Avaliação da adesão ao tratamento e dos resultados clinicos e humanisticos na investigação da hipertensão arterial resistente
Walneia Aparecida de Souza
TESE
Português
(Broch.)
T/UNICAMP So89a
[Assessment of the adherence to treatment and clinical and humanistic results in the investigation of resistant arterial hypertension]
Campinas, SP : [s.n.], 2008.
158 p. : il.
Orientador: Heitor Moreno Junior
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Resumo: Introdução: O diagnóstico de hipertensão arterial resistente requer cuidadosa avaliação da adesão ao tratamento prescrito. Objetivos: Analisar a adesão ao tratamento dos pacientes com hipertensão arterial de difícil controle, referenciados ao Ambulatório de Farmacologia Cardiovascular do...
Ver mais
Resumo: Introdução: O diagnóstico de hipertensão arterial resistente requer cuidadosa avaliação da adesão ao tratamento prescrito. Objetivos: Analisar a adesão ao tratamento dos pacientes com hipertensão arterial de difícil controle, referenciados ao Ambulatório de Farmacologia Cardiovascular do Hospital das Clínicas da Universidade Estadual de Campinas, a fim de identificar os hipertensos resistentes ao tratamento farmacológico. Avaliar também os resultados clínicos e humanísticos durante o seguimento farmacoterapêutico. Método. Realizou-se um estudo prospectivo de 44 pacientes acompanhados por um período de 12 meses. Durante o seguimento farmacoterapêutico, utilizaram-se os seguintes instrumentos: Teste de Morisky et al. e contagem de comprimidos para análise da adesão ao tratamento; teste do conhecimento em relação à doença e ao tratamento anti-hipertensivo; análise da pressão arterial (PA) ambulatorial e através da Monitorização Ambulatorial da Pressão Arterial (MAPA); para qualidade de vida, utilizou-se o instrumento genérico como o SF-36 e instrumento específico (perfil de sintomas físicos); também utilizaram-se os facilitadores de cuidados à saúde (urgência hipertensiva e internação hospitalar). Resultados: Com relação à adesão ao tratamento pelo método contagem de comprimidos, 63,6% dos pacientes foram aderentes no início e, 95,4%, no final do estudo. Pelo Teste de Morisky et al., a adesão foi de 36,4%, no início e, 68,2%, no final. Os hipertensos apresentaram altos níveis de conhecimento em relação à doença e ao tratamento, porém não houve relação com o controle da pressão arterial. Houve redução significativa da pressão arterial (p<0,05) pela MAPA e ambulatorial, mas 59% dos pacientes não controlaram a PA. Quase todos os domínios do SF-36 não sofreram alteração durante o estudo. Mas, para o instrumento específico (perfil de sintomas físicos), houve uma redução significativa nos sintomas moderados e graves (p=0,005). Houve também uma redução significativa no número de urgências hipertensivas (p=0,0001) e de internação hospitalar (p=0,0006). Conclusões: O seguimento farmacoterapêutico foi efetivo na redução da pressão arterial, de sintomas físicos, de urgência hipertensiva e de internação hospitalar; mas não foi sensitivo o suficiente para detectar mudanças nos domínios do SF-36. Apesar dos elevados níveis de adesão ao tratamento, a maioria dos pacientes não controlou a PA. Portanto, outros fatores devem ser investigados, a fim de se caracterizar esses pacientes como resistentes ao tratamento
Ver menos
Abstract: Introduction: The diagnosis of resistant arterial hypertension requires careful evaluation of the adherence to the therapies prescribed.
Objectives: Study of the adherence to therapy for patients with difficult-to-control hypertension referred to the Cardiovascular Pharmacology... Ver mais Abstract: Introduction: The diagnosis of resistant arterial hypertension requires careful evaluation of the adherence to the therapies prescribed.
