PREVENTIVE MEDICINE (3)

Author: GONZALEZ NUEVO QUIÑONES JESUS PABLO.
Year: 2006.
University: OVIEDO [www.uniovi.es].
Place of defense: SEMI. DE BIOQUI. EDIF. SANTIAGO GASCON.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: Introduction. No conclusive results about which method better controlled blood pressure (BP) in Primary Health Care (PHC): if automedición home of the PA (AMPA) or a follow-on hypertensive in the consultation. The objective of this study was to compare the level of control of the PA in two hypertensive groups: one that used the method AMPA and other monitoring usual query. Materials and methods. We developed a pilot study in APS. 109 patients with high blood pressure (hypertension) in bad light and control over their PA were captured in an opportunistic manner. Subsequently were randomly assigned to the intervention group (GI), which was instructed to perform AMPA a automedidor electronic validated, and the control group (CG), which followed the ETS program area 4 Health Asturias, which provides quarterly track. It was an educational intervention to modify the main risk factors for hypertension modifiable (diet, weight, snuff, alcohol, physical inactivity) and to promote the taking of medication prescribed. We checked the PA of both groups by monitoring ambulatory blood pressure (MAP) at baseline and 6.18 and 30 months. It was considered controlled the PA if the average value obtained by MAP of 24 hours was less than 130/80 mm Hg. There were taking medication (Defined Daily Dose), the index of Psychological Welfare, visits to the health center-both because of the ETS as a total-some cardiovascular risk factors and various demographic variables. It also evaluated the behavioral risk factors and their impact on control of the ETS. To analyze the data were conducted bivariate and multivariate analysis using multiple linear regression and logistic regression. Results. The decline in PA was similar in both groups at 6 and 18 months. For the 30 months, this decline was lower GI than in the GC, with a difference of 3.6 mm Hg in systolic BP (p = 0036) in MAP of 24 hours. Also significant differences were detected between groups in the decline of the PA night, both systolic (p = 0004) and diastolic (p = 0015). No significant differences were detected in the level of overall control of the PA between GI and GC in MAP of 24 hours. The IG consumed less drugs (1.1 versus 1.3, p = 0010). Patients in the GI fewer consultations by ETS to 6 (p = 0018), 18 (p = 0001) and 30 months, although in the latter case the differences were not significant (p = 0160). Nor significant differences were detected in the index Welfare between the two study groups. Most of the behavior improved at the 6 and 18 months but deteriorated globally to 30. Conclusions: The group that controlled his tension by AMPA had a worse control of the PA that the group that carried out the monitoring in consultation PHC; this control can be worse than for the AMPA are considered normal figures that might be addressed. The impact of AMPA on the process of care is favorable, reducing the consumption of drugs and the number of visits to the center of APS The educational intervention succeeded in improving the risk because of behavior related to the ETS to 6 and 18 months, but not to 30, so that educational interventions should be repeated to maintain the long-term impact. The best performance of preventive behavior was associated with a decrease in systolic blood pressure to 30 months. Keywords: hypertension, ambulatory monitoring of blood pressure, automedida blood pressure, health education