Are doctors assessing patients with hypertension appropriately at their initial presentation?

Background: The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients’ first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. Methods: This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient’s first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit. Result: A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%–40.8%). Assessments for a history of TOD were found in only 5.8%–11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%–63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered Conclusion: There was poor assessment of the patients’ CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations

Kajian keratan rentas mengenai pengetahuan, sikap dan amalan terhadap pencegahan demam denggi di Kampung Belawai, Sarikei dari 20 Jun hingga 5 Ogos 2000

A cross-sectional study was carried out in Kampung Belawai, Sarikei to assess the knowledge, attitude and practice of the villagers towards the prevention of Dengue Fever. The study was conducted from 20 July 2000 to 5 August 2000 by fourth year medical students from Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS). A total of 232 respondents were selected based on systematic random sampling method and were interviewed by using a set of pre-tested questionnaire. A presumptive survey on Aedes larvae infestation rate was also carried out together with the interview. The majority of the respondents were female (61.3%). The results showed that the mean score for knowledge, attitude and practice of the general population was 53.5%, 69.7% and 45.7%, respectively. There was also significant association between knowledge, attitude and practice with sociodemographic factors such as age, education level and the household income. The Aedes larvae survey showed that the Breteau Index was 54.7, House Index was 33.6 and Container Index was found to be 14.4%. Pottery was the commonest container found to be infested with Aedes larvae. After the survey, an intervention program by the theme of `Hapuskan Denggi, Bekrwai Boleh! ' was carried out on 22nd and 23`d July 2000 at Kampung Belawai to raise the knowledge, attitude and practice of dengue prevention among the target population. The intervention program was also aimed to reduce the Aedes larvae infestation rate. It is recommended that continuous health education in small groups to be implemented among the target population to improve their knowledge, attitude and practice towards the prevention of Dengue Fever

Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes

Background: The US Federal and Drug Administration (FDA) recently revised statin drug labels to include the information that increases in fasting serum glucose and glycated haemoglobin levels have been reported with the use of statins. Yet in a survey, 87% of the doctors stated that they had never or infrequently observed increases in glucose or HbA1c levels in patients on statin. In this study we would like to determine the association between the use of statins and glycaemic control in a retrospective cohort of patients with hypertension. Methods: A retrospective review of 1060 medical records of patients with hypertension at a primary care clinic was conducted. These records were selected using systematic random sampling (1:4). Data on patient socio-demographic factors; clinical profile; investigation results and prescribed medications were collected. Independent t-test was used for continuous variables while Pearson’s χ2 test was used for categorical variables. Logistic regression was done to adjust for confounders. Results: 810 (76.4%) patients with hypertension were on statins, out of which 792 (97.8%) were taking simvastatin 10 mg or 20 mg daily. Analysis of the whole group regardless of diabetes status showed that the statin user group had higher HbA1c and fasting blood glucose values. The difference in HbA1c levels remained significant (adjusted OR = 1.290, p = 0.044, 95% CI 1.006, 1.654) after adjustment for diabetes, diabetic medication and fasting blood glucose. In the study population who had diabetes, statin users again had significantly higher HbA1c level compared to statin non-users. This difference remained significant (adjusted OR 1.208, p = 0.037, 95% CI 1.012, 1.441) after adjustment for age and diabetic medications. Conclusions: Statins use is associated with increased HbA1c levels among hypertensive patients and hypertensive patients with diabetes. Clinicians managing hypertensive patients on statins should consider monitoring the HbA1c level and ensure that those with diabetes have their hyperglycaemia kept under control