Pressure points in primary care

Carrington, Melinda; Jennings, Garry; Stewart, Simon

doi:10.1097/hjh.0b013e3283606bc7

Cited by 19 publications

(9 citation statements)

References 21 publications

(27 reference statements)

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“…In the context of the ELSA-Brasil study, 34% of participants responded that a physician had already told them that they had hypertension, and 29% were taking medication to control their blood pressure. Among those who knew they had hypertension and were taking antihypertensive drugs, 31% did not have their blood pressure controlled, corroborating data from various studies in other populations [ 157 , 158 ]. The percentage of blood pressure control was higher in women.…”

Section: Introductionsupporting

confidence: 81%

The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach

et al. 2015

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The most common modeling approaches to understanding incidence, prevalence and control of chronic diseases in populations, such as statistical regression models, are limited when it comes to dealing with the complexity of those problems. Those complex adaptive systems have characteristics such as emerging properties, self-organization and feedbacks, which structure the system stability and resistance to changes. Recently, system science approaches have been proposed to deal with the range, complexity, and multifactor nature of those public health problems. In this paper we applied a multilevel systemic approach to create an integrated, coherent, and increasingly precise conceptual framework, capable of aggregating different partial or specialized studies, based on the challenges of the Longitudinal Study of Adult Health – ELSA-Brasil. The failure to control blood pressure found in several of the study's subjects was discussed, based on the proposed model, analyzing different loops, time lags, and feedback that influence this outcome in a population with high educational level, with reasonably good health services access. We were able to identify the internal circularities and cycles that generate the system’s resistance to change. We believe that this study can contribute to propose some new possibilities of the research agenda and to the discussion of integrated actions in the field of public health.

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Section: Introductionsupporting

confidence: 81%

The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach

et al. 2015

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“…25 One potential explanation for the more aggressive use of statins among white men relative to the other groups may lie in physicians' treatment patterns and habits. 25 to that of other countries, [30][31][32] it was still low.…”

Section: Discussionmentioning

confidence: 75%

Stroke at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis

2018

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“…Less frequent, however, is the high proportion (about 70%) of our study participants who were in treatment with drugs and whose blood pressure was controlled[ 38 ]. In a meta-analysis based on Brazilian cross-sectional studies (10 studies)[ 8 ], the percentage of control estimated for Brazil in the 2000s was 24.1%, which is comparable with other countries[ 49 , 51 ]. The difference between control in the ELSA population and in other population groups in Brazil can be explained by the high level of education in our study population.…”

Section: Discussionmentioning

confidence: 87%

“…Importantly, although awareness of a diagnosis of high blood pressure is a key factor in controlling the condition, it is not enough to assure adherence to treatment nor to change behaviour, especially because high blood pressure is generally asymptomatic. Confidence in the health system[ 47 ], routine visits to the same service or doctor[ 48 ] and the number of visits[ 49 ] have been cited as factors that can influence control of high blood pressure. In Brazil, although many of the drugs used are distributed free of charge by the national health system (e.g., all the diuretics most used by the ELSA population, except amiloride), these drugs are not always available.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study

et al. 2015

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High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14–1.28), and among Asian (PR = 1.21; 95% CI: 1.12–1.32) and ‘Whites (PR = 1.19; 95% CI: 1.12–1.26) compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access.

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Pressure points in primary care

Abstract: In the absence of any significant gains in the community control of hypertension since 2005, a more intensive approach to BP management in primary care is required to ensure more patients achieve BP targets.

Cited by 19 publications

References 21 publications

The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach

The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach

Stroke at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis

Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study

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