Encourage and support patients to regularly monitor their blood pressure at home, detect risky blood pressure levels, record results and promptly respond to doctors at the district level. These solutions will motivate patients who are abandoning treatment to return to treatment as well as encourage them to better comply with treatment.
Thai Binh and Hung Yen are two provinces in the Red River Delta, with a diverse population of many occupations, with a standard of living similar to many rural areas in Northern Vietnam. By December 2014, the two provinces had not yet implemented the National Hypertension Prevention Program, but in Tien Hai district, Thai Binh province and 4 districts in Hung Yen, outpatient clinics for hypertension were implemented at the district health center and district general hospital under the local elderly support program. Here, the elderly in some communes were supported for outpatient treatment by health insurance, at that time, more than 1,000 patients in each province were screened and supported for hypertension treatment management at the district level. Therefore, we chose some communes in Tien Hai, Thai Binh province and some communes in Hung Yen province as the locations to conduct the study "Evaluation of intervention results to improve self-monitoring of blood pressure and treatment adherence in hypertensive people over 50 years old in some communes in Tien Hai district, Thai Binh province in 2015".
RESEARCH OBJECTIVES
1. Assessment of the current status of self-monitoring of blood pressure at home and adherence to medication of hypertensive people aged 50 and over in some communes of Thai Binh and Hung Yen provinces and some related factors in 2015.
2. Develop an intervention model and evaluate the model's results in enhancing self-monitoring of blood pressure at home and adherence to medication in hypertensive people aged 50 and over in some communes of Thai Binh province.
Chapter 1
DOCUMENT OVERVIEW
1.1. Overview of hypertension
1.1.1. Concept, measurement and classification
1.1.1.1. Concept of hypertension
According to the World Health Organization (WHO), a person is considered to have high blood pressure (HTN) when he or she has one or both of the following values:
Maximum blood pressure (systolic blood pressure) ≥ 140 mmHg and/or minimum blood pressure (diastolic blood pressure) ≥ 90 mmHg. The value is calculated as the average of at least 2 consecutive measurements using standard measurement methods [71].
In this study, the researcher used the World Health Organization's concept of hypertension presented above. This concept also coincides with the concept that the Ministry of Health and health programs in Vietnam are using [28].
1.1.1.2. How to measure blood pressure properly
According to the Vietnam Heart Association and the Vietnam Hypertension Association, the standard blood pressure measurement methods applied at clinics and at home are recommended as follows:
1.1.1.2.1. Blood pressure measurement in clinic/clinical blood pressure
Blood pressure can be measured with a mercury sphygmomanometer with components (rubber tube, valve, mercury dosing tube, etc.) stored under appropriate conditions. Some non-invasive blood pressure monitors include pneumatic pressure-based devices with stethoscopes or semi-automatic waveform devices. These are the most common types of devices widely used today because mercury sphygmomanometers are bulky, fragile, and require strict storage. A standard measuring device must be standardized and have high accuracy when compared with the value measured by a mercury sphygmomanometer [26, 29].
1.1.1.2.2. Common blood pressure measurement in the community / self-measurement at home
The patient sits for 5 minutes in a quiet room before starting the measurement. Sit up straight in a chair and relax during the measurement.
- For the elderly and diabetic patients, if it is the first examination, standing blood pressure should be measured.
- Remove tight clothing, rest your arm on the table at heart level, relax your arm and do not talk during the measurement.
- Measure at least twice, 1-2 minutes apart. If the two measurements are too different, continue measuring a few more times and average the last two values.
- Use a bandage to wrap the arm tightly at a moderate level, placing the bandage at heart level regardless of the patient's position. The lower edge of the bandage should be 3 cm above the elbow line.
- After the air pressure in the cuff causes the radial pulse to disappear, inflate it another 30 mm Hg and then slowly lower the mercury column.
- Use the first and second change sounds to determine the blood pressure corresponding to systolic and diastolic blood pressure.
- Measure BP in both arms at the first measurement to detect differences caused by peripheral vascular disease. The higher value is then monitored for long-term use.
- Never treat hypertension based on the results of a single blood pressure measurement.
- Should use standardized measuring device and measure according to correct procedure [29].
1.1.1.2.3. Some points to note when measuring commonly in the community or measuring at home
- Standardized measuring devices should be used; wrist-based devices are often less accurate than arm-based devices. When measuring the patient's arm, it must be placed at heart level.
