de Regressão , República da Coreia/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários
7.
J Fr Ophtalmol ; 41(10): e491-e492, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30449640
8.
Nurs Clin North Am ; 53(4): 481-489, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30388974

RESUMO

Caring for a patient with renal disease requires an understanding of the basics renal nutritional therapy. The goals of nutritional therapy include maintaining renal function, preventing complications, and providing adequate nutrients. Because cardiovascular disease and hypertension are highly correlated with renal disease, sodium reduction is a major goal of the renal diet. Particularly in early stage renal disease, the Mediterranean diet and the dietary approaches to stop hypertension (DASH) eating plan may help to prevent disease progression. The role of other nutrients such as phosphorous, calcium, protein, and potassium will also be discussed.


Assuntos
Dieta Mediterrânea , Hipertensão/dietoterapia , Nefropatias/dietoterapia , Humanos , Hipertensão/enfermagem , Nefropatias/enfermagem
9.
Rev Bras Enferm ; 71(5): 2398-2403, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30304168

RESUMO

OBJECTIVE: To report the development of a nursing consultation software for hypertensive users of the Family Health Strategy. METHOD: Applied methodological research based on Roger Pressman's Software Engineering, developed in three cycles: planning, composed of the definition of the database prototyping and modelling; development of the navigation interface; and development of functional expressions and programming. RESULT: The software consists of administrative and nursing consultation screens. In the history, there is the option of undertaking the first and next consultation; nursing diagnoses are suggested by the system after entering information and can be selected by nurses. Interventions for diagnoses are suggested and can be chosen by nurses after structuring the medical plan. CONCLUSION: It is believed that the introduction of computer technology for nursing consultation brings several contributions, such as standardization, integration with different information systems, and continuous update.


Assuntos
Hipertensão/enfermagem , Encaminhamento e Consulta/tendências , Desenho de Programas de Computador , Brasil , Saúde da Família/normas , Humanos , Interface Usuário-Computador
10.
JBI Database System Rev Implement Rep ; 16(9): 1779-1784, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30204668

RESUMO

REVIEW QUESTION/OBJECTIVE: The question of this review is: what is the effectiveness of nurse case management in primary healthcare for improving blood pressure, in adults over 18 years with hypertension?The objective of this review is to synthesize the best available evidence regarding the effectiveness of nurse case management in primary healthcare, compared to usual care, in improving blood pressure in adults over 18 years with hypertension.


Assuntos
Pressão Sanguínea , Administração de Caso , Hipertensão/terapia , Enfermeiras e Enfermeiros , Atenção Primária à Saúde/métodos , Adulto , Humanos , Hipertensão/enfermagem , Papel Profissional
11.
Nurs Womens Health ; 22(4): 346-354, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30077241

RESUMO

Hypertension is a leading risk factor for the development of cardiovascular disease. In 2017, the American College of Cardiology and the American Heart Association published a new guideline for the prevention, detection, evaluation, and management of hypertension. The guideline adjusts the clinical parameters for diagnosis and management of hypertension. In this article we summarize the updates and provide some background on these changes as they relate to nursing practice implications, with specific implications for women's health.


Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Guias de Prática Clínica como Assunto , Feminino , Humanos , Hipertensão/enfermagem , Hipertensão/prevenção & controle , Gravidez , Medição de Risco , Saúde da Mulher
13.
Trials ; 19(1): 429, 2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30086778

RESUMO

BACKGROUND: The proportion of patients with controlled hypertension (< 140/90 mmHg) is very low in India. Thus, there is a need to improve blood pressure management among patients with uncontrolled hypertension through innovative strategies directed at health system strengthening. METHODS: We designed an intervention consisting of two important components - an electronic decision support system (EDSS) used by a trained nurse care coordinator (NCC). Based on preliminary data, we hypothesized that this intervention will be able to reduce mean systolic blood pressure by 6.5 mmHg among those with uncontrolled blood pressure in the intervention arm compared to the standard treatment arm (paper-based hypertension treatment guidelines). The study will adopt a cluster randomized trial design with the community health center (CHC) as the unit of randomization. The trial will be conducted in Visakhapatnam district (southern India). A total of 1876 participants aged ≥30 years with high blood pressure - systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg will be enrolled from 12 CHCs. The intervention consists of trained NCCs equipped with an evidence-based hypertension treatment algorithm in the form of the EDSS with regular SMSs to patients with hypertension to promote hypertension treatment and blood pressure control for 12 months. The primary outcome will be difference in the mean change of SBP, from baseline to 12 months, between the intervention and the standard treatment arm. The secondary outcomes are the difference in mean change of DBP; difference in the proportion of patients with controlled blood pressure (< 140/90 mmHg); difference in mean change of fasting blood sugar, HbA1C, eGFR, and albumin to creatinine ratio; difference in the proportion of patients visiting the CHC regularly (number of actual visits to the CHC/number of visits suggested by the EDSS > 80%); difference in proportion of patients compliant to anti-hypertensive medication/s; cost-effectiveness of intervention versus enhanced care. All the outcomes will be assessed at 12 months. DISCUSSION: The study is expected to provide evidence on the effectiveness of NCC-led, EDSS-based hypertension management in India and can likely offer an exemplar for improving cardiovascular disease (CVD) management in India within the resource-constrained public healthcare system. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03164317 ). Registered retrospectively on 23 May 2017 (first patient enrolled on 6 April 2017) because the authors did not receive a response to their original registration submission (5 January 2017) to the Clinical Trial Registry - India (CTRI).


