PROCJENA KRVNOG TLAKA, LIJEČENJA I KARDIOVASKULARNOG RIZIKA KOD HIPERTONIČARA LIJEČENIH U PRIMARNOJ ZDRAVSTVENOJ ZAŠTITI

OBJECTIVES: The aims of the paper were to establish the patients’ BP grading and disease staging, stratify the CV risk of the hypertensive population, determine if the BP treatment target ranges are achieved and assess their treatment parameters. MATERIALS AND METHODS: The study is a cross-sectional retrospective study including 168 patients with HTN from the 1 st of September 2018 to the 1 st of April 2019. The data was collected from eight different offices of family medicine specialists in Split. Following the gathering of materials from the specialist’s databases and archives, the patients’ medical records were then reviewed and inserted into Microsoft Excel program. RESULTS: Hypertension grading demonstrated that 35% of patients are normotensive, 30.3% have high-normal BP, grade 1 HTN population makes up 28.5% and grade 2 HTN comprises the remaining 5.3%, no patient belongs in grade 3 HTN. Staging of the disease was then evaluated, the results showed that 84.5% of patients are at stage 1 with an uncomplicated disease, 10% remain asymptomatic and are classified at stage 2 of the disease and stage 3 constitute 4.6% and defines patients with an established disease. CV risk was stratified, the outcome displayed that 49% of patients are at low-risk for CV disease, 28% at medium risk, 10% at high risk and the remaining 2.5% at very-high risk for CV event occurrence. Women (35.5% vs. 24.0%) and patients under 65 years old achieve both their systolic and diastolic BP target (≤130/70-79 mmHg) more consistently (39.8% vs. 22.5% and 48.75% vs. 40.0%, respectively). Antihypertensive monotherapy and dual therapy are prescribed equally in our study sample, nearly reaching 40% each. CCB and ACE are the two most commonly single drug prescribed (13.9% and 15.6% respectively) with a BP control rate of 58.8%. The most common combination dual therapy prescribed medications are CCB + ACE, prescribed to 13.1% of all patients and its control rate over BP reaches 31.3%. Triple therapy is used in 17% of our patients, it most often consists of ACE + CCB + BB, representing only 4.9% of all prescriptions. 62.3% of patients are taking a single pill, 29.5% of individuals are administered 2 pills and the remaining 8.2% get 3 or 4 pills. Efficacy in controlling BP was best achieved in patients under triple therapy with 55.6%, patients taking 1 or 3 pills both attain a BP success rate of about 52.7. CONCLUSIONS: Most patient of our study are normotensive, high-normal or exert grade 1 HTN. Majority of hypertensive individuals are at stage 1 of the disease and are at low to moderate risk for occurrence of CV disease. Demographically, women and younger individuals tend to achieve their treatment BP target more efficiently. Mono- and dual therapy represent 80% of all prescription, the most common drugs used are ACE and CCB taken in the form of one or two pills.
CILJ: Ciljevi ovog istraživanja bili su odrediti stupanj i stadij bolesti, potom stratificirati hipertenzivne bolesnike prema ukupnom stupnju kardiovaskularnog rizika, te utvrditi da li su postignute ciljne vrijednosti arterijskog tlaka uz procjenu terapijskog pristupa. ISPITANICI I METODE: Provedeno je presječno, retrospektivno istraživanje u koje je uključeno 168 ispitanika sa dijagnozom arterijske hipertenzije kojima je u periodu od 01. rujna 2018. do 01. travnja 2019. urađeno 24 h monitoriranje arterijskog tlaka. Podatci su prikupljeni u osam specijalističkih ordinacija obiteljske medicine u Splitu. Za istraživanje je osmišljen upitnik temeljem kojeg su prikupljeni podatci iz elektronskih zdravstvenih kartona. Po prikupljanju podataka za sve ispitanike kreiran je skupni zapis u Microsoft Excel programu. REZULTATI: Temeljem izmjerenih vrijednosti arterijskog tlaka 35% ispitanika bilo je normotenzivno a 30,3% imalo je visoko normalan arterijski tlak. Prvi stupanj arterijske hipertenzije zabilježen je kod 28,5% a drugi stupanj kod 5,3% ispitanika. U prvom stadiju bolesti bez komplikacija bila je većina ispitanika, njih 84,5%, u stadiju dva sa asimptomatskom bolesti 10%, dok je u stadiju 3 bilo 4,6% ispitanika. Nakon stratifikacije prema ukupnom kardiovaskularnom riziku 49% ispitanika imalo je nizak, 28% umjeren, 10% visok i 2,5% vrlo visok rizik. Žene i ispitanici mlađi od 65 godina bolje su postizali ciljne vrijednosti arterijskog tlaka. Više od 80% ispitanika liječeno je s jednim ili dva lijeka a najčešće propisani lijekovi bili su ACEI i blokatori kalcijevih kanala. ZAKLJUČAK: Većina ispitanika je postigla ciljne vrijednosti tlaka (>60%) a kod trećine (28,5%) je zabilježen prvi stupanj arterijske hipertenzije. Većina ispitanika (84,5% ) je u prvom stadiju bolesti bez komplikacija, sa niskim i umjerenim ukupnim kardiovaskularnim rizikom. Žene i mlađi ispitanici su najčešće postizali ciljne vrijednosti arterijskog tlak. Više od 80% ispitanika liječeno je s jednim ili dva lijeka a najčešće propisani lijekovi bili su ACEI i blokatori kalcijevih kanala.