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Health Educ Health Promot 2021, 9(1): 49-54 |
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Rabiei N, Gholami Fesharaki M, Rowzati M. Antihypertensive Medications in Hypertension Control in Male Industrial Employees: a Retrospective Cohort Study. Health Educ Health Promot 2021; 9 (1) :49-54
URL: http://hehp.modares.ac.ir/article-5-48809-en.html
URL: http://hehp.modares.ac.ir/article-5-48809-en.html
1- Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
2- Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran , mohammad.gholami@modares.ac.ir
3- Occupational Health Center, Mobarakeh Steel Company, Isfahan, Iran
2- Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran , mohammad.gholami@modares.ac.ir
3- Occupational Health Center, Mobarakeh Steel Company, Isfahan, Iran
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Introduction
Hypertension is one of the most important public issues and treatable risk factors for cardiovascular disease (CVD) [1]. Hypertension is the leading cause of cardiovascular disease and premature death worldwide [2]. According to the world health organization report, hypertension (13%), tobacco consumption (9%), high blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%) are responsible for mortality throughout the world [3]. Hypertension prevalence is 52.0% and 44.3% in Iranian men and women, respectively [4]. Over the last few decades, hypertension treatment has improved, and the incidence of mortality due to stroke and coronary heart disease (CHD) decreased but remains uncontrolled in all societies [5, 6]. Monotherapy or some combinations of diuretics, angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers, and angiotensin receptor blockers are satisfactory for starting and preserving anti-hypertensive treatment [7].
Hypertension is one of the most important challenges to human health in both developed and developing countries. Hypertension is common, but it can be detected and treated [8]. The high prevalence of hypertension and the serious effects on the body's organs have made it a major health challenge in all communities, and control of that became so important for minimizing the outcomes of this illness [9]. Even though preventing and treating of this illness is attention and offered some detected approaches for treating of that [10], (such as availability more than 100 types of different medicines of hypertension that efficiency of all of them are proved) but the reported statistics in this field is frustrating [11]. The success rate for control of hypertension in the USA is reported only 27%, and in England, France and Germany is less than 27% [12]. Also, analyzing of clinical characteristics of patients by COVID-19 proved that 20-30% of all of these patients and 58.3% of patients in the intensive care unit (ICU) are patients with hypertension and the reason of 60.9% of mortality of COVID-19 patients is hypertension [13].
Approaches about selecting medicine and choosing the best decisions for different subgroups are changed over time, and it is variable in different countries, and experts cannot choose the best medicine [14]. Some primary medicine for control hypertension is Thiazide-diuretics, Calcium channel blockers (CCB), Angiotensin-Converting Enzyme Inhibitors (ACE), angiotensin receptor blockers (ARB) [15]. In addition to the direct effect of medicine in reducing hypertension, some other factors are effective on hypertension; Such as BMI increasing [16, 17], age increasing [17], shift work [18], and facing high noises in the workplace [19].
Due to the incapability of physicians to control hypertension in patient populations in their clinics (less than 30%), alternative medical care such as workplace interventions has been suggested [1]. Some intervention programs like "Stop Hypertension in Mobarakeh Steel Company" (SHIMSCO) study [2] reported hypertension reduction after the intervention.
Given the importance of controlling hypertension, this research was done to study the effect of anti-hypertensive drugs on changing blood pressure, Body Mass Index (BMI), and Framingham Risk Score (FRS).
Instrument and Methods
This retrospective cohort study (from January 2014 to January 2018) was done on workers who work in MSCO. They were chosen using the census method by referring to their medical records, initially, by referring to 7892 medical records registered in the occupational health center of MSCO, all those who were diagnosed with hypertension in 2014 and were taking medication to control their BP at the beginning of the study considered as a case group and the others person who were health during study period considered as a control group. The inclusion criteria were as follows (i) being male, (ii) being official or contract employment, (iii) at least two years of services, (iv) age between 20 and 60. Workers unwilling to participate in the study or high missing information in medical records were excluded. The full details of sample selection were presented in Diagram 1.
The FRS is a gender-specific algorithm used to estimate the 10-year risk of cardiovascular in individuals. This Score estimates the probability that a person will develop cardiovascular disease within a specified amount of time, usually 10 to 30 years. They also indicate who is the most likely to benefit from prevention [22]. The formulation of this index is presented in Bazyar et al.'s study [20].
