In The Name of God HTN Education Presented

In The Name of God ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ آﻤﻮﺯﺵ ﺍﻫﻤیﺖ HTN & Education Presented by: SM Gatmiri MD, Nephrologist, Assistant Professor, Imam Khomeini Hospital, TUMSNRC Aban 92

World Hypertension Day ﻋﻨﻮﺍﻥ ﺑﻪ ( ﻣﺎﻩ ﺍﺭﺩیﺒﻬﺸﺖ 27) ﻣﻪ ﻣﺎﻩ 17 ﺭﻭﺯ 2005 ﺳﺎﻝ ﺍﺯ . ﺷﺪ ﻓﺸﺎﺭﺧﻮﻥ ﺟﻬﺎﻧی ﺭﻭﺯ Health ﺑﻬﺪﺍﺷﺖ ﺟﻬﺎﻧی ﺭﻭﺯ ﺑﺮﺍی ﻓﺸﺎﺭﺧﻮﻥ ﺷﻌﺎﺭ ﺗﻌییﻦ ﺩﺭ WHO ﺑﻬﺪﺍﺷﺖ ﺟﻬﺎﻧی ﺳﺎﺯﻣﺎﻥ ﺗﻮﺳﻂ Day World 2013 ﺳﺎﻝ -WHL initiated a global awareness campaign on HTN in 2005 and dedicated May 17 of each year as World HTN Day (WHD). -Hypertention as the Theme of World Health Day in 2013

HTN DETECTION FOLLOW-UP PROGRAM COOPERATIVE GROUP 1977 -In 14 U. S. communities, were used to examine the relationship of education to the well-documented racial differences in prevalence of HTN. -BP were obtained on 158, 906 adults. -18. 0% of whites and 37. 4% of blacks were defined as

ﺩﺭ ﺍیﻦ ﻣﻄﺎﻟﻌﻪ ﻫﻤچﻨیﻦ ﻣﺸﺨﺺ ﺷﺪ ﺳﻄﺢ آﻤﻮﺯﺵ ﺩیﺪگی ﺩﺭ ﻫﺮ ﺩﻭ ﻧژﺎﺩ ﻭ ﻫﺮ ﺩﻭ ﺟﻨﺲ ﺑﺎ ﻓﺸﺎﺭﺧﻮﻥ ﻧﺴﺒﺖ ﻋکﺲ ﺩﺍﺭﺩ ﺍﻟﺒﺘﻪ ﺍیﻦ ﺍﺭﺗﺒﺎﻁ ﻣﻌکﻮﺱ ﺩﺭ ﺟﻮﺍﻥ ﺗﺮﻫﺎ ﻗﻮی ﺗﺮ ﻭ ﺩﺭ چﺎﻕ . ﺗﺮﻫﺎ ﺿﻌیﻒ ﺗﺮ ﺑﻮﺩ This Study showed: Education was inversely associated with HTN for each race and sex group. This inverse association remained when age was taken into account, was more striking in the younger age groups & in blacks, but was diminished in the highest weight classes.

Previous evaluation of 2 year experience demonstrated a positive effect of program on compliance with the treatment & BP control. All-cause life table mortality rate was 57. 3% less for the experimental group compared to the control group (%12. 9 vs %30. 2, p <. 05), while the HTN-related mortality rate was 53. 2% less (%8. 9 vs %19. 0, p <. 01).

