Lowered blood pressure targets identify new, uncontrolled hypertensive cases: patient characteristics and implications for services in Thailand

Abstract

Background According to the new hypertension treatment guidelines blood pressure (BP) readings need to be kept below or equal to 130/80 mmHg in patients aged less than 65 years old. This study shows the change in proportion of identified cases of uncontrolled blood pressure in light of these changes. Methods The data was collected from 248 hypertensive patients who had visited an outpatient clinic at the Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand. Patients were classified into three groups: The 3 groups were: 1) controlled BP group (BP is 130/80 mmHg or lower); 2) newly identified uncontrolled group (BP between 130/80 mmHg and 140/90 mmHg) and 3) existing uncontrolled group (BP higher than 140/90 mmHg). Health behaviors, past history related to hypertensive disease and current pharmacological treatments were compared. Results Of the total 248 patients, 56% were female and the mean age was 58.8 (sd 5.99) years old. Following application of the new guidelines, the group designated as uncontrolled increased from 21.7 to 74.2%, an additional 52.4% due to new BP targets. Higher BMI was associated with uncontrolled HT (p = 0.043). While the average number of medication taken was similar across the three groups, it was poor medication adherence (p < 0.013) which was associated with the uncontrolled disease. Conclusions Lower BP targets will increase the number of identified hypertensive patients. While intensifying pharmacological treatment may be considered, our study suggests that two behavioral factors should not be overlooked. Weight reduction and enhancement of medication adherence remains an important mainstream treatment strategy.

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

“…Our findings are in‐line with previous studies where CCBs are the most commonly used antihypertensive medication, while diuretics are less commonly used. 14 , 19 , 20 This is likely due to the 2011 Asian Pacific Heart Associations’ recommendation for CCBs to be the preferred drug for managing hypertension in East Asian countries, 21 while the use of diuresis is usually avoided due to the expected problems with diuresis and the need to monitor serum potassium. This is also reflected in our result where only about one‐third had their serum potassium assessed.…”

“…Our study found dose adjustment to be especially important for hypertension control, but other factors may be considered to improve the overall hypertension control rates in Thailand. 20 Literature suggests that suboptimal control usually reflect existing programmatic challenges including suboptimal management, long waiting times for consultation and drug collection which encourage loss to follow‐up. 35 , 36 Reorganization services to include a multidisciplinary care team may be necessary.…”

Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care

“…The translation of the questionnaire followed the WHO suggested standard procedure. The validation study has not been performed for the Thai language but has been used in published research [ 22 ]. Factor analysis was performed and the factor loadings of all MGL items ranged from 0.54 to 0.74 (>0.4).…”