Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP

Therapy Adherence of 40-75 Y.o. Hypertension Respondents Using Morisky Instrument in Ngemplak, Sleman, DIY (Study on Age, Demography, Social, and Life-style Factors)

Hypertension is systolic blood pressure (SBP) ≥140mmHg and/or diastolic blood pessure (DBP) ≥90mmHg. The risk factors of hypertension consist of age, life-style, demographic, and social factors. The risk factors have a significant association with antihypertension adherence. Adherence is the suitability of patient behavior to the prescriber's recommendations. Morisky instrument can be used to measure the level of hypertension therapy adherence. The aims of this study were to assess respondent's profile and therapy adherence based on age, life-style, demographic, social factors among the subjects in Ngemplak, Sleman, Daerah Istimewa Yogyakarta (DIY). Total respondents were 63 respondents. The observational study was done with cross-sectional design. Technique for determining the location used random sampling, data were collected by door to door in the villages of Morangan, Jimat, and Jelapan. Data analysis used chi square with 95% confidence level. There were 23.8% good adherent and 76.2% poor adherent subjects to antihypertensive medication. There was no significant difference between age, life-style, demographic, and social factors to the level of hypertension therapy adherence. However, it was found that controlled blood pressure (p-value<0.01) were significantly associated with therapy adherence. This study also found that SBP at age 60-75 years and 40-59 years was significantly different (p-value <0.05)

Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP