QUALITY OF LIFE OF PERSONS WITH HYPERTENSION AND RELATIONSHIP WITH THE STATUS OF TREATMENT: RESULTS OF CROSS-SECTIONAL EXAMINATION EMPLOYEES OF DNIPRO EDUCATIONAL INSTITUTIONS

L.V. Kriachkova; V.Yu. Krotova; L.O. Krotova

doi:10.36013/jimsa.v3i1.83

L.V. Kriachkova
V.Yu. Krotova Dnipropetrovsk Medical Academy
L.O. Krotova

DOI: https://doi.org/10.36013/jimsa.v3i1.83

Keywords: Ukraine, hypertension, Dnipro, patients' autonomy, treatment status, blood pressure measurement, employees of educational institutions, quality of life

Abstract

Aim. To assess the quality of life of patients with hypertension, the relationship with the effectiveness of treatment, and their participation (autonomy) in the treatment process among employees of educational institutions in Dnipro.

Materials and methods. Following the initiative of the International Society of Hypertension within the program «May Measurement Month, » a group of staff and students at Dnipro State Medical University made a cross-sectional study of blood pressure (BP) among 131 adults (over 18 years) employed by schools and universities of Dnipro region, especially teachers. Each participant had three BP measurements and completed a demographic, lifestyle, and environmental factors questionnaire. The general questionnaire «SF-36» (Health Status Survey-36) was used for the study of the quality of life (QOL). Hypertension (HTN) was defined as a systolic BP of ≥140 mm Hg or a diastolic BP of ≥90 mm Hg based on the mean of the second and third BP recordings. Those taking antihypertensive medications were also assumed to have HTN and were aware of their condition.

Results. A survey supplemented by instrumental examinations revealed that HTN was detected in 84 (64.1 %) persons (95 % CI 55.3 - 72.3). Of those surveyed, 59 received appropriate antihypertensive treatment, corresponding to 70.2 % of detected cases of HTN. Of those who received antihypertensive medications, 39 (66.1 %) had controlled BP, which represents 46.4% of all patients with HTN included in the study. From the number of persons with known HTN (n=64), only 39 (60.9 %) reached the target values of BP. 33.9 % of patients receiving antihypertensive treatment did not achieve adequate control of HTN, which may indicate the ineffectiveness of the treatment. Of those surveyed, 59 (45.0 %) (95 % CI 36.3 - 54.0) received appropriate AHT, which corresponds to 70.2 % of detected cases of HTN. From the number of people with known HTN (n=64), only 39 (60.9 %) reached the target values of BP.

Assessment of QOL according to the SF-36 method showed that most respondents assess their health as good (56.1 %) or satisfactory (37.8 %). Educators rated the QOL field of Physical Functioning as the best, Role-Physical, and Social Functioning as the worst. Patients with HTN had a statistically significantly lower value of QOL on the Role-Physical (p=0.004) and Role-Emotional (p=0.026) scales compared with persons without HTN, which indicates the important role of physical and emotional problems in limiting the activity of patients with HTN.

Conclusion. The finding indicates a low propensity of patients to make decisions about their health. More than half of the respondents with high BP were unaware of their condition and did not receive appropriate treatment, while more than a third of patients did not achieve BP control even while taking medication. This justifies the need for a more thorough diagnosis and treatment of HTN involving patients in this process. These results seem to be impacted by a special study cohort representation of the patients-employees of educational institutions.

References

1. Beaney, Thomas et al. “May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension.” European heart journal vol. 40,25 (2019): 2006-2017. doi:10.1093/eurheartj/ehz300.
2. Williams, Bryan et al. “2018 ESC/ESH Guidelines for the management of arterial hypertension.” European heart journal vol. 39,33 (2018): 3021-3104. doi:10.1093/eurheartj/ehy339.
3. Order of the Ministry of Health № 384. Guidelines and clinical protocol for medical care "Hypertension» [Valid from 24.05.2012]. — К., 2012. — 108 p.
4. TseluikoV.I.Systolic hypertension in Ukraine: the realities of clinical practice according to the study SYSTEM/ V.I. Tseluiko// Hypertension. – 2016. – № 12(46). – P. 69-75.
5. The European Society for Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESCCOVID-19-Guidance.
6. SnarskaK, ChorążyM, SzczepańskiM, Wojewódzka-ŻelezniakowiczM, ŁadnyJR. Quality of Life of Patients with Arterial Hypertension. Medicina (Kaunas). 2020 Sep 9;56(9):459. doi: 10.3390/medicina56090459.
7. Balanova Yu.A., Kontsevaya A.V., Shalnova S.A., Deev A.D., Kapustina A.V., Evstifeeva S.E., Muromtseva G.А., Imaeva A.E., Boytsov S.A. Life quality of persons with arterial hypertension in Russia — is there relation to treatment? (by data from populational study ESSE-RF). Russian Journal of Cardiology. 2016;(9):7-13. (In Russ.) https://doi.org/10.15829/1560-4071-2016-9-7-13.
8. Coulter A., Parsons S., Askham J. Where are the patients indecision-making about their own care? Copenhagen: WHO Regional Office for Europe, 2008. 24 с.
9. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. IranRedCrescentMed J. 2014 Jan;16(1):e12454. doi: 10.5812/ircmj.12454.
10. Fisher KA, Tan ASL, Matlock DD, Saver B, Mazor KM, Pieterse AH. Keeping the patient in the center: Common challenges in the practice of shared decision making. PatientEducCouns. 2018 Dec;101(12):2195-2201. doi: 10.1016/j.pec.2018.08.007.
11. Mirzoev T, Kane S. What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Glob Health. 2017 Oct 31;2(4):e000486. doi: 10.1136/bmjgh-2017-000486. PMID: 29225953; PMCID: PMC5717934.
12. Kriachkova L.V. Ways to ensure the responsiveness of the healthcare system to the requirements of the population (on the example of Ukraine). Medycznezeszyty naukowe. UczelniWarszawskiejim. Marii Skłodowskiej-Curie. 2016. № 1. S. 137-157.
13. Alifer O.O. Assessment of quality of life in patients with hypertension. Achievements of clinical and experimental medicine. 2017. №2 (July 2017). doi:https://doi.org/10.11603/1811-2471.2017.v0.i2.7734.
14. The PADQOL: development and validation of a PAD-specific quality of life questionnaire / D. TreatJacobson, R. A. Lindquist, D. R. Witt, et al. // Vasc. Med. – 2012. – Vol. 17,6. – P. 405–415.