Visanuyothin Sawitree, Plianbangchang Samlee, Somrongthong Ratana
Social Medicine Department, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
J Multidiscip Healthc. 2018 Feb 23;11:131-138. doi: 10.2147/JMDH.S156518. eCollection 2018.
Hypertension (HT) is the major risk factor for cardiovascular diseases because of its poor control. To control HT at the primary care level in urban communities, there is a demand for deeper comprehension of the manifestations of poorly controlled HT. This study aimed to examine appearance of HT, including the association between the appearance and home blood pressure (HBP) control at the primary care level in urban communities.
A cross-sectional study was conducted in July-October 2017 in an urban community in Thailand. The total sample size from randomization was 125 poorly controlled HT patients who were diagnosed with an average clinic blood pressure ≥140/90 mmHg in their last three visits. Data were collected by face-to-face interviews, HBP monitoring (HBPM), and blood and urine testing. Data analysis was conducted via descriptive statistics and the chi-square tests, with a significance level of <0.05.
HBPM revealed that 58.4% of patients with poorly controlled blood pressure from clinic measurement had a systolic blood pressure and diastolic blood pressure that were below the HBP target. Most patients were overweight/obese, but they were nonsmokers and nondrinkers. As comorbidities, they had hyperlipidemia (64.0%) and diabetes mellitus (53.0%). One-quarter of them had good levels of knowledge and literacy. Nearly half had good health self-care literacy. Only 13% exhibited adequate self-management behaviors, but more than half had biochemistry results within normal limits. There were significant associations of smoking history and having hyperlipidemia as a comorbidity with HBP control ( =0.010 and 0.046, respectively).
The role of HBPM is important in practice when it comes to monitoring HT control at the primary care level in an urban context. Smoking cessation and control of the blood lipid levels should be highlighted not only at the practice, but also at the policy level.
高血压（HT）因其控制不佳而成为心血管疾病的主要危险因素。为了在城市社区的初级保健层面控制高血压，需要更深入地了解控制不佳的高血压的表现。本研究旨在探讨高血压的表现，包括在城市社区初级保健层面其表现与家庭血压（HBP）控制之间的关联。
2017年7月至10月在泰国的一个城市社区进行了一项横断面研究。随机抽取的总样本量为125例血压控制不佳的高血压患者，他们在最近三次就诊时诊所测量的平均血压≥140/90 mmHg。通过面对面访谈、家庭血压监测（HBPM）以及血液和尿液检测收集数据。数据分析采用描述性统计和卡方检验，显著性水平<0.05。
家庭血压监测显示，诊所测量血压控制不佳的患者中，58.4%的收缩压和舒张压低于家庭血压目标。大多数患者超重/肥胖，但他们不吸烟、不饮酒。作为合并症，他们患有高脂血症（64.0%）和糖尿病（53.0%）。其中四分之一的患者知识水平和素养良好。近一半的患者健康自我护理素养良好。只有13%的患者表现出充分的自我管理行为，但超过一半的患者生化结果在正常范围内。吸烟史和合并高脂血症与家庭血压控制之间存在显著关联（分别为=0.010和0.046）。
在城市环境的初级保健层面监测高血压控制时，家庭血压监测在实践中具有重要作用。不仅在实践层面，而且在政策层面都应强调戒烟和控制血脂水平。
