1 School of Medicine, Health Sciences University of Mongolia
2School of Public health, Health Sciences University of Mongolia
Өгүүллийн PDF-ийг татах
In Mongolia, 1 out of 3 deaths are caused by CVD which is leading cause of mortality and estimated 6000-6500 deaths caused by CVD annually. Failure to adhere to antihypertensive medication regimes will increase the risk of complications. According to the WHO survey, 50-70% of hypertensive patients don’t follow the medication regimes as doctor suggested. In Mongolia, hypertension prevalence is increasing therefore data on the antihypertensive medication adherence is needed.
We conducted cross sectional study and selected 1676 people who were randomly chosen by registrations of family practitioner. As international standard, uncontrolled hypertension includes those who are unaware of their hypertension, those who are aware but not treated with medication, and those who are aware and treated with medication but still have uncontrolled hypertension.
The prevalence of uncontrolled hypertension was 68.2%. In the uncontrolled hypertensive group, 6.2% were unaware that they were hypertensive, 27.5% were aware that they were hypertensive but were untreated and 56% were aware of their hypertension and treated but were not controlled with their current medical regimen.
Also the result shows that 60.9% of doctors counseled about significance of BP home control, 65.4% of doctors counseled about reducing salt intake, 67.6% of doctors counseled benefits of reducing animal derived or saturated fat, 53.6% of doctors counseled of physical activity benefits, 21.2% of doctors counseled of smoking cessation and 24% of doctors counseled of reducing alcohol consumption.
Poor medication adherence considered as possible underlying cause of uncontrolled hypertension which is further negatively influencing hypertension health care.
Introduction
Hypertension, heart attack and stroke are the main causes of cardiovascular mortality. Untreated hypertension predisposes coronary heart disease, congestive heart failure and stroke. According to the WHO studies, 13% of total mortality in worldwide is caused by the arterial hypertension [1]. Since 1980, the urbanization, high prevalence of risk factors, lifestyle changes and epidemiological transition are contributing to the increase of non communicable diseases (NCDs) in developing countries and the associated rate is steadily increasing [2-12].
In Mongolia, 1 out of 3 deaths are caused by CVD which is leading cause of mortality and estimated 6000-6500 deaths caused by CVD annually [12].
Failure to adhere to antihypertensive medication regimes will increase the risk of complications. According to the WHO survey, 50-70% of hypertensive patients don’t follow the medication regimes as doctor suggested [13]. In Mongolia, hypertension prevalence is increasing therefore data on the antihypertensive medication adherence is needed.
This study surveyed the prevalence of uncontrolled hypertension in four Mongolian Aimags (provinces: Orkhon, Dornod, Khovd and Dornogovi) in order to compare regions and determine the prevalence of hypertension control and assess reasons for non- compliance with medical treatment.
Materials and methods
We conducted cross sectional study and selected 1676 people who were randomly chosen by registrations of family practitioner. Age was restricted persons 18 – 69 years old. We chose four aimags from each of 4 geographical regions in Mongolia. The survey methodology was approved by the Medical ethics committee at the HSUM and the permission to carry out the survey was granted by the order #14-1/1B of July 22nd, 2011. As international standard, uncontrolled hypertension includes those who are unaware of their hypertension, those who are aware but not treated with medication, and those who are aware and treated with medication but still have uncontrolled hypertension.
The Mongolian health care system is largely government run especially in the outside of the city of Ulaanbaatar which is the only major urban area. Public facilities are classified by three major levels: Level I representing primary care hospitals and clinics staffed by primary care physician. These facilities are called soum and inter-soum hospitals in the aimags. Level II or secondary hospitals are called aimag general hospitals in the aimags. Level III facilities are considered to be specialized professional centers in the regions and have some level of tertiary care. As a part of our survey, we compared the completeness of counseling by medical professionals at each hospital/clinic level.
Medical treatment adherence was assessed by the Morisky Medication Adherence Score. Blood pressure was measured on both arms by the National Hypertension Guideline as blood pressure measured on both side and highest reading was taken. Statistical analysis was performed by SPSS 20 statistical software.