This research was approved by the Medical Ethics Committee of Tarbiat Modares University. Demographic data, including age, work experience, educational level, besides variables such as SBP, DPB, BMI, and FRS, were measured in each participant. The blood pressure of both arms was measured by three general practitioners using a calibrated portable or wall-mounted Baumometer sphygmomanometer Kompak Model-260 mm Hg (WA Baum, Copiague, NY).
Continuous variables are described with mean±SE, and discrete variables are presented with numbers and percentages. An independent t-test was used to compare SBP, DBP, BMI, FRS between two groups in 2014. For evaluating the effect of time on changing SBP, DBP, BMI, FRS within and between two groups the multilevel modeling [23] was used. Data were analyzed by R 3.2.1 software and package "NLME". p-values less than 0.05 were considered significant.
Diagram 1) Follow up study
Findings
The demographic data showed in table 1.
Table 1) The mean±SE variables in two group in 2014 (n= 2197)
For evaluating the effect of time on changing SBP, DBP, BMI, FRS within and between two groups, variables like age, work experience, besides baseline variables like SBP, DBP, BMI, and FRS, were controlled using multilevel modeling.
In Table 2, the frequency of anti-hypertensive medication during five years study was presented. The adherence to the use of anti-hypertensive drugs in the first year of study was a maximum of 49%, but this rate decreased to less than 10% in the second to fifth years of study.
Table 2) Frequency of anti-hypertensive medication during the study (the numbers in parentheses are in percent)
The trend of change of variable during 5 years follows up compared with anti-hypertension drug presented in Diagram 2 besides the change of SBP, DBP, BMI, and FRS during time and comparison between two groups with controlling unequal baseline variables using multilevel analysis presented in Table 3.
The results of this study showed that changes in SBP, DBP, and FRS during 2014 to 2018 in the case group compared to the control group had a significant decrease (p<0.001), but this decrease was not significant for the BMI (p=0.588).
Diagram 2) The trend of DP, SBP, DBP, FRS, and BMI during 5 years (2014-2018) follow up. DP: Drug Prevalence, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, FRS: Framingham Risk Score, BMI: Body Mass Index, ACE: Angiotensin-converting-enzyme, ARB: Angiotensin II receptor
Table 3) βchange±SE of SBP, DBP, BMI, and FRS during time and comparison between two groups with controlling unequal baseline variables using multilevel analysis
Hypertension is one of the most important public issues and treatable risk factors for cardiovascular disease (CVD) [1]. Hypertension is the leading cause of cardiovascular disease and premature death worldwide [2]. According to the world health organization report, hypertension (13%), tobacco consumption (9%), high blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%) are responsible for mortality throughout the world [3]. Hypertension prevalence is 52.0% and 44.3% in Iranian men and women, respectively [4]. Over the last few decades, hypertension treatment has improved, and the incidence of mortality due to stroke and coronary heart disease (CHD) decreased but remains uncontrolled in all societies [5, 6]. Monotherapy or some combinations of diuretics, angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers, and angiotensin receptor blockers are satisfactory for starting and preserving anti-hypertensive treatment [7].
Hypertension is one of the most important challenges to human health in both developed and developing countries. Hypertension is common, but it can be detected and treated [8]. The high prevalence of hypertension and the serious effects on the body's organs have made it a major health challenge in all communities, and control of that became so important for minimizing the outcomes of this illness [9]. Even though preventing and treating of this illness is attention and offered some detected approaches for treating of that [10], (such as availability more than 100 types of different medicines of hypertension that efficiency of all of them are proved) but the reported statistics in this field is frustrating [11]. The success rate for control of hypertension in the USA is reported only 27%, and in England, France and Germany is less than 27% [12]. Also, analyzing of clinical characteristics of patients by COVID-19 proved that 20-30% of all of these patients and 58.3% of patients in the intensive care unit (ICU) are patients with hypertension and the reason of 60.9% of mortality of COVID-19 patients is hypertension [13].
Approaches about selecting medicine and choosing the best decisions for different subgroups are changed over time, and it is variable in different countries, and experts cannot choose the best medicine [14]. Some primary medicine for control hypertension is Thiazide-diuretics, Calcium channel blockers (CCB), Angiotensin-Converting Enzyme Inhibitors (ACE), angiotensin receptor blockers (ARB) [15]. In addition to the direct effect of medicine in reducing hypertension, some other factors are effective on hypertension; Such as BMI increasing [16, 17], age increasing [17], shift work [18], and facing high noises in the workplace [19].
