Evaluation of the effectiveness of arterial hypertension control in a primary health unit

Abstract

The present study is part of a performance evaluation of the Aging Health Care Program carried out at a Primary Health Care Clinic. Activities for Arterial Hypertension (AH), control oriented accorging to a risk assessment, in conformity with Ministry of Health norms, are included in the Program mentioned. The effectiveness of the reduction of blood pressure (BP) levels in hypertensive individuals subjected to programmatic activities for disease control, in an attempt to identify conditions associated with that reduction, is evaluated. Of the 396 patients with AH registered under the Program between 01/01/92 and 06/30/93, 250 cases were included for this evaluation. These patients had, in addition to high blood pressure levels (BP ≥ 160/95 mm Hg) on the first attendances at the health center (before registration in the programme), at least two medical consultations during program follow-up. The differences in blood pressure levels between measurements taken during consultations before the beginning of attendance at the program and those taken on the first attendances to the programme were analysed according to initial blood pressure level, age, sex, registering diagnosis and absences during the program follow-up. Reductions of ≥ 5 mm Hg in diastolic blood pressure (DBP) and/or ≥ 10 mm Hg in systolic blood pressure (SBP) were obtained in 197 (78.8%) patients. The mean reduction was 8.8 mm Hg (sd = 11.4) for DBP and 17.7 mm Hg (sd = 18.6) for SBP. Results of several epidemiological studies allow the inference that a decrease in the mortality risk from Cardiovascular Disease can be achieved in a significant proportion of the individuals registered in the program. Blood pressure normalization according to program norms occurred in 111 (44.4%) individuals. Multiple linear regression analysis demonstrated that initial blood pressure and percentages of absenteeism during the follow-up were independently associated with the reductions in SBP and DBP. Age was independently associated only with the reductions in SBP. Participation of age and percentage of absenteeism during follow-up thus reveal that the final result of the programmed work is also a result of the different ways people take care of their own health.