A patient with arterial hypertension in an outpatient clinic:  how to use preventive tools

N. V. Korneeva; E. S. Gavrilov; А. L. Yugai; S. P. Pavlova; T. V. Mogila; V. V. Dubinina; I. V. Li

doi:10.31549/2542-1174-2024-8-1-18-28

A patient with arterial hypertension in an outpatient clinic: how to use preventive tools

N. V. Korneeva, E. S. Gavrilov, А. L. Yugai, S. P. Pavlova, T. V. Mogila, V. V. Dubinina, I. V. Li

https://doi.org/10.31549/2542-1174-2024-8-1-18-28

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Abstract

Introduction. It is difficult for primary care physicians to use, under conditions of limited consultation time, multi-page orders for prevention and outpatient follow-up, clinical guidelines on arterial hypertension (AH) in adults. At the same time, compliance with the basic time characteristics of orders and clinical guidelines is important for effective management of hypertension patients.

Aim. To study some aspects of the work of a general practioner in real life outpatient practice in screening and following-up of patients with hypertension and to present simple algorithms for routing such patients, which are a synthesis of clinical guidelines for hypertension and basic orders.

Materials and methods. A survey of patients waiting for an attendance of a general practioner was performed simultaneously, once in three outpatient clinics of Khabarovsk. The survey included all patients waiting for an appointment at the time of the study, regardless of gender, age and purpose of the visit. A questionnaire contained 5 questions: about the presence of blood pressure (BP) up to 140/90 mm Hg and higher; established diagnosis of AH; administered medications (without specifying which ones and their dosage) to correct high BP; by which specialist he is followed-up with the diagnosis of AH, and what the purpose of this visit to the outpatient clinic is. From the outpatient records of the interviewed patients, information about BP measurement that day at the attendance was obtained; presence of a previously established diagnosis of AH; adding AH to the diagnosis structure that day; previously prescribed treatment for AH; achieving BP targets; compliance with the standard of examination for AH; date of last visit due to hypertension.

Results. The responses of 149 patients were analyzed. A male/female ratio was 1:4 (31:118 people), average age was 64.4 ± 1.3 years. In 77.2% (115 people), BP had ever increased to 140/90 mm Hg and higher, of which the diagnosis of hypertension was established in 103 (69%) respondents. 87 (84.5%) patients diagnosed AH are followed-up by a doctor. At the doctor’s appointment, BP was measured in 95 people out of 149 (63.8%), and in 74 people (71.8%) out of 103 diagnosed with AH. On the appointment day, AH was included in the diagnosis structure only in 42.7% patients with an already established diagnosis of AH. In 39% of cases, non-compliance with the minimum required frequency of visiting a doctor for AH was revealed, which was less than once a year.

Conclusion. To achieve the target BP level in AH management is important to comply with the time intervals while working with AH patients: establishing a diagnosis, excluding secondary AH, initiating the outpatient follow-up, achieving the BP targets and timely referral to a cardiologist. The algorithms proposed for a general practitioner will help ensure the correct routing of patients with AH, compliance with the standard of management of such patients, achieving BP control and reducing the risks of development and progression of cardiovascular diseases.