Department of Pharmacology and Toxicology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia.
Health Center "Dr Janoš Hadži" Bačka Topola, Novi Sad, Serbia.
BMJ Open. 2022 Nov 2;12(11):e064306. doi: 10.1136/bmjopen-2022-064306.
To determine rate of blood pressure (BP) control and to analyse patient-related, medication-related and healthcare system-related factors associated with poor BP control in outpatients with hypertension (HT).
Cross-sectional study.
Two study sites with different levels of healthcare (primary healthcare (PHC) and secondary level of healthcare (SHC)) in Vojvodina, Northern Serbia.
A total of 581 patients (response rate 96.8%) visiting their primary care physician between July 2019 and June 2020 filled out a pretested semistructured questionnaire and had a BP reading during their regular appointments.
Data on demographics, medication, BP control (target systolic BP≤140 mm Hg and∕ or diastolic BP≤90 mm Hg) and knowledge on HT was collected. Based on the median of knowledge score, patients were classified as having poor, average and adequate knowledge.
Majority of the respondents (74.9%) had poorly controlled BP and had HT longer than 10 years. Larger number of patients at PHC site was managed with monotherapy while at the SHC majority received three or more antihypertensive drugs. Respondents from SHC showed a significantly lower knowledge score (9, 2-15) compared with the respondents from PHC (11, 4-15, p=0.001). The share of respondents with adequate knowledge on HT was significantly higher in the group with good BP control (26% and 9.2%, respectively). In a multivariate regression analysis, factors associated with poor BP control were knowledge (B=-1.091; p<0001), number of drugs (B=0536; p<0001) and complications (B=0898; p=0004).
Poor BP control is common in outpatients in Serbia, irrespective of the availability of different levels of healthcare. Patients with poor knowledge on HT, with complications of HT and those with multiple antihypertensive drugs, were at particular risk of poor BP control. Our study could serve as a basis for targeted interventions to improve HT management.
确定高血压（HT）门诊患者血压（BP）控制率，并分析与 BP 控制不佳相关的患者相关、药物相关和医疗保健系统相关因素。
横断面研究。
塞尔维亚北部伏伊伏丁那两个具有不同医疗保健水平的研究地点（初级保健（PHC）和二级保健（SHC））。
2019 年 7 月至 2020 年 6 月期间，共有 581 名（应答率 96.8%）患者在其初级保健医生就诊时填写了预先测试的半结构式问卷，并在常规就诊期间进行了 BP 读数。
收集了人口统计学、药物、BP 控制（目标收缩压≤140mmHg 和/或舒张压≤90mmHg）和 HT 知识的数据。根据知识评分中位数，患者被分为血压控制不佳、平均和充分了解 HT。
大多数患者（74.9%）的 BP 控制不佳，且 HT 患病时间超过 10 年。在 PHC 地点，更多患者接受单一疗法治疗，而在 SHC 地点，大多数患者接受三种或更多种降压药物治疗。与 PHC 地点的患者相比，SHC 地点的患者的知识评分显著较低（9，2-15）（p=0.001）。在良好 BP 控制组中，具有足够 HT 知识的患者比例明显更高（分别为 26%和 9.2%）。在多变量回归分析中，与 BP 控制不佳相关的因素包括知识（B=-1.091；p<0001）、药物数量（B=0536；p<0001）和并发症（B=0898；p=0004）。
无论医疗保健水平如何，塞尔维亚的门诊患者 BP 控制普遍不佳。HT 知识较差、HT 并发症和使用多种降压药物的患者尤其存在 BP 控制不佳的风险。我们的研究可以为改善 HT 管理提供有针对性的干预措施的基础。
