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Chajag Project: Control of Hypertension in
the Municipality of Jaguey Grande
Dueñas, Alfredo*; Hernandez, Osvaldo**;
Debs, Giselle*; Aguiar, Jesus**; Gonzalez JC*.
* Dpt.of Preventive Cardiology. Institute
of Cardiology. Havana. Cuba. **
Municipal Center of Hygiene and Epidemiology.Jaguey Grande. Matanzas.Cuba
Introduction: High Blood Pressure (HBP) is not only a disease, it is also a risk factor of other diseases with higher fatality rate than HBP itself. Currently HBP is not well controlled all over the world, in Cuba only 30% of the hypertensives are controlled.
Objectives: To increase the number of hypertensive under control, decreasing the mean value of systolic and diastolic blood pressure of the population.
-Lower morbidity and mortality by diseases related with HBP.
Methods: In 1997 this project started in this Municipality of 56 873 inhabitants. Two surveys were made in population samples, one to determine the magnitude of the problem and the other to evaluate the quality of medical care given to the hypertensives; after, the family doctors and nurses were trained through seminars, lectures, workshops etc. in the management of this disease as a community problem. The results of the surveys were also discussed with the health personal. Since 1997 registers for myocardial infarction and stroke patients were carried out. The local government has increased the production of fruits and vegetables to cover the increasing demand of these products by the population. Mortality statistics are evaluated yearly. Since this year we are evaluating cardiovascular risk in all the adult population.
Results: Prevalence of HBP (Population over 30 years, both sexes).
Mortality (variation 1997 - 2000)
Conclusion: Increasing the control of Arterial Hypertension we could lowered the mortality rate by related diseases, mainly by cardiovascular diseases.
High Blood Pressure is the most common disease a family doctor has to face. It is a disease and a risk factor of other diseases with a very high mortality rate. Currently hypertension is not well controlled all over the world, in Cuba only 30% of the hypertensives are under control.
On the other side, if you reach a control of a high number of these patients you can lower the mean of the blood pressure of the population and in consequence lower the morbidity and mortality rate of related diseases, in this project we are trying to demonstrate that principle.
-To increase the number of patients under control, decreasing the mean value of systolic and diastolic blood pressure of the population.
-To lower morbidity and mortality by diseases related with High blood pressure.
MATERIALS AND METHODS
Jaguey Grande is a municipality of 56873 inhabitants in the central-south part of the Matanzas province, 140 Kms. from Habana. It has 3 health areas and 72 family doctors and nurses directly involve in primary care. In 1997 this project was started. Two surveys were made at the end of this year, one to determine the magnitude of the problem, prevalence, distribution, awareness and control of hypertensives and the other to evaluate the quality of medical care given to these patients. Later all the family doctors and nurses, were trained in the management of the hypertensives, better detection and follow up, classification, better treatment and in the education of the patient, following the Patient Education Project of WHO. After we went to educate the high risk persons and the general population, using mass media radio, newspaper, bulletins and conferences and workshops talking about the importance of risk factors, better diet, lowering the salt intake and increasing vegetables, physical exercise, to keep normal weight etc.
A register of cerebrovascular diseases and cardiac infarction has been established since 1998. Mortality has been monitored since 1997. A second survey is planned for 2002.
Now we are starting to measure cardiovascular risk in all the adult population.
-High Blood Pressure: Systolic/Diastolic >= 140/90 mmHG.
-Hypertensive controlled: Treated patient who always had blood pressure <140/90 in the last year, at least in 4 determinations in a year.
In 1997 the registered prevalence of Hypertension was only 12.5% of the adult population (pop. 18 years and over), aware of the disease were 70.6% and controlled 17.0%, in the year 2000, these figures are: registered prevalence 25.7%, awareness 91.7% and controlled 62%,( )
In 1997 only 9.8% of the patients were treated with non pharmacological treatment alone 1n the year 2000 25.7% of the patients are treated without drugs.
The intake of vegetables has increased three times from 1997-2000.
The changes in the mortality rates 1997-2000 are shown in the.
We have improved the detection on patients with the measurement of blood pressure to all the adult population, probably the registered prevalence is very close to the real one, it permit us to educate the patients, to get a better adherence to treatment and a better control, this 62% is probably the better in the world, in a population greater than 50 000 people.
The preliminary results in mortality are very good, lowering the mortality rates in cardio and cerebrovascular diseases, probably these rates are also influenced by the decreasing of others risk factors such as smoking, obesity, and sedentarism, because the registered prevalence of smokers, obese, and sedentary people has decreased, but it is going to be measured by a survey in a population sample next year.
Hypertension can be controlled in the community through a better detection, classification, treatment and education of patients, its influence in lowering mortality by cardio and cerebrovascular disease is also demonstrated.
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