| Abstract | Cilj istraživanja: Odrediti i prikazati raspodjelu bolesnika koji boluju od arterijske hipertenzije prema spolu, dobi i vremenu kada im je arterijska hipertenzija dijagnosticirana, istražiti kolike su prosječne vrijednosti sistoličkog i dijastoličkog arterijskog tlaka u kroničnih i novootkrivenih bolesnika te prikazati distribuciju terapije među bolesnicima.
Odrediti i prikazati raspodjelu bolesnika koji boluju od arterijske hipertenzije i šećerne bolesti tipa II po spolu i životnoj dobi, istražiti kakva je reguliranost arterijske hipertenzije, te prikazati prosječne vrijednosti arterijskog tlaka i distribuciju antihipertenzivne terapije u toj populaciji, prikazati raspodjelu vrste terapije te odrediti u kojoj se mjeri oboljelima od šećerne bolesti ordiniraju ACE-i i ARB-ovi.
Materijali i metode: U retrospektivno presječno istraživanje uključene su dvije skupine bolesnika s arterijskom hipertenzijom kao osnovnom dijagnozom. U prvoj su skupini bili bolesnici koji se liječe isključivo od arterijske hipertenzije, a u drugoj su skupini oni koji se liječe i od šećerne bolesti tipa II. Korišteni su podatci zabilježeni u elektronskim zdravstvenim kartonima bolesnika iz sedam ambulanti obiteljske medicine s područja grada Splita. U prvu je skupinu uključeno 486 bolesnika koji se liječe od arterijske hipertenzije, a u drugu je skupinu uključen 181 bolesnik koji, osim hipertenzije, boluje i od šećerne bolesti tipa II. Svi su bolesnici u periodu od 1. travnja 2017. godine do 1. travnja 2018. godine barem jedanput pristupili ambulantnom mjerenju arterijskog tlaka kod izabranog liječnika obiteljske medicine.
Rezultati: Ciljne vrijednosti arterijskog tlaka ne uspijeva postići 33,3% bolesnika s arterijskom hipertenzijom iz našeg istraživanja, od toga 87% kronični bolesnici, a 13% novootkriveni bolesnici. Značajno je više loše reguliranih bolesnika među novootkrivenima u odnosu na veterane, P=0,046. Prosječni sistolički arterijski tlak u cijelom uzorku bolesnika iznosio je 138,42±14 mmHg, a prosječni dijastolički arterijski tlak iznosio je 81,03±8 mmHg.
Značajna je razlika u prosječnim sistoličkim i dijastoličkim arterijskim tlakovima između novootkrivenih bolesnika i veterana. Prosječna životna dob populacije oboljelih od arterijske hipertenzije iznosila je 64,5±10,5 godina, nije bilo značajne razlike u starosti između novootkrivenih bolesnika i kroničnih bolesnika, P=0,609. Od ukupnog broja ispitanika 60,7% bili su muškarci, 39,3% su bile žene. Postoji značajna razlika između novootkrivenih i veterana što se tiče propisane farmakoterapije, P=0,009. Od ukupno 441 veterana, njih 35,1% liječi arterijsku hipertenziju uzimajući samo jedan antihipertenziv, 38,5% uzima dva ili više hipertenziva, a 26,3% uzima dva ili više lijeka u fiksnoj kombinaciji.
Od ukupno 45 novootkrivenih bolesnika, 51,1% uzima monoterapiju, 15,6% uzima dva ili više antihipertenziva, a 33,3% uzima fiksnu kombinaciju antihipertenziva.
Od ukupno 181 bolesnika sa šećernom bolesti, 55,8% uspijeva postići ciljne vrijednosti arterijskog tlaka, a 44,2% to ne uspijeva. Prosječna vrijednost sistoličkog arterijskog tlaka u populaciji oboljelih iznosi 140,39 ±13,99 mmHg. Najniža izmjerena vrijednost SAT iznosi 100 mmHg, a najviša 180 mmHg.
Prosječna vrijednost dijastoličkog arterijskog tlaka u populaciji bolesnika sa šećernom bolesti iznosi 80,52 ± 7,02 mmHg. Najniža izmjerena vrijednost DAT iznosi 60 mmHg, a najviša 105 mmHg.
Prosječna životna dob populacije tih bolesnika iznosila je 66.58±9,66 godina, muškarci su činili 59,67% ispitanika, a 49,33% bile su žene.
Od ukupnog broja bolesnika, 28,2% uzima samo jedan lijek za regulaciju svoje arterijske hipertenzije, 54,1 uzima dva ili više antihipertenziva, 17,7% uzima fiksnu kombinaciju dva ili više lijeka. Među bolesnicima koji uzimaju antihipertenzivnu terapiju, 61,9% uzima ACE-inhibitore, 16,6% uzima inhibitore renin-angiotenzin sustava, 20,4% ne uzima nijedan od lijekova iz ove dvije navedene skupine, a njih 1,1% uzima oba lijeka.