- Although the mercury blood pressure monitor is highly accurate, it is more suitable for measuring in clinics/hospitals. With the conventional measurement method, for convenience in storage and transportation, semi-automatic and automatic machines should be used, even mechanical measuring machines (including air cuffs and headphones) should be considered if the patient measures by himself if the patient's hearing and reflexes are impaired, especially in the elderly.
- The patient needs to sit and rest for a few minutes before measuring and the patient needs to be informed that blood pressure values may vary in different measurements due to automatic blood pressure changes.
- Do not measure too many times in a row, but measure several times before deciding to take medication and during the treatment.
- Note that normal values measured at home are lower than those measured in the clinic. A home value of 135/85 mm Hg corresponds to 140/90 mgHg measured in the clinic or hospital. Therefore, some other organizations have proposed the concept of hypertension with a lower threshold, corresponding to different blood pressure measurement circumstances [28, 29].
- Patients are advised to regularly monitor their blood pressure at home. The Vietnam Hypertension Prevention Association and the National Hypertension Prevention Program recommend weekly monitoring and preferably every few days for patients on stable treatment. Patients who are newly treated or have changes in medication or have comorbidities should be monitored more frequently, preferably daily. This frequency is consistent with the recommendations of several international hypertension prevention organizations and the CDC [28, 61, 122].
In this study, synthesizing the guidelines, the researcher proposed a standard for evaluating the correct blood pressure measurement practice of observed patients based on a checklist including the following main criteria:
- Patient rests 5 minutes before measuring
- Place your arm/wrist at heart level.
- Wrap with moderate steam
- Sit/lie down to relax/relax
- Do not talk or laugh while measuring.
- Correct start
- Read blood pressure/heart rate index.
These are also criteria based on the guidelines of the Vietnam Hypertension Association and the Vietnam Cardiology Institute.
1.1.1.3. Blood pressure classification
In fact, there are two commonly used ways to classify high blood pressure, including classification based on the cause found and classification based on blood pressure index level.
- Classification by cause is widely used in clinical practice and includes 2 groups: Primary hypertension (formerly known as idiopathic) and Secondary hypertension.
The subgroup of Primary Hypertension is classified according to the index level into levels 1, 2 and 3 corresponding to levels 140-159/90-99; 160- 179/100-109; ≥ 180/≥ 110.
In addition, the name isolated systolic hypertension is reserved for the group with systolic blood pressure index of 140 mmHg or higher while diastolic blood pressure < 90 mmHg.
Table 1.1: Blood pressure classification according to the World Health Organization (2003) [96]
WHO classification
HATT (mmHg) | HATTr (mmHg) | |
Optimal HA | < 120 | < 80 |
Normal BP | < 130 | < 85 |
Normal high BP | 130-139 | 85-89 |
Grade 1 hypertension (mild) | 140-159 | 90-99 |
Grade 2 hypertension (moderate) | 160-179 | 100-109 |
Grade 3 hypertension (severe) | ≥ 180 | ≥ 110 |
Isolated systolic hypertension | ≥ 140 | ≤ 90 |
Maybe you are interested!
-
Results in Increased Knowledge and Skills in Self-Monitoring Blood Pressure -
Average Vmtt Thickness of High Blood Pressure and Normal Blood Pressure Groups -
Some Factors Related to High Blood Pressure in People 18 - 69 Years Old -
Classification According to the Condition of the Upstream Water Pressure Plant -
Factors Affecting the Results of Cord Blood Stem Cell Transplantation for the Treatment of Hematological Diseases
![Blood Pressure Classification According to the World Health Organization (2003) [96]](https://tailieuthamkhao.com/en/uploads/2025/02/09/blood-pressure-classification-according-to-the-world-health-organization-2003-96-445x306.jpg)
Table 1.2: Blood pressure classification in people ≥ 18 years old according to JNC 7, 8-2014 [115]
JNC 8 grading
HATT (mmHg) | HATTr (mmHg) | |
Normal BP | < 120 | < 80 |
Pre-hypertension | 130-139 | 85-89 |
Stage 1 hypertension | 140-159 | 90 - 99 |
Stage 2 hypertension | ≥ 160 | ≥ 100 |
The classification of pre-hypertensive patients by WHO and the above organizations is very meaningful based on many research evidences showing that the mortality rate due to coronary artery disease in the group of subjects with this index is significantly higher than that of normal blood pressure. People with pre-hypertensive patients, if their blood pressure is not brought back to normal, will progress to true hypertension. This group is recommended to improve their blood pressure through lifestyle changes [40, 95, 115].
