engleski

Effectiveness of arterial hypertension treatment in family medicine clinics in urban, rural and island environment in South Croatia: historical prospective study

Objectives: Comparison of characteristics and effectiveness of hypertension control in urban, rural and island environment (Split vs. Dalmatian hinterland vs. southern Croatian islands), in the first year of treatment. We assumed different living conditions – better transport connections and higher socio-economic standard in the city, the geographical isolation of hinterland and islands with less access to medical services and public pharmacies. Patients And Methods: Data were collected by following each patient the same period (365 days) from the visit when hypertension was diagnosed. In case of insufficient medical records, severe acute/chronic diseases or diabetes mellitus, patients weren't involved. The primary outcome measures were rates of achieving normotension, MAP before and after one-year treatment and complications of treatment. Secondary outcome measures included choice of initial treatment, diagnosis by a physician or a medical specialist, prescribing drugs fully or partially covered by insurance, length of sick leave and number of visits to physicians. Types of antihypertensives and number of daily pills were also compared. The research also covered economic aspects. For the statistical analysis of data, the program MedCalc was used. Results: Statistical analysis included a total of 213 patients. A higher proportion of women with hypertension was in urban areas while men led in rural and island areas (64, 1 % vs. 57, 7 % vs. 54, 9 % ; P=0, 022). Relatively high success rates of achieving normotension were found in all three areas (57, 8 % vs. 57, 7 % vs. 56, 3 % ; P=0, 981). Only diastolic blood pressure differed after one-year treatment (P=0, 012). Calcium channel blockers were the most frequently prescribed initial pharmacotherapeutic group in urban areas (28, 6 %) while ACE inhibitors were in rural (28, 0 %) and island areas (22, 7 %). Prescribing medications from Croatian list of medications fully or partially covered by Croatian Health Insurance Fund differed among 9 physicians (P=0, 001). Conclusion: Urban, rural and island areas of the South Croatia do not differ by rate of achieving normotension, and it’s relatively high (~57 %). It's higher than other most significant international results. It potentially referrs to more successful regulation of arterial hypertension in Croatia. It's required to raise physicians' awareness about benefits of fixed-drug combinations. Differences in total annual cost of treating one newly diagnosed hypertensive patient for the Croatian Health Insurance Fund and prescribing preferences among physicians clearly point to necessary national guidelines for the management of arterial hypertension based on the pharmacoeconomic studies.

Arterial hypertension ; Family medicine ; Hypertension control ; Urban area ; Rural area ; Island area

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