Due to the incapability of physicians to control hypertension in patient populations in their clinics (less than 30%), alternative medical care such as workplace interventions has been suggested [1]. Some intervention programs like "Stop Hypertension in Mobarakeh Steel Company" (SHIMSCO) study [2] reported hypertension reduction after the intervention.
Given the importance of controlling hypertension, this research was done to study the effect of anti-hypertensive drugs on changing blood pressure, Body Mass Index (BMI), and Framingham Risk Score (FRS).
Instrument and Methods
This retrospective cohort study (from January 2014 to January 2018) was done on workers who work in MSCO. They were chosen using the census method by referring to their medical records, initially, by referring to 7892 medical records registered in the occupational health center of MSCO, all those who were diagnosed with hypertension in 2014 and were taking medication to control their BP at the beginning of the study considered as a case group and the others person who were health during study period considered as a control group. The inclusion criteria were as follows (i) being male, (ii) being official or contract employment, (iii) at least two years of services, (iv) age between 20 and 60. Workers unwilling to participate in the study or high missing information in medical records were excluded. The full details of sample selection were presented in Diagram 1.
The FRS is a gender-specific algorithm used to estimate the 10-year risk of cardiovascular in individuals. This Score estimates the probability that a person will develop cardiovascular disease within a specified amount of time, usually 10 to 30 years. They also indicate who is the most likely to benefit from prevention [22]. The formulation of this index is presented in Bazyar et al.'s study [20].
This research was approved by the Medical Ethics Committee of Tarbiat Modares University. Demographic data, including age, work experience, educational level, besides variables such as SBP, DPB, BMI, and FRS, were measured in each participant. The blood pressure of both arms was measured by three general practitioners using a calibrated portable or wall-mounted Baumometer sphygmomanometer Kompak Model-260 mm Hg (WA Baum, Copiague, NY).
Continuous variables are described with mean±SE, and discrete variables are presented with numbers and percentages. An independent t-test was used to compare SBP, DBP, BMI, FRS between two groups in 2014. For evaluating the effect of time on changing SBP, DBP, BMI, FRS within and between two groups the multilevel modeling [23] was used. Data were analyzed by R 3.2.1 software and package "NLME". p-values less than 0.05 were considered significant.
Diagram 1) Follow up study
Findings
The demographic data showed in table 1.
Table 1) The mean±SE variables in two group in 2014 (n= 2197)
For evaluating the effect of time on changing SBP, DBP, BMI, FRS within and between two groups, variables like age, work experience, besides baseline variables like SBP, DBP, BMI, and FRS, were controlled using multilevel modeling.
In Table 2, the frequency of anti-hypertensive medication during five years study was presented. The adherence to the use of anti-hypertensive drugs in the first year of study was a maximum of 49%, but this rate decreased to less than 10% in the second to fifth years of study.
Table 2) Frequency of anti-hypertensive medication during the study (the numbers in parentheses are in percent)
The trend of change of variable during 5 years follows up compared with anti-hypertension drug presented in Diagram 2 besides the change of SBP, DBP, BMI, and FRS during time and comparison between two groups with controlling unequal baseline variables using multilevel analysis presented in Table 3.
The results of this study showed that changes in SBP, DBP, and FRS during 2014 to 2018 in the case group compared to the control group had a significant decrease (p<0.001), but this decrease was not significant for the BMI (p=0.588).
Diagram 2) The trend of DP, SBP, DBP, FRS, and BMI during 5 years (2014-2018) follow up. DP: Drug Prevalence, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, FRS: Framingham Risk Score, BMI: Body Mass Index, ACE: Angiotensin-converting-enzyme, ARB: Angiotensin II receptor
Table 3) βchange±SE of SBP, DBP, BMI, and FRS during time and comparison between two groups with controlling unequal baseline variables using multilevel analysis
Discussion
Hypertension is one of the most important challenges to human health in both developed and developing countries. Hypertension is common, but it can be detected and treated [12]. The high prevalence of hypertension and the serious effects on the body's organs has made it a major health challenge in all communities, and control of that became so important for minimizing the outcomes of this illness [13]. Even though preventing and treating of this illness is attention and offered some detected approaches for treating of that [14], (such as availability more than 100 types of different medicines of hypertension that efficiency of all of them are proved) but the reported statistics in this field is frustrating [15]. The success rate for control of hypertension in the USA is reported only 27%, and in England, France and Germany is less than 27% [16]. Also, analyzing of clinical characteristics of patients by COVID-19 proved that 20-30 % of all of these patients and 58.3 % of patients in the intensive care unit (ICU) are patients with hypertension, and 60.9 % of mortality of COVID-19 patients is hypertension [17].