In the group of secondary hypertension, many causes have been known such as aortic stenosis, renovascular disease, renal failure, hyperaldosteronism syndrome, pheochromocytoma [3, 45].
Thus, there are many ways to classify blood pressure according to blood pressure levels that are quite different between organizations. These classifications ensure academic meaning and are mainly used by doctors but are not suitable and difficult to understand and remember for patients [46].
Therefore, in this study, the researcher aims to build an interpretation table that integrates the above classification tables but at the same time is suitable for patients to use to explain the meaning of measured values.
1.1.2. Hypertension and disease burden caused by hypertension
1.1.2.1. Hypertension
1.1.2.1.1. The situation of high blood pressure in the world
Hypertension has now become a global concern as it crosses geographical and wealth gaps between countries, with the highest prevalence among non-communicable diseases in the community. The prevalence tends to increase in most countries worldwide and is closely related to age.
According to the World Health Organization in 2008, the rate of hypertension in people over 25 years old globally is about 40%. Of which, the African region has the highest rate at 46% and the lowest is the Americas at 35%. The rate of hypertension in men is higher than in women, besides, countries with low per capita income have a higher rate of hypertension than rich countries in a statistically significant way. Because of its close relationship with age, hypertension always accompanies the process of population aging, for that reason, the rate of hypertension tends to increase rapidly in the Asian region, including Vietnam [59].
CDC statistics also show that high blood pressure is one of four diseases with a high incidence in the United States. During the period from 1999-2000, about 29.6% of Americans over 25 years old had high blood pressure, 31% were in the pre-hypertension group. However, 10 years later, from 2007-2011, the incidence of high blood pressure in Americans over 18 years old was still about 30%.
According to Mozaffarian D (2012), in the age group of 25-34, the rates of women and men are 6.2% and 8.6% respectively; in the age group of 35-44, it increases to 18.3% and 22.6%, and from 65 years old onwards, the rate of women is 53.7% and men is 54.6%. At the age of 75 and above, the rate of hypertension is approximately 80%. In addition, the study also showed that the incidence rate has a significant difference between races, black people tend to have more hypertension than white people and is lowest in the Mexican region, this finding is true for both men and women [52, 61, 69].
In 2010, the rate of hypertension in the German age group of 20-79 years was 15.9% and in the UK it was 10.4%, in the 40-49 age group it was approximately 20% and in the over 60 age group it was 40-45%. Investigations in Malaysia showed that the rate of hypertension has been increasing continuously since 1998, in 2013 the rate of people over 25 years old with hypertension was approximately 33%. In China, in 2013 and 2014, the rate of hypertension in adults was reported to be from 26.6% - 41%. A 2014 review study in India by Anchala R et al. reported that the prevalence of hypertension in this South Asian country was 29.8%, despite having a young population structure [67, 88, 100, 101, 120] .
Thus, it can be seen that in most regions of the world, from developed countries to countries in the Southeast Asian region, hypertension is a disease with a common incidence in adults. This reality completely changes the previous concept that hypertension is a common disease in rich countries and aging populations.
1.1.2.1.2. Hypertension situation in Vietnam
The prevalence of hypertension in Vietnam is said to have changed rapidly since the first large-scale survey in 1992 conducted by the Institute of Cardiology - Bach Mai Hospital, when the prevalence in adults was only a few percent. In 2011, a study by Ha Anh Duc on 2368 people ≥ 25 years old in Thai Nguyen showed that the prevalence of hypertension in adults here was 23%, with clear differences between men and women, age groups and in overweight and obese people [21, 51].
A 2012 survey by Pham Thai Son and colleagues from the National Heart Institute estimated the prevalence of hypertension in people over 25 years old to be 25.1%, of which 28.3% were in men and 23.1% in women. This prevalence increased with age in both sexes (32.7% and 17.3%, p<0.001). The study also showed that the prevalence of hypertension in urban areas was higher than in rural areas (p<0.001) [110].