Complicated High Blood Pressure in Hospital Area in Lomé

The target of the study was to identify patients living with Compound high blood pressure and describe the epidemiological, treatment and progressive aspects. We had realized retrospective and descriptive study completed throughout twelve months from 1st January to December 31, 2011. The study took into account 250 hypertensives known or not admitted in the cardiology and medical intensive care units at the Sylvanus Olympio Teaching Hospital in Lomé. In total, the frequency of complications of the High Blood Pressure was 33.3% with a male predominance. Patients’ average age was 52.4 years. The most frequent reasons of admission were coma (32%) and hypertensive eruption (28%). The excessive consumption of salt and alcohol were other dominant modifiable risks factors with respectively 36.8% and 22.8%. Neurologic complications were the most frequent of cerebrovascular accidents (CVA) (66%) among which strokes represented 69.7%. Cardiac complications came in second position (31.2%). Double treatment was optional in 62.2% cases with IEC+ Ica++ associated. In 56.6% cases patients with renal disease in terminal stage had been dialysed. The level of total lethality was 34%. The main cause of death was CVA (cerebrovascular accidents) (85.9%). High Blood Pressure is then a very plague with regard to its complications. Its effective caretaking is nothing but through primary prevention based on sensitization, education of the entire grass-roots and it requires the mobilization of all social components.

High Blood Pressure in External Consultation in Cardiology of Kati

Objective: To study hypertension and its manifestations in?Out-patients’ Department of Cardiology of Kati. Methods: The study was traversal and it was based on a sample of 300 patients, reached during the interval of 12 (twelve) months (from June 2012 to June 2013). Results: The predominance was among the females with 68.7%. The average age was about?55.8 ± 12.2 years old. The extreme ages were?about 21 and 90 years?old. In the set,?66% of the patients lived in the town of Kati.?The symptoms of Dieulafoy were predominantly the reasons for consultation with 55.7%. The cardiac frequency in the vast majority of cases was normal (85.3%). The left ventricular hypertrophy in the electrocardiogram was observed in more than half of the cases,?that is to say,?51.3%. In a bit higher proportion,?the echocardiography Doppler became normal,?that is to say,?54%. Brain scanner done on 9 patients found out signs of cerebrovascular stroke in 8 patients,?that is to say,?a frequency of 88.9%. In 76% of cases?of orthostatic hypotension,?the patients were hypertensive.?The blood pressure was normal during the passage of orthostatism in the cases of 258 of our patients,?that is to say,?86.0% of the cases. However, the orthostatic hypotension (OH) was observed in the cases of 42 patients, that is to say,?14.0% of the cases. In this set of patients,?41.6% of the moans were due to cephalgias and dizziness’s. The monotherapy of patients with OH represented 47.6% of the cases. Blood pressure was not controlled in 66.7% of the?cases of?OH. The biological examinations required were normal in 52.4% of the cases. Conclusion: The hypertension is a disease which is frequently the reason for consultation in cardiology. The symptoms of Dieulafoy can be the signs of call. The complications are sometimes recurrent. The orthostatic hypotension should be found out even under monotherapy on a balanced or non-balanced hypertensive patient through treatment.

Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.

Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = -0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = -0.13, p = 0.25) and patients’ level of education (rpb = -0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included;quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.

上海市某医院老年高血压患者高血压认知状况调查及影响因素分析

目的:对接受降压药物治疗的老年高血压患者的高血压认知水平进行区域性调查,分析其高血压认知水平的影响因素。方法:对2021年1月—12月上海市嘉定区迎园医院接受降压药物治疗的734例老年高血压患者进行问卷调查,采用多因素logistic回归分析其高血压认知水平的影响因素,并对相关防控措施进行探讨。结果:734例高血压患者中,高血压疾病相关知识知晓者481例,占65.53%;单项知晓率为26.02%~95.50%,其中知晓高血压可以遗传的人数最少,占26.02%,知晓高血压患者需要经常测量血压的人数最多,占95.50%。患者自我管理情况良好,能够坚持经常测量血压、体重,限盐,均衡饮食,规律服药及复诊的患者占60%以上。分析结果显示,已婚、文化程度为高中及以上、职业为工人及公务员或其他职业、与家人居住、家庭人均月收入高的老年高血压患者对高血压的认知水平更高。结论:老年高血压患者对高血压的认知水平较高,且自我管理情况良好。相关部门应加强对丧偶离异、文化程度低、家庭月收入较低的独居老年患者进行疾病知识宣传和健康教育工作,提高其高血压认知水平,有效控制高血压,改善生活质量。

Blood Pressure Targets in the Hypertensive Elderly

Objective： Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure （BP） targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty. Data Sources： We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords ＂hypertension,＂ ＂elderly,＂ ＂blood pressure,＂ and ＂antihypertensive.＂ Study Selection： Articles that related to BP targeting in the hypertensive elderly were selected for this review. Results： The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly （60 years or older） with systolic BP 〉 160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients （80 years or older）, there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful. Conclusions： There are solid evidences that patients who are 60-80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. Antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.

联合治疗对腹型肥胖老年原发性高血压患者降压疗效及动脉硬化程度的影响

目的探讨氨氯地平联合阿托伐他汀钙片对腹型肥胖老年原发性高血压患者降压治疗效果及动脉硬化的影响。方法选取2020年1月-2021年10月临沂市人民医院就诊治疗的366例腹型肥胖老年原发性高血压患者,随机分为强化组207例和基础组159例。两组均给予氨氯地平(5 mg/d)进行降压治疗,强化组在此基础上给予阿托伐他汀钙片(10 mg/d)。定期随访,对两组的血压与动脉硬化相关指标进行统计学分析。结果①治疗后,组间收缩压(SBP)、脉压差(PP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-L)较治疗前均显著降低(P<0.05)。②强化组的舒张压(DBP)显著降低(P<0.05),高密度脂蛋白胆固醇(HDL-C)显著升高(P<0.05)。③强化组的降压总有效率、动脉硬化改善的总有效率均显著高于基础组(P<0.05)。④强化组的AI显著降低,两组间的ABI均显著升高(P<0.05)。⑤治疗时两种药物对患者的SBP、DBP、PP、ABI、AI存在交互作用,F值分别为26.338、3.852、31.570、18.025、27.536,组间差异有统计学意义(P<0.05)。⑥对组别进行控制后,偏相关分析结果显示ABI与AI存在正相关(r=0.636,P<0.05)。结论氨氯地平联合阿托伐他汀钙片对腹型肥胖老年高血压者的降压疗效显著,能够有效调节血脂水平,预防和控制动脉硬化疾病的发生与发展。

健康教育对提高高血压患者用药依从性和治疗效果的探讨

目的 :探讨健康教育对提高高血压患者用药依从性和治疗效果的作用。方法 :应用多种教育方式对 5 4例高血压患者实施系统的健康教育 ,并以高血压 48例作对照 ,对接受健康教育的患者随诊 1年 ,比较血压控制程度。结果 :两组差异有高度显著性 (P <0 0 1)。结论 :健康教育明显提高了高血压患者的用药依从性 ,对高血压的规范治疗 ,提高疗效有协同作用。

合并颈动脉粥样硬化的老年高血压患者危险因素分析

目的探讨合并颈动脉粥样硬化(CAS)的老年高血压患者其危险因素情况。方法将2009年4月—2014年5月在我院进行高血压治疗的318例老年患者,测量颈动脉内膜-中膜厚度IMT),观察是否有斑块形成,分为颈动脉粥样硬化组和颈动脉非粥样硬化组,对两组患者的相关危险因素进行对比以及Logistic多因素分析。结果通过对两组患者治疗开始时的各项指标进行检测,发现除年龄、吸烟、肥胖外,两组患者在病程、24 h平均收缩压(SBP)、24 h平均舒张压(DBP)、脉压、血脂异常、糖尿病、葡萄糖调节受损(impaired glucose regulation,IGR)、高尿酸血症等差异均有统计学意义(P<0.05)。进一步的Logistic多因素回归分析表明血脂异常、SBP、脉压、糖尿病、IGR对颈动脉粥样硬化形成相关(OR分别为1.123、3.989、1.902、2.641、2.789、2.513,P<0.01)。结论血脂异常、SBP、脉压、糖尿病、IGR对于老年高血压患者颈动脉粥样硬化形成及恶化有显著的关系,在临床实践中,应重视对相关危险因素的控制。

基于老年高血压病临床特点的中西医机制探析

高血压病在我国老年人群中患病率较高,是老年人致死和致残的主要原因之一。老年高血压患者有其特有的生理病理特点,同时,其临床表现也有一定特殊性。中医注重整体观念,注重气血阴阳的调和,"阴平阳秘"以及"天、地、人"合一的学术思想,认为人体血压的动态变化与人体内气血运行、阴阳消长关系密切,而老年高血压患者气血阴阳失调,脏腑精气亏虚,这就决定老年高血压患者的中医病因病机与青年人不同。以老年高血压病的独有特点为主线,探讨老年高血压病的西医生理病理以及中医病因病机。