Results
Out of the total 1676 participants, 550 people’s blood pressure was within normal range and 1126 people were hypertensive. The prevalence of uncontrolled hypertension was 68.2%. In the uncontrolled hypertensive group, 6.2% were unaware that they were hypertensive, 27.5% were aware that they were hypertensive but were untreated and 56% were aware of their hypertension and treated but were not controlled with their current medical regimen.
We have investigated some influencing factors to the uncontrolled hypertension, the result shows that 60.9% of doctors counseled about significance of BP home control, 65.4% of doctors counseled about reducing salt intake, 67.6% of doctors counseled benefits of reducing animal derived or saturated fat, 53.6% of doctors counseled of physical activity benefits, 21.2% of doctors counseled of smoking cessation and 24% of doctors counseled of reducing alcohol consumption.
|
Answer |
I level |
II level |
III level |
Total |
P-value |
|||||
|
n |
% |
n |
% |
n |
% |
n |
% |
|||
|
BP home control |
0.367 |
|||||||||
|
yes |
38 |
65.5 |
31 |
53.4 |
40 |
63.5 |
109 |
60.9 |
||
|
no |
20 |
34.5 |
27 |
46.6 |
23 |
36.5 |
70 |
39.1 |
||
|
Reducing salt intake |
0.268 |
|||||||||
|
yes |
41 |
70.7 |
33 |
56.9 |
43 |
68.3 |
117 |
65.4 |
||
|
no |
17 |
29.3 |
25 |
43.1 |
20 |
31.7 |
62 |
34.6 |
||
|
Reducing saturated fat intake |
1.000 |
|||||||||
|
yes |
39 |
67.2 |
39 |
67.2 |
43 |
68.3 |
121 |
67.6 |
||
|
no |
19 |
32.8 |
19 |
32.8 |
20 |
31.7 |
58 |
32.4 |
||
|
Physical activity |
0.461 |
|||||||||
|
yes |
30 |
51.7 |
35 |
60.3 |
31 |
49.2 |
96 |
53.6 |
||
|
no |
28 |
48.3 |
23 |
39.7 |
32 |
50.8 |
83 |
46.4 |
||
|
Smoking cessation |
0.720 |
|||||||||
|
yes |
10 |
17.2 |
13 |
22.4 |
15 |
23.8 |
38 |
21.2 |
||
|
no |
48 |
82.8 |
45 |
77.6 |
48 |
76.2 |
141 |
78.8 |
||
|
Alcohol consumption reduction |
0.437 |
|||||||||
|
yes |
11 |
19.0 |
17 |
29.3 |
15 |
23.8 |
43 |
24.0 |
||
|
no |
47 |
81.0 |
41 |
70.7 |
48 |
76.2 |
136 |
76.0 |
||
Among the uncontrolled hypertensive patients (reasons for stopping are not exclusive) 71.7% had stopped medications when their symptoms resolved, 61.2% admitted to forgetting to obtain their medication, 66.4% do not obtain their medication regularly and 60.5% stopped their medication when other complaints appear.
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Discussion
According to the “2009 Mongolian STEPS Survey on the prevalence of non communicable disease and injury risk factors” result shows that aware, untreated hypertension prevalence were 61,1% and treated, uncontrolled hypertension prevalence were 25.6% of patients using medication but which is not effective. Our result of aware, untreated hypertension level were lower than STEPS survey result but treated, uncontrolled hypertension prevalence were lower than previous study[14].
Tsolmon U, Naranchimeg S et all carried out survey among Ulaanbaatar city population, according to their result nonadherence of medical treatment regimen was 68.3 %[15], which was close to our result. This result shows antihypertensive medication nonadherence is quite high throughout Mongolia, therefore we need to improve community health education.
By the comparison of international researchers, medical regimen adherence was 52-74%, but nonadherences were 12-57%, these results were close to our results. Магtа Регеiга et all made meta analysis on 44 studies performed in 35 countries, as a result aware, untreated hypertension level were between 34-89%[16]. According to our result aware, untreated hypertension level were 56% which was close to previous study.
Conclusion
Uncontrolled hypertension prevalence was 68.2%, which shows we need to improve healthcare quality of arterial hypertension. The physician did not suggest using medication regularly for 38.6% of uncontrolled hypertension patients. These factors might be influencing to hypertension healthcare service negatively.
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