ﻃﺮﺣی ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣکﺎﻧیﺴﻢ ﺍﻧﺘﺸﺎﺭ آﻤﻮﺯﺷﻬﺎی ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ ﺩﻭ Fors. s. w 1989 ﺩﺭ ﺗﻦ ﺍﺯ ﻭﺍﻟﺪیﻦ آﻨﻬﺎ 1446 ﺩﺍﻧﺶ آﻤﻮﺯ ﺑﺎ 1204 گﺮﻭﻩ ﺑﺎ ﻭ ﺑﺪﻭﻥ کﻨﺘﺮﻝ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ ﻣﻨﺰﻝ ﺩﺭ ، ﺳپﺲ ﺍﻃﻼﻋﺎﺕ ﻭﺍﻟﺪیﻦ ﻭ ﻣﻬﺎﺭﺕ ﻫﺎی آﻨﺎﻥ ﺩﺭ ﺧﺼﻮﺹ ﻓﺸﺎﺭﺧﻮﻥ. ﺑﻪ ﺍﺟﺮﺍ گﺬﺍﺷﺖ ﺍﻋﺘﻤﺎﺩ ﺑﻪ ﻧﻔﺲ ﺑچﻪ ﻫﺎ ، ﺩﺭیﺎﻓﺖ ﻣﺮﺍﻗﺒﺖ ﻭ ﺭﻓﺘﺎﺭﻫﺎی پﺬیﺮﻧﺪﻩ ﺩﺭﻣﺎﻥ ، ﺭیﺴک ﻓﺎکﺘﻮﺭﻫﺎ ﺍیﻦ ﺑﺮﻧﺎﻣﻪ ﺑﺎﻋﺚ ﺍﻓﺰﺍیﺶ ﺷﺎﺧﺺ ﻫﺎی ﺩﺍﻧﺶ ﻣﻬﺎﺭﺕ. ﻭ ﺍﺭﺗﺒﺎﻁ ﺧﺎﻧﻮﺍﺩگی ﺑﺮﺭﺳی ﺷﺪ . کﻨﺘﺮﻝ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ گﺮﻭﻩ ﻣﻮﺭﺩ ﻣﺪﺍﺧﻠﻪ ﺷﺪ 1989 Fors. s. w -Evaluation of a diffusion strategy for school-based HTN education. -The purpose of this research was to evaluate the effectiveness of HTN education within a population of sixth grade students (n = 1204) and their parents (n = 1446 with and without a home BP measurement). -Students were compared for knowledge, BP measurement skill, and home diffusion activities and parents for knowledge, risk factor reduction, BP, care-seeking, & compliance behaviors. Student knowledge, BP measurement skills, and diffusion to parents was increased by the 3 Rs and HBP curriculum with the home component. Parental effects beyond the diffusion process were limited to knowledge improvement in certain groups.

2 ﺷﻬﺮ ﺷﺎﻫﺪ ﻭ 3) ، ﺷﻬﺮ ﺍﻣﺮیکﺎ 5 ﻧﺘﺎیﺞ پﺮﻭژﻪ ﻫﺎیی ﺭﺍ ﺩﺭ Fortmann Stephan P 1990 ﺩﺭ . ﺷﻬﺮ ﻣﻮﺭﺩ ﻣﺪﺍﺧﻠﻪ( ﺩﺭ ﺧﺼﻮﺹ آﻤﻮﺯﺵ ﻓﺸﺎﺭﺧﻮﻥ ﻣﻨﺘﺸﺮکﺮﺩ پﺰﺷکﺎﻥ ﻭ پﺮﺳﻨﻞ ، ﺑﺮﻧﺎﻣﻪ ﻫﺎی ﺍﺟﺘﻤﺎﻋی ، آﻐﺎﺯ ﻭ ﺩﺭ آﻦ ﺍﺯ ﺭﺳﺎﻧﻪ ﻫﺎ 1978 ﺑﺮﻧﺎﻣﻪ ﻫﺎ ﺍﺯ ﺍﺻﻼﺡ ﺍﻓﺰﺍیﺶ ، ﻣﺮﺩﻡ ﺑﺮﺍی آگﺎﻫی ﺍﺯ ﻓﺸﺎﺭﺧﻮﻥ. ﺑﺮﺍی ﺍﺭﺍیﻪ آﻤﻮﺯﺵ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ ، ﺑﻬﺪﺍﺷﺘی . ﻭﺭﺯﺵ ﻣﻨﻈﻢ ﻭ کﺎﻫﺶ ﻣﺼﺮﻑ ﻧﻤک ﺗﺸﻮیﻖ ﺷﺪﻧﺪ ، ﻭﺯﻥ FORTMANN, STEPHEN P. 1990 EFFECT OF LONG-TERM COMMUNITY HEALTH EDUCATION ON BP & HTN CONTROL: THE STANFORD FIVE-CITY PROJECT Was initiated in 1978 on cardiovascular risk factors, including BP. 2 treatment cities received an education program (mass media, various community-based programs, and health professionals, designed to encourage individuals to learn their BP levels, stay in the care of a physician if hypertensive, achieve ideal weight, exercise regularly, and reduce dietary sodium).

Physicians were encouraged to follow guidelines and patient education. 4 cross-sectional surveys and 4 repeated surveys of a cohort were conducted in treatment and control cities. After 5– 1/3 years of intervention, BP in the treatment cities exhibited an overall decline of 7. 4 and 5. 5 mm. Hg systolic and 5. 0 & 3. 7 mm. Hg diastolic in the cohort & independent surveys, respectively. These declines produced net changes between the treatment and control cities ranging from − 1. 1 to − 3. 8 mm. Hg. While the magnitude of these changes is not large, the results are significant from a public health perspective because they reflect changes in the overall community.

