Zhongguo quanke yixue (Apr 2022)
Hypertension and Glycemic Control and Associated Factors for Poor Control in Patient Populations at High Risk of Atherosclerotic Cardiovascular Disease in the Community
Abstract
BackgroundThe low hypertension control rate or low glycemic control rate in people in the community have been attributed to patients' poor disease awareness and irregular medication in some studies. However, few studies have explored hypertension control rate and/or glycemic control rate in patients with good disease awareness and regular medication.ObjectiveTo investigate the adequate hypertension control rate and/or adequate glycemic control rate in hypertension and diabetic patients who are at high risk of atherosclerotic cardiovascular disease (ASCVD) but have good disease awareness and regular medication, and to explore the reasons for poor control, offering a theoretical basis for better prevention and control of ASCVD.MethodsBy use of cluster sampling, contracted patients with complete data of the China-PAR model who visited 10 community health centers in Shenzhen's Luohu District from August 2018 to April 2019 were selected, and received an assessment for screening the risk of 10-year ASCVD using the China-PAR model, and those with hypertension and/or diabetes who were at high risk of ASCVD (≥10 points) and volunteered to attend this study were further surveyed using a questionnaire developed by our research group. After that, those who were on regular medication with a good understanding of the threats of hypertension and/or diabetes, and targets for blood pressure control and/or fasting glycemia control, were finally enrolled. The rate of adequate hypertension control was compared between those with hypertension, the rate of adequate glycemic control was compared between those with diabetes, and the rates of adequate hypertension and glycemic control were compared between those with both hypertension and diabetes, by demographcihc factors. Then those who were found with inadequate hypertension and/or glycemic control were selected to attend an in-depth, semi-structured individual interview using a descriptive qualitative research design for understating the causes of inadequate hypertension and/or glycemic control. The contents of the interview were coded and categorized using NVivo 12, and were sorted, analyzed, and themes in which were identified using content analysis.ResultsTotally 299 patients were finally enrolled, including 130 (43.5%) with hypertension, 9 (3.0%) with diabetes, and 160 (53.5%) with both hypertension and diabetes. Among the 290 hypertensive patients, 140 (48.3%) had adequate hypertension control. Among the 169 diabetics, 71 (42.0%) had adequate diabetes control. Among the 130 patients with simple hypertension, those with adequate hypertension control had older mean age than did those without (t'=3.758, P<0.001) . Among the 160 patients with both hypertension and diabetes, those with adequate hypertension control had older mean age than did those without (t'=2.203, P=0.031) . Among the 169 patients with diabetes, those with adequate control of fasting glycemia had lower rate of regular exercising (χ2=4.314, P=0.038) and shorter mean duration of diabetes (t=-3.180, P=0.002) , as well as lower mean frequency of blood glucose monitoring (Z=2.228, P=0.026) than did those without. Seven themes emerged from the interview: Patients did not feel compelled to reach the targets, feeling indifferent; Patients gave up after repeated treatments followed by failures to achieve the targets, feeling powerless; Patients took medicines regularly, but had problems in practical medication; Patients were restricted by various realistic factors; Patients were influenced by doctor-related factors, including doctors' irrelevant and ignorant attitudes; Patients had failures due to lack of self-control and unhealthy lifestyles; Other reasons, including unsuccessful medical insurance reimbursement, being afraid of over-control due to previous experiences of too low blood pressure or glucose, etc.ConclusionThe high-risk population of ASCVD who had good disease awareness and took medications regularly still had low hypertension control rate and/or low glycemic control rate. Attention should be specially given to blood pressure levels in young hypertensive patients, and glycemic level in diabetic patients with regular exercising, a long history of diabetes, or frequent blood glucose monitoring. It is necessary to optimize the management of ASCVD in the community by encouraging patients to improve their mindset and change their unhealthy lifestyles, strengthening the promotion of standardized medication use, improving community health services, and improving patients' knowledge, beliefs and behaviors from the biopsychosocial perspective.
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