Rayner Brian, Blockman Marc, Baines Donette, Trinder Yvonne
Division of Hypertension, Department of Medicine, University of Cape Town, South Africa.
S Afr Med J. 2007 Apr;97(4):280-4.
Control of hypertension remains an elusive goal, but doctors' non-compliance with guidelines, patient attitudes and adherence to treatment, and poor delivery of care at clinics are important contributing factors.
To determine the overall quality of hypertensive care, and compliance with current hypertension guidelines at community health centres (CHCs) in the Western Cape.
Consecutive patients attending hypertension clinics at two CHCs were selected to participate. A questionnaire was designed to determine patient demographics, doctors' compliance with hypertension guidelines, factors leading to treatment non-adherence, and delivery of care. Accuracy of blood pressure (BP) recording was evaluated by comparing the clinic BP with that measured using an approved manometer.
One hundred and sixty-one patients were evaluated, 100 from CHC 1 and 61 from CHC 2. There was no difference in both control systolic and diastolic BP measured by the hypertension nurse (147.9 v. 144.8 mmHg, p = 0.45, and 89.3 v. 85.6 mmHg, p = 0.14) respectively. All clinic BP readings were recorded to the nearest 10 mmHg mercury. The difference in both systolic and diastolic BP > 10 mmHg between the clinic and control BP was significantly greater at CHC 2 than CHC 1 (28% v. 56%, p = 0.005, and 43% v. 64%, p = 0.007) respectively. Overall, 39.8% of patients had a systolic and diastolic BP < 140 and < 90 mmHg. The mean number of antihypertensive drugs was 2.4 per patient. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants was high at both centres, and few patients underwent basic investigations, lifestyle interventions, risk stratification or global cardiovascular risk reduction.
39.8% of patients achieved a BP < 140/90 mmHg. There is significant scope for improvement in prescription of medication, application of uniform lifestyle changes, and avoidance of NSAIDs and tricyclic antidepressants. Major deficiencies were identified in BP measurement, assessment of target organ damage, risk stratification and the reduction of overall cardiovascular risk.
高血压的控制仍然是一个难以实现的目标，但医生不遵守指南、患者的态度和治疗依从性以及诊所护理服务不佳是重要的促成因素。
确定西开普省社区卫生中心（CHC）高血压护理的总体质量以及对当前高血压指南的遵守情况。
选取在两家社区卫生中心高血压诊所就诊的连续患者参与研究。设计了一份问卷，以确定患者人口统计学信息、医生对高血压指南的遵守情况、导致治疗不依从的因素以及护理服务情况。通过将诊所测量的血压与使用经批准的血压计测量的血压进行比较，评估血压（BP）记录的准确性。
共评估了161名患者，其中100名来自社区卫生中心1，61名来自社区卫生中心2。高血压护士测量的收缩压和舒张压控制情况无差异（分别为147.9对144.8 mmHg，p = 0.45；89.3对85.6 mmHg，p = 0.14）。所有诊所血压读数均记录至最接近的10 mmHg汞柱。社区卫生中心2诊所血压与对照血压之间收缩压和舒张压差值>10 mmHg的情况分别显著高于社区卫生中心1（28%对56%，p = 0.005；43%对64%，p = 0.007）。总体而言，39.8%的患者收缩压和舒张压<140和<90 mmHg。每位患者使用的抗高血压药物平均数量为2.4种。两家中心非甾体抗炎药（NSAIDs）和三环类抗抑郁药的使用频率都很高，很少有患者接受基本检查、生活方式干预、风险分层或总体心血管风险降低措施。
39.8%的患者血压<140/90 mmHg。在药物处方、统一生活方式改变的应用以及避免使用NSAIDs和三环类抗抑郁药方面有很大的改进空间。在血压测量、靶器官损害评估、风险分层以及总体心血管风险降低方面发现了主要缺陷。