ﺑیﻤﺎﺭ ﻗﺎﺑﻠیﺖ پﺬیﺮﺵ ﺩﺭﻣﺎﻥ ﺭﺍ 453 ﻧﺰﺩ Sclar. D. A (HMOs) 1991 ﺩﺭ یک ﺟﺰﻭﻩ ﺣﺎﻭی ، ﻗﺮﺹ آﺘﻨﻮﻟﻮﻝ 30 ﺑﻪ ﺑیﻤﺎﺭﺍﻥ کیﺘی ﺷﺎﻣﻞ. ﺑﺮﺭﺳی ﻧﻤﻮﺩ ﺍﻃﻼﻋﺎﺗی ﺭﺍﺟﻊ ﺑﻪ ﺗﻐﺬیﻪ ﻭ ﺳﺒک ﺯﻧﺪگی ﻭ ﺗﻮﺿیﺤﺎﺗی ﺩﺭ ، ﻧکﺎﺕ آﻤﻮﺯﺷی . ﻣﻮﺭﺩ ﻣﺪﺍﺧﻠﻪ ﺗﺤﻮیﻞ ﺷﺪ ﺑﺮﻧﺎﻣﻪ ﺍﺯ ﻃﺮیﻖ ﺗﻠﻔﻦ پﺎیﺶ ﺷﺪ ﻭ ﻫﺮ ﻣﺎﻩ ﻗﺮﺹ ﻫﺎ ﻭ ﺟﺰﻭﺍﺕ ﺟﺪیﺪی ﺑﺮﺍی . ﺑیﻤﺎﺭﺍﻥ ﺍﺭﺳﺎﻝ ﻣی ﺷﺪ . ﺭﻭﺯ ﺍﺩﺍﻣﻪ یﺎﻓﺖ 180 ﺑﺮﻧﺎﻣﻪ Sclar, D. A. 1991 Effect of health education in promoting prescription refill compliance among patients with HTN Enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients (HMOs). 180 -day study period was used Classify patients as either new or existing cases of HTN. Patients were randomly assigned to a control or an experimental group. Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription (new patients) or their first refill request (existing patients).

The kit contained: -A 30 -day supply of atenolol; -An educational newsletter about HTN; -Information on nutrition and life-style changes; and -An explanation of the intent and content of the program. Each patient was contacted by telephone. Each month thereafter, the kits were mailed to each patient. The medication possession ratio, (Number of daily atenolol during the 180 -day study period, was significantly (P ≤ 0. 001) enhanced for the new & existing experimental groups relative to the control groups. Multiple regression analyses revealed that enrollment in the health-education program increased the number of days' supply of atenolol obtained by existing patients by 27 (P ≤ 0. 001), and by new patients by 40 (P ≤ 0. 001).

Subjects > 70 Y (hypertensives & controls) demonstrated a lower level of knowledge (P < 0. 05). -Satisfaction was Higher in Educated Patients. -And hypertensive patients were not more knowledge able about Their diseases.

Results Prescriptions for all antihypertensive agents increased significantly between 1996 and 2001 11% for thiazides, 45% for beta-blockers, 68% for ACEis, 19% for CCBs, 4332% for ARBs & 27% for Loop diuretic. But prescriptions for digoxin (19%) and nitrates (8%) declined over this time frame.

ﺍﺭﺗﺒﺎﻁ ﺳﻄﺢ آﻤﻮﺯﺵ پﺎیﻪ ﺑﺎ ﺳﻄﺢ ﺍﻃﻼﻋﺎﺕ ﺩﺭ ﻣﻮﺭﺩ ﻓﺸﺎﺭﺧﻮﻥ Roca, Bernardino 2003 -Usefulness of a HTN Education Program -Objective: Assessment of knowledge about HTN in hospitalized patients with HTN & in their relatives, & usefulness of education. Results: Association was found between higher education level and knowledge about HTN; differences were significant(P< 0. 005) & was improved 4 months after the

ﺍﺭﺗﺒﺎﻁ ﺳﻄﺢ آﻤﻮﺯ ﺵ پﺎیﻪ ﺑﺎ ﻓﺸﺎ ﺭﺧﻮﻥ Ordunez, Pedro 2005 -Ethnicity, Education, and BP in Cuba -A population-based sample 1, 667 persons aged 15– 74 years was checked in Cuba. 2001– 2002. 29% Black or mulatto and 71% White. -Non-White women had higher BP(3. 0/1. 7, SBP/DBP) & higher prevalence of HTN (24%, 95% CI: 20, 28 vs. 15%, 95% CI: 12, 18). -Men with a lower level of education had a 14% lower risk of HTN. -Women with a lower level of education had a 24% increase in risk of HTN.

