Reorganization and clinical management for hypertension control at primary healthcare

In Mexico, 40% of hypertensive patients see their blood pressure under control. The evidence to keep hypertension (HT) under control is scarce, particularly in older adults who have the highest prevalence and require more health services. The objective was to determine the impact of a double intervention to increase the percentage of hypertensive patients with blood pressure levels under control and estimate differences among adults and older adults.

Quasi-experimental design including reorganization and training to physicians using clinical guidelines in four primary healthcare units at the Instituto Mexicano del Seguro Social (IMSS). We included adults who participated whether in the intervention group (IG) or in the control group without equivalence (CGNE). We used regression models for longitudinal data for systolic pressure (SP) and diastolic pressure (DP) variables and proportion of patients with hypertension under control.

530 participants, 272 in the IG; 57.5% were ≥ 60 years. In the IG decreased the SP, β= −5.93 (95%CI −9.59, −2.28) and increased the proportion with blood pressure under control in young adults (OR 1.48, 95%CI 1.02, 2.14). In the elderly the intervention decreased the DP among those with HT and other comorbidities, β= −3.57(95%CI −6.72, −0.41), p < 0.05.

The interventions reduced SP among adults and DP among older adults with hypertension and other comorbidities. Actions of secondary prevention addressed to each group of age are needed to achieve the control of hypertension at IMSS.