الفهرس 
EPIDEMIOLOGY OF HYPERTENSIONOnly 14 pages are availabe for public view
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Abstract
Hypertension is a major health problem and a leading cause of mortality and morbidity worldwide (Ogedegbe et al, 2013), and it is the most important modifiable risk factor for heart diseases, stroke, renal diseases and retinopathy (Bani, 2011).
The goal of hypertension treatment is to prevent death and complications by achieving and maintaining the blood pressure at 140\90 mm hg or lower (Lambert et al, 2006). Lifestyle modification including special diet and physical activity together with pharmacotherapy are the cornerstone to treat patients with hypertension so both are called antihypertensive regimen (Lemone & Burke, 2008)
Compliance is defined as the degree to which a patient correctly follows medical advice, it refers to medications, self-care advice, self-directed exercise, or change a life style behavior, both the patient and the health care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance (WHO 2003)
An interventional prospective two arms study design had been conducted in Family Medical Centers in El-Shrouk city- New Cairo, as in spite of the major importance of hypertension disease and its morbid complications there is low awareness about the disease and low compliance to its treatment, especially the life style modification line of treatment which includes both exercise and diet modifications.Study hypothesis:
Appropriate educational intervention program including information about hypertension disease and its complications, nutritional advice and exercise advice for hypertensive patients attending outpatient clinics in El-Shrouk family centers will improve compliance to antihypertensive regimens (medications, diet, and exercise), and improve their blood pressure readings.
Research questions:
1-What is the effect of an intervention program on compliance to antihypertensive regimens among hypertensive patients in El-Shrouk family medical centers?
2- What is the effect of an intervention program on knowledge about hypertension among hypertensive patients in El-Shrouk family medical center?
3-What is the effect of an intervention program on the blood pressure of hypertensive patient in El-Shrouk family medical center?
Subjects and Methods:
A sample size of at least (140) patients in each group was enough to detect such difference, with an increase of 15% of the sample size to compensate for any DROP outs.All hypertensive patients recorded in El-Shrouk family medical centers and fulfilling the inclusion criteria which were having primary hypertension diagnosed for at least one year and taking their prescribed medications, aged 25-60 years old, and able to communicate, were included in the study.
Patients in (El-mostakbal center) was considered the intervention group and patients in (60 meter center) was considered the control group, and to eliminate in source of results bias if for example any of the control group participants tried to follow the intervention program implemented to the intervention group.
This study was implemented to achieve some objectives; Ultimate ones which was to improve the quality of life of our population, and decrease health expenditures by decreasing morbidities and mortalities from the disease, Specific Ones which were; assess the knowledge of hypertension and compliance to antihypertensive regimens among hypertensive patients attending El-Shrouk Family Medical Centers before implementation of the intervention program, to develop and implement an intervention program for hypertensive patients attending El-Shrouk Family Medical Centers to improve compliance to anti-hypertensive regimens, and to control blood pressure, to assess the knowledge of hypertension and compliance to antihypertensive regimens among hypertensive patients after implementation of the intervention program, and to evaluate the effect of the intervention program on the blood pressure of those patients.Three interviews had been used to collect data from the two groups:
Socio-demographic and clinical data sheet, Hypertension knowledge questionnaire, Assessment of Compliance to anti- hypertensive regimens questionnaires including Drug compliance assessment, life style modification assessment through risk factors assessment, nutritional and physical activity assessment.
Then for proper conduction of the study, three phases had been utilized, assessment phase, implementation phase and evaluation phase.
Assessment and evaluation phases were the same for both intervention and control groups, but Implementation phase included only educational part in control group and included educational and practical (physical activity and proper diet) in intervention group both were followed up for six months.
After intervention there was significant difference between intervention and control groups as regards serum cholesterol level (higher in control group).
And also there was significant difference between both groups as regards knowledge score immediately after the session (P value < 0.05), and also significant difference as regard knowledge score one month after the session (P value < 0.05), and three months after the session (P value <0.05).There was significant difference in intervention group as regards clinical data before and after intervention. (P value <.001). This means that our intervention program was successful, as it was found that mean of SBP and DBP decreased from 134/83 to130/81 in intervention group and from 133/82 to 132/82 in control group, which reflect the effect of the intervention program on intervention group.
Blood pressure control is the main finding in the present study which revealed significant decline in systolic and diastolic blood pressure among patients in the study group at 6 months evaluation. This is explained by the fact that lifestyle patterns correlated significantly with control of systolic and diastolic blood pressure which means that high adoption of healthy lifestyle associated with better blood pressure control, but patients in the control group reported slight reduction in systolic and diastolic blood pressure.
It was found that there is significant decrease in cholesterol level, LDL, and TGA level in intervention group after intervention, compared to control group, and this agrees with the evident that life style modification including diet control with low salt intake and physical activity improve health and decrease blood pressure.
It was found that 27% and 26% of patients in intervention and control group respectively smoke cigarettes or shisha this considered large percentage compared to several studies.There was significant difference in intervention group as regard risk factors to hypertension before and after intervention in the mean number of cigarettes per day, it decreased after intervention from 15 to 11, but unfortunately, only 0.7% of smokers quit smoking at the end of our study.
Stressful life as a risk factor decreased in intervention group after intervention and didn’t change in control group; this is likely due to the effect of regular follow up for the participants in intervention group that helped stress management and due to the benefits of social interaction, positive reinforcement, and positive peer group effect which were helpful on stress changes.
The most contributing risk factor was found is family history and there were about 75% positive family history of hypertension in both groups.
And there was highly significant difference between both groups as regards mean score of compliance to treatment (P value < 0.05), compliance mean score improved greater in intervention group, but the baseline medication adherence score mean did not significantly differ between them.
Also one of the crucial factors to in-adherence is that patients sometimes forget to take their medicine which was insignificantly different between groups before intervention (P value=0.56) and changed after intervention to become significantly different between groups where number of patients who forget to take their medicine in intervention group decreased (from 49.3% to 42.5%) while in the control group (from 49.3% to 46%), which ensures the effectiveness of our intervention program on improving compliance to medications and the importance of patients’ follow up monthly, which will relatively improves blood pressure control and decreases hypertension complications.
There were statistically significant increases in hypertension-related knowledge scores in both groups. However, the increase was significantly greater in the intervention group (mean score increased from 15.98±4.99 to 19.88±2.31) than in the control group (mean score increased from 16.58±5.73 to 19.04±3.56).