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Técnicas de Apoio para a Decisão , Hipertensão/tratamento farmacológico , Liderança , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Telemedicina/organização & administração , Algoritmos , Tomada de Decisão Clínica , Prestação Integrada de Cuidados de Saúde/organização & administração , Humanos , Hipertensão/diagnóstico , Hipertensão/enfermagem , Hipertensão/fisiopatologia , Índia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
14.
Int J Nurs Stud ; 86: 139-150, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30007585

RESUMO

BACKGROUND: Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES: To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS: The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS: Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS: Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.


Assuntos
Diabetes Mellitus/enfermagem , Gerenciamento Clínico , Educação em Saúde/normas , Hipercolesterolemia/enfermagem , Hipertensão/enfermagem , Doença Crônica , Educação em Saúde/organização & administração , Humanos , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde
15.
Rev Lat Am Enfermagem ; 26: e2936, 2018 Jul 16.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30020330

RESUMO

OBJECTIVES: to evaluate the efficacy of a laser acupuncture protocol developed and applied by nurses in arterial hypertension patients. METHOD: randomized, multicenter, triple-blind and two-armed clinical trial. The sample consisted of 102 participants, 51 per arm, both sexes, aged between 30 and 75 years, undergoing drug therapy for a year or more, with difficulty to control blood pressure, maintaining regular measures >140x90 mmHg. Participants underwent six standard or simulated laser-acupuncture sessions, for 24 minutes, within a period of six weeks. Descriptive analyzes expressed as frequencies of occurrences, means and medians were used, and analysis of the association between variables was performed using Student's t-test and Anova, using Statistica® software, version 12.0. The significance level was set at 5% (alpha=0.05). The comparison between blood pressure measurements was performed using Student's t-test for paired samples and Anova for repeated measures. RESULTS: a significant reduction in systolic (p<0.001) and diastolic (p<0.001) blood pressure was observed among participants in the intervention arm, which was not observed in the simulation arm. CONCLUSION: the results have demonstrated the efficacy of the protocol. Reduction and control of blood pressure have been demonstrated, indicating the possibility of using this technology for the care of patientes with essential systemic arterial hypertension. Brazilian Registry of Clinical Trials. UTN: U1111-1177-1811. Clinical Trials NCT02530853.


Assuntos
Terapia por Acupuntura/métodos , Hipertensão/terapia , Pontos de Acupuntura , Adulto , Idoso , Tecnologia Biomédica , Pressão Sanguínea/fisiologia , Projetos de Pesquisa Epidemiológica , Feminino , Humanos , Hipertensão/enfermagem , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem , Encaminhamento e Consulta
16.
Rev Gaucha Enferm ; 38(4): e63922, 2018 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29933419

RESUMO

OBJECTIVE: To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care. METHOD: Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis. RESULTS: The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care. CONCLUSION: The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.


Assuntos
Hipertensão/terapia , Atenção Primária à Saúde , Índice de Gravidade de Doença , Adulto , Anti-Hipertensivos/uso terapêutico , Ansiedade/etiologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/enfermagem , Hipertensão/psicologia , Entrevista Psicológica , Estilo de Vida , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/complicações , Qualidade de Vida , Autocuidado , Fumar/efeitos adversos , Apoio Social , Fatores Socioeconômicos
17.
Worldviews Evid Based Nurs ; 15(4): 247-256, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29902358

RESUMO

BACKGROUND: Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low- and middle-income countries have increasing rates of hypertension, much of it undiagnosed. AIMS: The purpose of the project is to review studies of nurse-led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low-resource settings. METHODS: A scoping review was conducted following Arksey and O'Malley's (2005) format. An electronic search in six databases for citations was conducted by the medical librarian author. The parameters for this scoping review were nurse interventions related to hypertension in East Africa. RESULTS: Fourteen full-text articles were identified that met inclusion criteria. Nurse-led interventions for hypertension were found to increase access to care and be cost- effective. Medication Adherence Clubs were an innovative intervention that increased the retention of patients in care. LINKING EVIDENCE TO ACTION: This scoping review provides evidence from studies of nurse-led hypertension interventions in East Africa relevant to implementing or improving hypertension screening, diagnosis, and treatment. Nurses provide 80% of health care in East Africa, and nurse-led hypertension interventions are critically needed to ameliorate the significant hypertension-related increases in morbidity and mortality globally.