ﻧﺸﺎﻥ ﺩﺍﺩ کﻪ Petrella. R. J 2005 ﺩﺭ ﻓﺸﺎﺭﺧﻮﻥ ﺑﺎﻻ ﺩﺭ ﺑیﺶ ﺍﺯ ﻧیﻤی ﺍﺯ کﺎﻧﺎﺩﺍیی ﻫﺎی ﻣﺒﺘﻼ ﺗﺸﺨیﺺ ﺩﺍﺩﻩ ﻧﺸﺪﻩ ﻭ ﻣﻮﻓﻖ ﺑﻪ ﺩﺭﻣﺎﻥ ﻭ ، ﺍﺯ ﻣﺒﺘﻼیﺎﻥ %13 ﺗﻨﻬﺎ کﻨﺘﺮﻝ ﻓﺸﺎﺭﺧﻮﻥ ﺗﺎ ﻣﺤﺪﻭﺩﻩ ﻃﺒیﻌی ﻣی . ﺷﻮﻧﺪ Petrella, R. J. 2005 Awareness and misconception of HTN in Canada: -A surveys that conducted between 1988 and 1992 showed that HTN was undetected in almost one-half of all hypertensive, and only 13% of those with HTN were treated and controlled to recommended BP targets.

ﺍﺯ ﻓﺸﺎﺭﺧﻮﻥ ﻫﺎ ﺗﻮﺳﻂ %34 ،Petrella ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺗﻠﻔﻨی ﺳیﺴﺘﻢ ﺑﻬﺪﺍﺷﺘی ﺗﺸﺨیﺺ ﺩﺍﺩﻩ ﺷﺪﻩ ﺍﻣﺎ ﻓﻘﻂ ﺑﻪ ﻣﺒﺘﻼیﺎﻥ ﺗﻮﺳﻂ پﺰﺷک ﺗﻮﺿیﺢ ﺩﺍﺩﻩ ﺷﺪﻩ ﺍﺳﺖ %58 ﺍﺯ ﺍﻓﺮﺍﺩ ﺍﺯ ﻓﺸﺎﺭﺧﻮﻥ ﻭ ﻣیﺰﺍﻥ %44 ﻭ ﺍﺯ ﺍیﻦ گﺮﻭﻩ ﺗﻨﻬﺎ . ﻃﺒیﻌی ﻭ ﻏیﺮﻃﺒیﻌی آﻦ ﻣﻄﻠﻊ ﺑﻮﺩﻧﺪ A national telephone survey showed that -34% of respondents had been diagnosed with high BP or HTN by a health care professional, but only -58% of respondents had ever discussed their BP with a physician, and only -44% were able to identify their own BP or differentiate BP levels considered to be above or below recommended targets.

The Impact of the CHEP on Antihypertensive Prescribing Trends -Campbell reported that Between 1998 and 2003, 280 million prescriptions for antihypertensive agents were filled in Ontario. -Total antihypertensive prescriptions increased by 58% annually. -Time series analyses confirmed that the prescribing rates for total antihypertensives, thiazide diuretics, βblockers, and calcium channel blockers increased significantly after 1999.

Onysko, Jay 2006 Large Increases in HTN Diagnosis and Treatment in Canada After Education Program Between 1994 and 2003 -Diagnosis of HTN increased by 51% (from 12. 37% to 18. 74%; P<0. 001), -Prescribtion of antihypertensive drugs increased by 66% (from 9. 57% to 15. 86%; P<0. 001).

From 1994 to 2003 the proportion of untreated aware hypertensives was reduced by half (from 31. 47% untreated to 15. 34% untreated; P<0. 001). Greater increase in awareness of HTN & use of antihypertensive drugs among men compared with women after 1999.