老年高血压患者脉压和心电图变化

目的:分析老年高血压患者脉压(PP)与心电图变化。方法:对291名老年高血压患者进行基本信息调查,并进行血压与心电图的测量,分析不同PP患者血压现状和心电图异常的差异。结果:在老年高血压患者中,1期高血压所占比例最大,为68.73%,86.95%的高血压患者PP值偏高,1期和2期高血压患者中,PP在41～60mmHg者所占比例最高,3期高血压患者中,PP>61mmHg者所占比例最高,且明显高于1期和2期高血压患者,差异均有统计学意义(P<0.05或P<0.01)。PP≥61mmHg组患者各种心电图异常率均高于PP≤40mmHg组(心律失常除外)和PP在40～60mmHg组(左室高电压除外),差异有统计学意义(P<0.05或P<0.01)。结论:高血压患者PP值普遍偏高,PP增加可加重心电图异常发生率,监测PP并行有效干预有助于预防心血管事件的发生。

正常高值血压患者认知行为干预效果评价

目的：探讨对正常高值血压患者进行认知行为干预的治疗效果。方法将2011年4月~2011年10月体检时发现正常高值血压患者60例作为对照组，将2011年11月~2012年4月体检时发现的60例正常高值血压患者作为干预组。对照组采用常规护理，干预组在常规护理的基础上通过电话进行为期1年的认知行为干预，内容包括改变患者生活习惯、鼓励患者低盐低脂饮食、禁烟限酒，适当增加运动等，并分别于第2年体检时通过问卷调查患者对正常高值血压治疗性生活方式相关知识的知晓率、生活方式改变等情况。同时收集两组患者干预前后的体检报告，内容包括：血压、空腹血糖、血脂、测量当日身高、体重等指标，评价两组患者认知行为干预的效果。结果通过1年系统的认知行为干预，与对照组比较，干预组正常高值血压治疗性生活方式相关知识知晓率较高（90% vs.73.3%，P＜0.05），同时高盐饮食（23.3%vs.46.7%，P＜0.05）、高脂饮食（13.3% vs.35.9%，P＜0.05）、吸烟人数（25.0 vs.48.3%，P＜0.05）、饮酒人数（30.0%vs.36.7%，P＜0.05）均减少，而坚持运动的人数增加（86.7%vs.50.0%），同时血脂、血糖也获得了改善，差异均有统计学意义（P＜0.05）。结论通过系统的认知行为干预可纠正正常高值血压人群不良生活方式，改善患者代谢水平。

住院老年高血压患者心理状态与治疗依从性的相关性研究

目的探讨老年高血压住院患者的心理健康状况和治疗依从性。方法将2012年5月至2014年5月我院收治的200例老年高血压住院患者分为空巢老人组、丧偶老人组、五保户老人组及常规老人组,使用症状自评量表(SCL-90),纽芬兰纪念大学幸福度量表(MUNSH),社会支持评定量表(SSRS),治疗依从性问卷对所有老年患者进行调查并分析。结果老人偏执、焦虑、抑郁、人际关系敏感及躯体化症状五因子差异有统计学意义(P<0.05);不同分组患者MUNSH量表中总分、NE、PE、NA及PA评分差异有统计学意义(P<0.05);不同分组患者其客观支持及主观支持间差异有统计学意义(P<0.05)。Logistic分析结果显示,年龄及患者主动性是患者治疗依从性的影响因素(P<0.05)。结论通过研究不同人群的住院老年高血压患者的心理状况,及时给予干预和影响,提高治疗依从性,为临床医护用药和治疗提供科学合理的依据。

内镜下逆行胰胆管造影高血压患者的麻醉方案研究

目的 了解内镜下逆行胰胆管造影术（ERCP）高血压患者的不同麻醉方案效果。方法 选择ASAⅡ、Ⅲ级,年龄50～70岁的择期行ERCP的患者120例,随机分为3组,右美托咪定组（A组）;丙泊酚组（B组）及咪达唑仑组（C组）,每组40例。观察和记录给药前、给药后1 min、内镜插入食管、停药及苏醒期5个时点的收缩压（SBP）、舒张压（DBP）、心率（HR）和动脉血氧饱和度（SPO2）的变化,并观察其不良反应的发生情况。结果 A组用药后各时间点的观察指标波动最小,且不良反应发生率最低。结论 右美托咪定复合芬太尼用于高血压患者ERCP安全可靠,是一种目前较为理想的麻醉方法。

