Improving control of hypertension by an integrated approach ??? results of the ???Manage it well!??? programme

Szirmai, László; Arnold, Csaba; Farsang, Csaba

doi:10.1097/00004872-200501000-00031

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…A study conducted in Hungary also assessed the effectiveness of a special care program called “Manage it well” for hypertensive patients. The outcomes of this study showed that strategies similar to those used in the present study significantly increased treatment success, decreased the in-office blood pressure measurements, and significantly increased blood pressure control (from 2.9% at baseline to 40.9% after a six-month intervention) 36. There is no doubt that the best levels of hypertension control are observed in randomized, prospective clinical trials that assess the efficiency of antihypertensive drugs.…”

Section: Discussionsupporting

confidence: 57%

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

Gusmão

Mion

Pierin

2009

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INTRODUCTION:The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL)OBJECTIVE:This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications.MATERIALS AND METHODS:Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher’s Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into “with complications” (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and “without complications” (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics.RESULTS:In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/84±11 and 144±21/93±11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128±17/75±13 and 128±15/83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the “with complications” group and from 78% to 50% in the “without complications” group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher’s Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher’s Questionnaire showed no differences in these scores.CONCLUSION:Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

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Section: Discussionsupporting

confidence: 57%

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

Gusmão

Mion

Pierin

2009

Clinics

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“…In our Manage It Well (MIW) programme, data on the ratio of well-controlled hypertensive patients show a much worse situation, as it was between 3 and 6%. 8 Both smoking and alcohol consumption are lower in the ECHP Study than the country average. 9 This applies even more to the participating GP-s (self-selection).…”

Section: Discussionmentioning

confidence: 94%

Effective control of hypertension: a project of the Hungarian society of hypertension, baseline data

et al. 2004

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The aim of the project is to assess the quality and improve the preventive and curative practices at the primary care level in Hungary. A total of 50 general practitionaires were selected on a voluntary basis in Budapest, Hungary, and from them, 30 were randomized to the intervention (I) group and 20 to the reference (R) group. The members in the I group have been trained for the official hypertension guideline and their everyday work is monitored. Those in the R group have only been monitored to measure the efficacy of the training. In all, 10% from the known hypertensive persons (N ¼ 10,799) and 5% of the remaining (nonhypertensive) patients (N ¼ 60,341) were selected randomly from the GP's computer files and invited for screening investigation performed by trained medical students. They measured the blood pressure of patients, assessed the cardiovascular risk status and the quality of education of patients by standardized questionnaires. In total, 4083 patients were invited, but only 39.2% attended the screening visit. The prevalence of undetected hypertension was 34.6%. This prevalence was significantly higher in the older (460 years: 46.8%) than in the younger (o50 years: 20.8%, Po0.0001) age group and it was higher in men (41.5%) than in women (30.1%, Po0.001). The proportion of H patients on drug treatment was 85.3% and the frequency of patients under effective blood pressure control (ego140/90 mmHg) was 27.8%. Counselling to patients for a healthier lifestyle (exercise, smoking, alcohol consumption, diet) was very rare. In conclusion, our data represent the primary care of Budapest and may not be relevant to the whole country. As a consequence of this study, education of primary care physicians and patients is a must for further improvement of hypertension care.

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“…Integrated programs for patient education contributed to the effective management of hypertension (34). Although our study did not include special educational programs, patients were encouraged to comply with the scheduled visits, which were more frequent than in other similar clinical trials (35)(36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)

Group¹

2008

Hypertens Res

349

206

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Improving control of hypertension by an integrated approach ??? results of the ???Manage it well!??? programme

Abstract: The integrated, patient-focused approach used in the MIW programme significantly increases the success of treatment in a 'real-world' setting.

Cited by 16 publications

References 30 publications

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

Effective control of hypertension: a project of the Hungarian society of hypertension, baseline data

Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)

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