Zaključak: U skupini bolesnika s arterijskom hipertenzijom 55,8% uspijeva postići ciljne vrijednosti arterijskog tlaka, dok ih 44,2% to ne uspijeva. Značajno je više loše reguliranih bolesnika među novootkrivenima u odnosu na kronične bolesnike, P=0,046. U skupini oboljelih od šećrne bolesti tipa II, 55,8% uspijeva postići ciljne vrijednosti arterijskog tlaka, dok ih 44,2% to ne uspijeva. |
| Abstract (english) | Research objective: To determine and show the distribution of hypertension by sex, age and time when their arterial hypertension was diagnosed, investigate the mean values of systolic and diastolic blood pressure for patients with chronic hypertension and newly discovered hypertensives and show the distribution of therapy among hypertensives.
Determine and show the distribution of diabetic hypertension by sex and age, investigate the regulation of arterial hypertension among diabetic hypertensives, and show the mean values of arterial pressure and distribution of antihypertensive therapy in the population of diabetics hypertensives, show the distribution of therapy among diabetic hypertensives and determine how often are ACE-i and ARBs being prescribed to diabetic hypertensives.
Materials and methods: In retrospective cross-sectional research two groups of patients with arterial hypertension were included. In the first group, patients were treated for arterial hypertension only, and in the second group they were taking medications for type II diabetes as well. Data were recorded in the electronic health records of patients from seven family medicine outpatient clinics in the Split area. The first group involved 486 patients who were getting treated for arterial hypertension, while the other group included 181 patients who, in addition to hypertension, also suffered from type II diabetes. All patients in the period from April 1st 2017 to April 1st of 2018 accessed at least once the outpatient blood pressure measurement at the chosen family doctor.
Results: 33.3% of hypertensives from our study failed to reach target values of arterial pressure, 87% of which were hypertensives with chronic hypertension and 13% were newly discovered hypertensives. Significantly poorer controlled patients were founded among the newly discovered hypertensives compared to hypertensives veterans, P = 0.046. The mean systolic arterial pressure in the whole patient sample was 138.42 ± 14 mmHg, and the mean diastolic blood pressure was 81.03 ± 8 mmHg.
Significant difference was founded in mean systolic and diastolic blood pressure between newly discovered hypertensives and hypertensives veterans. The average age of the hypertensive population was 64.5 ± 10.5 years. There was no significant difference in age among newly discovered hypertensives and hypertensives veterans, P = 0.609. Out of a total number of patients, 60.7% were men, 39.3% were women. There is a significant difference among newly discovered and hypertensive veterans regarding prescribed pharmacotherapy, P = 0.009. Out of a total of 441 hypertensive veterans, 35.1% were taking only one drug, 38.5% taking two or more drugs, and 26.3% taking two or more drugs in a fixed combination.
Out of a 45 newly discovered hypertensives, 51.1% was taking monotherapy, 15.6% was taking two or more antihypertensive drugs, and 33.3% take a fixed combination of antihypertensive drugs. There is a significant difference between newly discovered and hypertensive veterans regarding prescribed pharmacotherapy, P=0.009.
Out of a total of 181 diabetic hypertensives, 55.8% managed to achieve targeted arterial pressure and 44.2% failed in doing so. The average age of the hypertensive diabetic population was 66.58 ± 9.66 years. The mean value of systolic arterial pressure in the population of hypertensive diabetics is 140.39 ± 13.99 mmHg. The lowest measured SBP value is 100 mmHg, and the highest 180 mmHg.
The mean value of diastolic arterial pressure in the population of hypertensive diabetics is 80.52 ± 7.02 mmHg. The lowest measured DBP value is 60 mmHg and the highest 105 mmHg. Out of a total of 181 patients, 28.2% were taking only one medicine to regulate their arterial hypertension, 54.1% were taking two or more antihypertensives, 17.7% were taking a fixed combination of two or more drugs. Among patients with DM type II who were taking antihypertensive therapy, 61.9% were taking ACE inhibitors, 16.6% were taking renin-angiotensin system inhibitors, 20.4% weren't taking any of the drugs from these two groups and 1.1% were taking both drugs.
Conclusion: In a group of hypertensives, 55.8% succeeded in achieving target values of arterial pressure, while 44.2% of them failed. Significantly poorer controlled patients were among newly discovered compared to hypertensives veterans, P= 0.046. In the group of patients with diabetes mellitus type II, 55.8% managed to achieve arterial blood pressure target, while 44.2% have failed. |