全麻诱导期急性高容量血液稀释对老年患者血生化的影响

目的时比观察乳酸钠林格氏液和勃脉力A在老年患者术前急性高容量血液稀释前后血气、电解质、血糖、乳酸的变化。方法选择24例腹部择期手术老年患者，年龄65-76岁，ASAI-Ⅱ级，无心肺疾患，无高血压、糖尿病、肝功能、肾功能障碍病史。随机分为勃脉力A（BML）组和乳酸钠林格氏液（RL）组，患者入室开放静脉后分别给予2组液体15mL／kg，30min输注完毕，分别于输液前（T0）、后30min（T1）、60min（T2）、120min（T3），抽血查血气、电解质、血糖、乳酸。结果2组扩容前后钠离子、钾离子、血气无明显变化；血糖：RL组、BML组入室后都升高，且T3与T0比明显升高，P〈0.01。2组间各时点血糖值却无显著性差异；钙离子：BML组输液后明显降低，T1，T2，T3与T0相比P〈0.01。RL组各时点间无显著性差异。T1，T2，T3时点BML组钙离子显著低于RL组P〈0.01。红细胞体积比压力（HCT）、血红蛋白（Hb）：2组患者输液后均明显下降，T1，T2，T3与T0相比P〈0.01。但2组间各时点值却无显著性差异。结论勃脉力A用于急性高容量血液稀释时稳定机体生理内环境安全、有效，但可致血钙离子降低，注意加强监测。

手术室优质护理对妇科急诊手术患者的影响

目的:探讨围术期优质手术室护理对急诊手术患者焦虑水平、血压和心率的影响。方法:选择2016年3月至2017年2月我院手术室接受妇科急诊手术治疗的患者180例,根据随机数字表法,将患者等分为观察组和对照组。对照组患者接受常规护理;观察组患者在对照组患者的基础上接受手术室优质护理,比较两组患者的焦虑水平、血压、心率变化及两组患者护理满意度。结果:麻醉前观察组患者焦虑评分明显低于对照组(P<0.05),麻醉前观察组患者焦虑评分明显低于术前1 h(P<0.05);两组患者术前1 h收缩压、舒张压、心率比较差异无统计学意义(P>0.05);麻醉前舒张压比较差异无统计学意义(P>0.05),但观察组麻醉前收缩压、心率明显低于对照组(P<0.05)。观察组患者满意度评分明显高于对照组(P<0.05)。结论:手术室优质护理能够有效调整急诊手术患者的心理、生理状态,降低焦虑水平,平稳血压和心率,临床效果确切。

老年单纯收缩期高血压40例临床分析

目的探讨对患有单纯收缩期高血压病(ISH)病人的治疗与护理。方法配合非药物治疗,对40例单纯收缩期高血压病人应用钙通道拮抗剂(CCB)和血管紧张素转换酶抑制剂(ACEI)治疗单纯收缩期高血压。结果显效30例,有效8例。总有效率95%。结论及时确诊,重视非药物治疗,针对发病机制合理用药,是治疗单纯收缩期高血压病的关键。

提高脑卒中患者对高血压的认知率

合并高血压症是脑血管疾病的常见病和多发病。为了提高患者对高血压的认知,增强保健意识,从而降低脑卒中的发病率,通过QC小组活动,达到了健康宣传的目的。

初探血尿酸与高血压脑出血的相关性

目的探讨外周血浆中尿酸与高血压脑出血的关系。方法整群选取2014年1月—2015年12月就诊于郑州市第六人民医院神经内科原发性高血压患者241例,以头颅CT影像学确诊有无脑出血,将患者分为脑出血组(147例)和高血压组(94例)。采用免疫法检测外周血中尿酸,以尿酸≥430 umol/L作为诊断高尿酸血症的标准。结果高血压性脑出血患者外周血中尿酸水平高于高血压组(503.4±40.2)比(447.3±38.8),P<0.05。伴有高尿酸血症的高血压患者发生脑出血的比例高于高血压组患者(64.7%比9.6%,P<0.05)。多因素Logistic回归显示:影响高血压性脑出血的危险因素有高血脂(OR=1.08)、高尿酸血症(OR=1.04)、饮酒(OR=2.30)、收缩压(OR=1.10)、高同型半胱氨酸(OR=1.02),P<0.01。结论高尿酸血症高血压患者更易发生脑出血,即高尿酸血症高血压患者发生脑出血的危险性更高。

老年高血压患者健康素养影响因素分析

[目的]分析影响老年高血压患者健康素养水平的主要因素,为制定健康促进策略提供依据。[方法]采用多阶段分层抽样法抽取60岁以上的高血压患者384位进行问卷调查,运用Logistic回归和秩和检验进行统计分析。[结果]维族老年高血压患者健康素养评分低于其他民族(P<0.05),城市居民、高学历、离退休、与家人同住、家庭平均月收入高、办理慢病卡的老年高血压患者健康素养评分高(P<0.05);影响患者改善健康意愿的主要因素包括:城市或农村居民、家庭情况、职业、全家平均月收入。不同居民、职业、收入的老年高血压患者在各维度的健康素养评分均有差异(P<0.05),不同家庭居住情况的调查对象在改善健康意愿方面没有差异(P>0.05)。[结论]社会因素(包括居民、家庭居住情况)、经济因素(包括职业、家庭收入)对老年人健康素养有重大影响,在政策受益范围内可以加强农村地区的公共卫生服务,制定补偿政策,减轻看病的负担。