Barbakadze Vakhtang Y, Koblianidze Levan G, Kipshidze Nodar N, Grim Clarence E, Grim Carlene M, Tavill Frederick
Union of Laboratory Diagnostic, National Center of Therapy, Tbilisi, Georgia.
Ethn Dis. 2006 Spring;16(2 Suppl 2):S2-61-5.
52% of adults have uncontrolled hypertension in the Republic of Georgia. We incorporated a blood pressure control program into an existing primary healthcare system in an attempt to improve the rate of blood pressure control.
We conducted standardized trainings of rural primary care providers--doctors and nurses--in accurate measurement of blood pressure according to the Shared Care Method of Training and Certification. Our attention was focused especially on patient management based on Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines. Antihypertensive treatment was implemented by a stepped-care approach; hydrochlorothiazide and atenolol were given to patients at follow-up visits at no cost. The treatment goal was < 140/ 90 mm Hg based on the office blood pressure.
A total of 251 patients with uncontrolled hypertension were enrolled in the program; 32% had stage I hypertension, 41% had stage II hypertension, and 27% had stage III, as defined by JNC VI. During the first 30 months of followup, blood pressure decreased gradually from 170/95 to 140/ 82 mm Hg. The rate of high blood pressure control increased progressively up to 59%.
We conclude that hypertension control can be improved in all groups of patients, even in a healthcare system with limited resources. We emphasize that Georgia or any other healthcare system should not wait for universal health care to improve high blood pressure control. It can be incorporated into whatever system exists today.
在格鲁吉亚共和国，52%的成年人患有未得到控制的高血压。我们将一项血压控制项目纳入现有的初级医疗保健系统，试图提高血压控制率。
我们根据共享护理培训与认证方法，对农村初级保健提供者（医生和护士）进行了血压精确测量的标准化培训。我们尤其关注基于美国国家高血压预防、检测、评估和治疗联合委员会（JNC）指南的患者管理。降压治疗采用逐步护理方法实施；氢氯噻嗪和阿替洛尔在随访时免费提供给患者。治疗目标是基于诊室血压<140/90mmHg。
共有251例未得到控制的高血压患者纳入该项目；根据JNC VI标准，32%为I期高血压，41%为II期高血压，27%为III期高血压。在随访的前30个月中，血压从170/95mmHg逐渐降至140/82mmHg。高血压控制率逐步提高至59%。
我们得出结论，即使在资源有限的医疗保健系统中，所有患者群体的高血压控制情况都可以得到改善。我们强调，格鲁吉亚或任何其他医疗保健系统不应等待全民医疗保健来改善高血压控制。它可以纳入当今现有的任何系统。