ﻧﺸﺎﻥ ﺩﺍﺩ کﻪ ﺷیﻮﻉ Campbell 2008 ﺩﺭ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ کﺎﻧﺎﺩﺍ ﻧﻈیﺮ آﻤﺮیکﺎﺳﺖ ﻭ ﺍﻟﺒﺘﻪ ﺩﺭ ﺍیﻦ ﺩﻭ کﺸﻮﺭ کﻤﺘﺮ ﺍﺯ ﺍﺭﻭپﺎ ﺑﺎ ﺍیﻦ ﻭﺟﻮﺩ ﻣیﺰﺍﻥ کﻨﺘﺮﻝ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ کﺎﻧﺎﺩﺍ ﻧﻈیﺮ ﺍﺭﻭپﺎ ﻭ کﻤﺘﺮ ﺍﺯ ﺑﺮﻧﺎﻣﻪ کﺎﻧﺎﺩﺍ ﺑﺮﺍی ﻓﺸﺎﺭﺧﻮﻥ ﺷﺎﻣﻞ. آﻤﺮیکﺎﺳﺖ آگﺎﻫی ﻋﻤﻮﻣی ﻭ ، ﺳﺮﻭیﻼﻧﺲ ﻣﻠی ، آﻤﻮﺯﺵ . کﺎﻫﺶ ﻣﺼﺮﻑ ﻧﻤک ﺍﺳﺖ Campbell, CHEP, 2008, HTN prevention and control in Canada has a similar prevalence of HTN to the U. S. , which is lower than of Europe. In contrast, Canada had similar control rates of HTN to Europe, which are substantially lower than those of the U. S National strategic plan is: -Health professional education, -National surveillance, -Public awareness, and -Reduce dietary sodium.

گﺰﺍﺭﺷی ﺍﺯ ﺍﺛﺮ ﺗﻌییﻦ Chockalingam. A 2008 ﺩﺭ ﺭﻭﺯ ﺟﻬﺎﻧی ﻓﺸﺎﺭﺧﻮﻥ ﺑﺮ ﺍﺭﺗﻘﺎﺀ آگﺎﻫی ﺩﺭ ﻣﻮﺭﺩ ﺍیﻦ ﺑیﻤﺎﺭی ﺍﺭﺍیﻪ ﻭ ﻧﺴﺒﺖ ﺑﻪ ﻋﺪﻡ آگﺎﻫی ﺑیﺶ ﺍﺯ ﻣﺒﺘﻼیﺎﻥ ﺑﻪ ﻓﺸﺎﺭﺧﻮﻥ ﺩﺭ ﺩﻧیﺎ ﺍﺯ ﺑیﻤﺎﺭی ﺧﻮﺩ %50. ﻫﺸﺪﺍﺭ ﺩﺍﺩ Chockalingam, A. World HTN Day(May 17) and global awareness WHO attributes HTN, or high BP, as the leading cause of cardiovascular mortality. World HTN League (WHL), an umbrella organization of 85 national HTN societies and leagues, recognized that >50% of the hypertensive population worldwide are unaware of their condition.

. ﺑﺮ ﺍﺻﻼﺡ ﺳﺒک ﺯﻧﺪگی ﺗﺎکیﺪ کﺮﺩ Neutel. C. I 2008 ﺩﺭ CHEP ﻣﺠﺪﺩﺍ گﺰﺍﺭﺷی ﺍﺯ Campbell 2010 ﺩﺭ ﺷﺎﻣﻞ CHEP ﺍﺭﺍیﻪ ﺩﺍﺩ ﻭ ﺑﺮ ﺩﺳﺘﻮﺭﺍﻟﻌﻤﻞ ﺟﺪیﺪ ﻣیﺰﺍﻥ ﻣﺼﺮﻑ ﻧﻤک ﺣﺪﺍﻗﻠی ، ﻣﺎﻧیﺘﻮﺭ ﻓﺸﺎﺭﺧﻮﻥ ﺍﺳﺘﻔﺎﺩﻩ ﻣﺘﻨﺎﺳﺐ ﺍﺯ ، گﺮﻡ ﺳﺪیﻢ 2 ﺷﺎﻣﻞ . ﺗﺎکیﺪ کﺮﺩ ARB ﻭ ACEi ،CCBs Neutel, C. I. Lifestyle modification should be an important part of therapy when HTN is first diagnosed. Smoking cessation [18. 6% relative risk reduction (RRR)]. Decreasing physical inactivity (RRR 6. 2%). Allu, Selina Omar & Campbell, CHEP, 2010 emphasizes the need for health care professionals to stay informed about HTN & BP monitoring, salt restriction, CCBs, ACEis & ARB use.

Thanks for Your Attention

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