Assuntos
Assistência à Saúde , Hipertensão/enfermagem , África Oriental , Análise Custo-Benefício , Assistência à Saúde/métodos , Prática Clínica Baseada em Evidências , Humanos
18.
Curr Hypertens Rep ; 20(8): 65, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29904903

RESUMO

PURPOSE OF REVIEW: Hypertension consists a major risk factor for cardiovascular events. Despite the proven effectiveness of antihypertensive treatment, approximately half of hypertensive patients have inadequate blood pressure control. Non-adherence to medication has been shown to be an important barrier to achieving adequate blood pressure control and nurse interventions can substantially improve therapeutic compliance. We sought to evaluate the role of nurse interventions in alleviating non-adherence to medication in patients with hypertension by performing a systematic review of the literature for all relevant articles. RECENT FINDINGS: Ten clinical studies were identified. The majority of studies reported beneficial effect of nursing intervention on treatment adherence in hypertensive patients. Telephone contacts and home visits were found to be the most effective educational approaches. Although comorbidities are considered to be an important barrier to adherence, there was not enough evidence to elucidate this aspect. Identifying specific factors that affect behavioral change in the setting of a successful intervention was difficult due to high heterogeneity among studies regarding materials and methods. Nursing interventions were shown to alleviate non-adherence to medication in patients with hypertension. Large well designed clinical trials are needed to evaluate specific factors that are associated with effective interventions.


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão , Adesão à Medicação , Papel do Profissional de Enfermagem , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/enfermagem
19.
PLoS Med ; 15(5): e1002561, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29715303

RESUMO

BACKGROUND: Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. We conducted a study to evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task shifting strategy for hypertension control (TASSH) plus HIC on systolic blood pressure (SBP) reduction among patients with uncontrolled hypertension in Ghana. METHODS AND FINDINGS: Using a pragmatic cluster randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH + HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28, 2012, and June 11, 2014, and followed up to October 7, 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits, while TASSH + HIC comprised cardiovascular risk assessment, lifestyle counseling, and initiation/titration of antihypertensive medications for 12 months, delivered by trained nurses within the healthcare system. The primary outcome was change in SBP from baseline to 12 months. Secondary outcomes included lifestyle behaviors and blood pressure control at 12 months and sustainability of SBP reduction at 24 months. Of the 757 patients (389 in the HIC group and 368 in the TASSH + HIC group), 85% had 12-month data available (60% women, mean BP 155.9/89.6 mm Hg). In intention-to-treat analyses adjusted for clustering, the TASSH + HIC group had a greater SBP reduction (-20.4 mm Hg; 95% CI -25.2 to -15.6) than the HIC group (-16.8 mm Hg; 95% CI -19.2 to -15.6), with a statistically significant between-group difference of -3.6 mm Hg (95% CI -6.1 to -0.5; p = 0.021). Blood pressure control improved significantly in both groups (55.2%, 95% CI 50.0% to 60.3%, for the TASSH + HIC group versus 49.9%, 95% CI 44.9% to 54.9%, for the HIC group), with a non-significant between-group difference of 5.2% (95% CI -1.8% to 12.4%; p = 0.29). Lifestyle behaviors did not change appreciably in either group. Twenty-one adverse events were reported (9 and 12 in the TASSH + HIC and HIC groups, respectively). The main study limitation is the lack of cost-effectiveness analysis to determine the additional costs and benefits, if any, of the TASSH + HIC group. CONCLUSIONS: Provision of health insurance coverage plus a nurse-led task shifting strategy was associated with a greater reduction in SBP than provision of health insurance coverage alone, among patients with uncontrolled hypertension in Ghana. Future scale-up of these systems-level strategies for hypertension control in sub-Saharan Africa requires a cost-benefit analysis. TRIAL REGISTRATION: ClinicalTrials.gov NCT01802372.


Assuntos
Hipertensão/enfermagem , Seguro Saúde , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Pesquisa Comparativa da Efetividade , Feminino , Gana , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/terapia , Seguro Saúde/organização & administração , Masculino , Pessoa de Meia-Idade , Medição de Risco , Comportamento de Redução do Risco
20.
Nurse Pract ; 43(6): 33-37, 2018 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-29757834

RESUMO

The new hypertension guideline lowers the definition of high BP to 130/80 mm Hg. This means that millions of adults will now be diagnosed with hypertension and that many of those taking antihypertensive drugs are not at goal. The challenge is to communicate the change, the strength of evidence behind the change, and the options available to patients. Healthcare providers must be knowledgeable of the new guideline and must be ready to meet this challenge.


Assuntos
Hipertensão/enfermagem , Guias de Prática Clínica como Assunto , American Heart Association , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/etiologia , Programas de Rastreamento/enfermagem , Diagnóstico de Enfermagem , Fatores de Risco , Sociedades Médicas , Estados Unidos
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