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[The DISEHTAC II study: diagnosis and follow-up of hypertension in Catalonia. comparison with 1996 data]
M Benítez Camps1, S Pérez Zamora, A Dalfó Baqué
1EAP Gòtic, SAP Ciutat Vella, ICS, Barcelona, Spain. 32211mbc@comb.es
Insights
Hypertension management improved in Catalonia, with better blood pressure control and follow-up. However, screening for cardiovascular risk factors and diagnosis of hypertension needs further improvement.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypertension diagnosis and management are crucial in primary care.
- Cardiovascular risk factor evaluation is essential for effective hypertension management.
- Guidelines for Hypertension for Primary Care (Guía de Hipertensión Arterial para la Atención Primaria) provide a framework for optimal patient care.
Purpose of the Study:
- To evaluate changes in hypertension diagnosis and follow-up.
- To assess cardiovascular risk evaluation in Catalan primary care centers.
- To compare current practices with established hypertension management guidelines.
Main Methods:
- Multicenter, observational, before-after study (1996-2001) in primary care settings.
- Analysis of 990 patient records from twelve primary care centers.
- Evaluation of diagnostic criteria, blood pressure measurement frequency, and screening for cardiovascular risk factors (diabetes, dyslipidemia, smoking, obesity, left ventricular hypertrophy).
Main Results:
- Improved blood pressure control observed, with a statistically significant increase in patients achieving <140/90 mm Hg.
- Follow-up improved, with a higher percentage of patients having blood pressure measured within the preceding six months.
- Screening for cardiovascular risk factors showed a decline, with only 50.4% of patients assessed in 2001 compared to 63.1% in 1996.
Conclusions:
- Hypertension follow-up in Catalonia has significantly improved since 1996.
- Despite improved follow-up, the diagnosis of hypertension risk factors and comprehensive cardiovascular risk evaluation remain areas for improvement.
- Further efforts are needed to enhance the integrated management of hypertension and its associated risk factors in primary care.
Objective:
To evaluate the changes in the diagnosis and follow-up of hypertension, and in the evaluation of cardiovascular risk, in a population served by primary care centers in Catalonia (northeastern Spain). Management was evaluated with indicators published in the Guidelines for Hypertension for Primary Care (Guía de Hipertensión Arterial para la Atención Primaria).
Design:
Multicenter, observational, before-after design (1996-2001).
Setting:
Primary care.
Participants:
Twelve primary care centers chosen from among the 31 centers that took part in the DISEHTAC I study (1996), with a total of 990 patient records.
Main Measures:
We analyzed age, sex, date of diagnosis of hypertension, number of blood pressure measurements needed for diagnosis, use of the mean value of duplicate blood pressure determinations, values for all blood pressure measurements in 2001, blood pressure determinations during the preceding 6 months, screening for and diagnosis of diabetes, dyslipidemia, smoking, obesity, and left ventricular hypertrophy.
Results:
Of the 171 new cases of hypertension, 16.7% were diagnosed from at least 3 duplicate blood pressure measurements or as a result of acute episodes of hypertension. About one third (32.4%) of the patients with hypertension had blood pressure values below 140 and 90 mm Hg (25.7% in 1996), and the difference between the 2 sets of survey results was statistically significant. In three fourths (75.4%) of the patients, blood pressure had been measured during the preceding 6 months; this percentage was not significantly different in comparison to the figure found in 1996. Screening to detect cardiovascular risk factors was done in 50.4% of the patients (63.1% in 1996).
Conclusions:
Follow-up for hypertension in Catalonia has improved notably since 1996, but there was no improvement in the diagnosis of risk factors or in the integral evaluation of cardiovascular risk.
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