Improved treatment and control of hypertension in Swedish primary care

Holmquist, Charlotte; Hasselström, Jan; Boström, Kristina Bengtsson; Manhem, Karin; Wettermark, Björn; Hjerpe, Per; Kahan, Thomas

doi:10.1097/hjh.0000000000001429

Cited by 22 publications

(7 citation statements)

References 36 publications

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“…A likely explanation for the decline in non-OAC ICH incidence is improved detection and control of hypertension [11, 35]. Two Swedish studies have shown an increased number of patients with antihypertensive treatment but importantly also improved BP control between 1986 and 2009 and 2001/2002–2007/2008, respectively [36, 37]. Still, about half of the patients did not achieve adequate BP control indicating that even more cases of ICH can be prevented using established treatment.…”

Section: Discussionmentioning

confidence: 99%

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Drescher,

Buchwald,

Ullberg

et al. 2023

Neuroepidemiology

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Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010–2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010–2012, 2013–2016, and 2017–2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8–30.3) to 26.7 (95% CI 26.0–27.3) between 2010–2012 and 2017–2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0–26.3) to 20.7 (95% CI 20.1–21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61–4.12) to 6.01 (95% CI 5.70–6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010–2012 and 2017–2019 from 13.1% to 22.5% (p < 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146–164) to 106 (95% CI 98.6–113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1–29.4) to 65.5 (95% CI 59.9–71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.

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Section: Discussionmentioning

confidence: 99%

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Drescher,

Buchwald,

Ullberg

et al. 2023

Neuroepidemiology

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“…High blood pressure is a leading modifiable cause of premature death [ 1 ]. In Sweden, approximately, a third of the grown-up population is affected [ 2 , 3 ]. Many patients with hypertension do not reach recommended blood pressure targets and are thereby exposed to an unnecessary – but treatable – elevated risk of disease and death [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Quester,

Björck,

Manhem

et al. 2024

Scandinavian Journal of Primary Health Care

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Objective A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. Design and setting Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. Intervention Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. Patients Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. Main outcome measures Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. Results In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL- C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p = .043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations. Conclusion Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.

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“…The treatment is often based on severity of the hypertension, and patients preferences are not always considered [ 16 ]. One reason for lack of goal achievement, whether it is reaching the target BP or achieving successful lifestyle modifications, is presumably the limited opportunities for a shared understanding of health needs and everyday commitment to treatment [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension – a randomized controlled trial in primary care

Vestala,

Bendtsen,

Midlöv

et al. 2024

Scandinavian Journal of Primary Health Care

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Objective To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). Design A parallel group, non-blinded, randomized controlled trial, conducted October 2018–February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. Setting 31 primary healthcare centers in Sweden. Subjects 949 patients treated for hypertension. Main outcome measures The effects on preference-based patient participation, that is, the match between a patient’s preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. Results At baseline, 43–51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for ‘managing treatment myself’ at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. Conclusion The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.

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Improved treatment and control of hypertension in Swedish primary care

Abstract: BP control in hypertensive patients attending Swedish primary care has improved over 5-7 years, and more so in high-risk groups. There is, however, room for improvement. In uncontrolled hypertension the combination of several drug classes remain low.

Cited by 22 publications

References 36 publications

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010–2019: An Observational Study from the Swedish Stroke Register (Riksstroke)

Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension – a randomized controlled trial in primary care

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