HYPERTENSION - ‘Three 'Synergistic' Problems When Taking Blood Pressure’, courtesy of MEDSCAPE.
We came across this PAHO release on the challenges in efforts to control Human Blood Pressure and thereby control and prevent the tragic consequences of missed, poorly managed high blood pressure (Hypertension- preventable and controllable non communicable disease). We are particularly interested because the messages mirror the ones we give to clinicians in PACK (Practical Approach to Care Kit) programme for primary health care implementation in LMICs like Nigeria, South Africa, Ethiopia, Brazil, others. Importantly the messages are needed at the other tiers of the health system, general hospitals and teaching hospitals, too.
The release in Medscape (Three 'Synergistic' Problems When Taking Blood Pressure (medscape.com) is a useful reminder to providers of care and education and training for those in training to become providers (clinicians):
https://www.medscape.com/viewarticle/992902?ecd=WNL_trdalrt_pos1_ous_230...
'Hypertension, or high blood pressure, is a condition that usually has no symptoms and, if left untreated, can lead to heart attacks, heart failure, stroke, kidney failure, and blindness. Associated risk factors include older age, being overweight or obese, lack of physical activity, high salt/sodium intake, and high alcohol consumption. Hypertension affects about 1 in 6 adults in the Americas and is the leading risk factor for cardiovascular diseases, which are the leading cause of death in the region, responsible for the loss of about 2 million lives each year.’’
"Often, the staff members at our primary care clinics are not prepared to diagnose and treat hypertension, because there aren't national protocols to raise awareness and prepare them to provide this care to the correct standard. Also, they are often unqualified to take blood pressure readings properly,"
‘’------- Measure your blood pressure accurately, control it, live longer! "We shouldn't underestimate the importance of taking blood pressure,"
"The importance of clinic blood pressure measurement has been recognized for many decades, but adherence to guidelines on proper, standardized blood pressure measurement remains uncommon in clinical practice," concludes a consensus document signed by 25 experts from 13 institutions in the United States, Australia, Germany, the United Kingdom, Canada, Italy, Belgium, and Greece.’’
The first problem lies in the low quantity of measurements. A recent study in Argentina of nearly 3000 visits to the doctor's office at nine healthcare centers showed that doctors took blood pressure readings in only once in every seven encounters. Even cardiologists, the specialists with the best performance, did so only half of the time.
"Several factors can come into play: lack of awareness, medical inertia, or lack of appropriate equipment.’’
‘’--------- the greatest obstacle is the lack of awareness among physicians and other healthcare staff about the importance of taking proper blood pressure measurements.’’. ‘’ ---- "Medical schools are also responsible for this. They go over this topic very superficially during undergraduate and, even worse, postgraduate training. The lack of time to take correct measurements, or the lack of appropriate instruments, is secondary to this lack of awareness among most healthcare staff members,".
‘’ --------------- it would be good practice for all primary care physicians to take blood pressure readings regardless of the reason for the visit and whether patients have been diagnosed with hypertension or not. "If a woman goes to her gynecologist because she wants to get pregnant, her blood pressure should also be taken! And any other specialist should interview the patient, ascertain her history, what medications she's on, and then ask if her blood pressure has been taken recently,"
Joseph Ana
Prof Joseph Ana
Lead Senior Fellow/ medical consultant.
Center for Clinical Governance Research & Patient Safety (ACCGR&PS) @ HRI GLOBAL
P: +234 (0) 8063600642
E: info@hri-global.org
8 Amaku Street, State Housing, Calabar, Nigeria.
www.hri-global.org
HIFA Profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria, established by HRI Global (former HRIWA). He is a member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health, he led the introduction of the Homegrown Quality Tool, the 12-Pillar Clinical Governance Programme, in Nigeria (2004-2008). For sustainability, he established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria. His main interest is in whole health sector and system strengthening in Lower, Low and Middle Income Countries (LLMICs). He has written six books on the 12-Pillar Clinical Governance programme, suitable for LLMICs, including the TOOLS for Implementation. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Nigeria Medical Association’s Award of Excellence on three consecutive occasions for the innovation. He served as Chairman, Quality & Performance, of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He is member, National Tertiary Health Institutions Standards Committee of the Federal Ministry of Health. He is the pioneer Secretary General/Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers. (http://www.hifa.org/support/members/joseph-0 http://www.hifa.org/people/steering-group). Email: info AT hri-global.org and jneana AT yahoo.co.uk