Objectives: Study of the adherence to therapy for patients with difficult-to-control hypertension referred to the Cardiovascular Pharmacology Out-Patient Clinic at the University Hospital of the State University of Campinas (UNICAMP), in Campinas, SP Brazil, in order to identify hypertensive patients with a resistance to pharmacological therapy. The humanistic and clinical results during the pharmacotherapeutic follow-up were also assessed. Method: A prospective survey of 44 patients was conducted where each patient was monitored for a 12-month period. During the pharmacotherapeutic used the following instruments: the test prepared by Morisky et al., and pill count to assess adherence to the treatment; a test to gauge the knowledge of the disease and of the anti-hypertension treatment; analysis made at the office blood pressure, and through Ambulatory Blood Pressure Monitoring (ABPM); the SF-36 (Short Form) questionnaire and a specific instrument (physical symptoms profile) were used to assess the Health-Related Quality of Life (HRQOL); and was also used the health care facilitators (hypertension urgent care and hospital admissions). Results: In relation to the adherence to therapy via the pill count method, 63.6% of the patients were adherent from the start, and 95,4% at the end of the survey. Through the Morisky et al. Test, the adherence to the therapy at the baseline was of 36.4%, and of 68.2% at the end. Hypertensive patients displayed significant knowledge about hypertension and therapy but no relation was found between that and the control of blood pressure. There was a significant blood pressure reduction (p<0.05) via the MAPA and in the office blood pressure, but 59% of the patients did not control their BP. Nearly all domains of the HRQOL assessed by SF-36 remained unchanged during the follow-up. But for the specific instrument there was a significant reduction in the moderate and severe physical symptoms (p=0.005). There were also significant reductions in the number of urgent care visits (p=0.0001) and hospital admissions (p=0.006). Conclusions: The pharmacotherapeutic follow-up was effective in reducing blood pressure, physical symptoms, and urgent care visit and hospital admission numbers; but it was not sensitive enough to detect changes in the domains of the SF-36. In spite of the high adherence levels to the therapy, most of the patients failed to control their BP. Therefore, other factors should be investigated in order to characterize these patients as resistant to treatment Ver menos
Objectives: Study of the adherence to therapy for patients with difficult-to-control hypertension referred to the Cardiovascular Pharmacology... Ver mais Abstract: Introduction: The diagnosis of resistant arterial hypertension requires careful evaluation of the adherence to the therapies prescribed.
Objectives: Study of the adherence to therapy for patients with difficult-to-control hypertension referred to the Cardiovascular Pharmacology Out-Patient Clinic at the University Hospital of the State University of Campinas (UNICAMP), in Campinas, SP Brazil, in order to identify hypertensive patients with a resistance to pharmacological therapy. The humanistic and clinical results during the pharmacotherapeutic follow-up were also assessed. Method: A prospective survey of 44 patients was conducted where each patient was monitored for a 12-month period. During the pharmacotherapeutic used the following instruments: the test prepared by Morisky et al., and pill count to assess adherence to the treatment; a test to gauge the knowledge of the disease and of the anti-hypertension treatment; analysis made at the office blood pressure, and through Ambulatory Blood Pressure Monitoring (ABPM); the SF-36 (Short Form) questionnaire and a specific instrument (physical symptoms profile) were used to assess the Health-Related Quality of Life (HRQOL); and was also used the health care facilitators (hypertension urgent care and hospital admissions). Results: In relation to the adherence to therapy via the pill count method, 63.6% of the patients were adherent from the start, and 95,4% at the end of the survey. Through the Morisky et al. Test, the adherence to the therapy at the baseline was of 36.4%, and of 68.2% at the end. Hypertensive patients displayed significant knowledge about hypertension and therapy but no relation was found between that and the control of blood pressure. There was a significant blood pressure reduction (p<0.05) via the MAPA and in the office blood pressure, but 59% of the patients did not control their BP. Nearly all domains of the HRQOL assessed by SF-36 remained unchanged during the follow-up. But for the specific instrument there was a significant reduction in the moderate and severe physical symptoms (p=0.005). There were also significant reductions in the number of urgent care visits (p=0.0001) and hospital admissions (p=0.006). Conclusions: The pharmacotherapeutic follow-up was effective in reducing blood pressure, physical symptoms, and urgent care visit and hospital admission numbers; but it was not sensitive enough to detect changes in the domains of the SF-36. In spite of the high adherence levels to the therapy, most of the patients failed to control their BP. Therefore, other factors should be investigated in order to characterize these patients as resistant to treatment Ver menos
Moreno Junior, Heitor, 1958-
Orientador
Bortolotto, Luiz Aparecido
Avaliador
Barros, Marilisa Berti de Azevedo, 1948-
Avaliador
Oliveira, Helenice Bosco de, 1949-
Avaliador
Simões, Maria Jacira Silva
Avaliador
Avaliação da adesão ao tratamento e dos resultados clinicos e humanisticos na investigação da hipertensão arterial resistente
Walneia Aparecida de Souza
Avaliação da adesão ao tratamento e dos resultados clinicos e humanisticos na investigação da hipertensão arterial resistente
Walneia Aparecida de Souza
Exemplares
Nº de exemplares: 1
Não existem reservas para esta obra