Approaches about selecting medicine and choosing the best decision for different subgroups are changed over time, and it is variable in different countries, and experts cannot choose the best medicine [18]. Some primary medicine for control hypertension is Thiazide-diuretics, Calcium channel blockers (CCB), Angiotensin-Converting Enzyme Inhibitors (ACE), angiotensin receptor blockers (ARB) [19]. In addition to the direct effect of medicine in reducing hypertension, some other factors are effective on hypertension; Such as BMI increasing [20, 21], age increasing [21], shift work [22], and facing high noises in the workplace [23].
This study showed that consumption of anti-hypertensive drugs and the execution of self-care programs lead to control hypertension. In this situation, after reducing monitoring authorities on this project, reducing self-care leads to increasing hypertension. It has a similar trend to the control group. It should be notice that the effect of reducing self-care in the graph of BMI is shown clearly. More results have shown that consumption of medicine to control hypertension is reduced in second to fifth years. It should be noticed that insufficient self-care is an important challenge for the patient with chronic illnesses especially patients with hypertension and by not obeying these treating programs, these patients will have serious outcomes such as extending these illnesses and need to immediate cares and hospitalize. Some outcomes such as brain stroke, Atherosclerosis, a heart attack will threaten them. Medical reports show that failure in hypertension control is not obeying the treatment team's comments [24]. In many surveys, consumption of medicines is so important and results showed that self-care in hypertension by the patient is inappreciable [16, 25-28]. So the execution of self-care programs and persistence in consumption of hypertension medicine are two of the most important basic cases of control hypertension that patients should notice.
One of the most important strengths of this is the high volume of the studied society which led to better matching of the control and case groups—strengths of this study that it was longitudinal. Participants were under long-term care, and during the follow-up period, the individuals having hypertension were identified, and medication interventions were made, which assist the physician in finding the effective medication for the patient. According to the factors affecting hypertension, there are other confounding factors that we did not pay attention to or lack of information in the model. For example, the variables such as quality of life, family history of high blood pressure, history of illness except for hypertension like diabetes.
Conclusion
The workplace Intervention Project is effective in controlling hypertension, and there must be continuity in its implementation. Furthermore, amending lifestyle and diet are recommended along with consumption of anti-hypertensive medications.
Acknowledgments: We gratefully acknowledge the Tarbiat Modares University for Financial support, and the authors wish to thank all the personnel of Mobarakeh steel company for their cooperation throughout the study.
Ethical Permissions: This research was approved by the Medical Ethics Committee of Tarbiat Modares University (IR.TMU.REC.1396.589).
Conflicts of Interests: Authors have no conflict of interests.
Authors' Contribution: Rabiei N. (First author), Introduction author/Assistant researcher/Statistical analyst (40%); Gholami Fesharaki M. (Second author), Original researcher/Discussion author (40%); Rowzati M. (Third author), Methodologist/Discussion author (20%).
Funding/Sources: Tarbiat Modares University.
Hypertension is one of the most important challenges to human health in both developed and developing countries. Hypertension is common, but it can be detected and treated [12]. The high prevalence of hypertension and the serious effects on the body's organs has made it a major health challenge in all communities, and control of that became so important for minimizing the outcomes of this illness [13]. Even though preventing and treating of this illness is attention and offered some detected approaches for treating of that [14], (such as availability more than 100 types of different medicines of hypertension that efficiency of all of them are proved) but the reported statistics in this field is frustrating [15]. The success rate for control of hypertension in the USA is reported only 27%, and in England, France and Germany is less than 27% [16]. Also, analyzing of clinical characteristics of patients by COVID-19 proved that 20-30 % of all of these patients and 58.3 % of patients in the intensive care unit (ICU) are patients with hypertension, and 60.9 % of mortality of COVID-19 patients is hypertension [17].
Approaches about selecting medicine and choosing the best decision for different subgroups are changed over time, and it is variable in different countries, and experts cannot choose the best medicine [18]. Some primary medicine for control hypertension is Thiazide-diuretics, Calcium channel blockers (CCB), Angiotensin-Converting Enzyme Inhibitors (ACE), angiotensin receptor blockers (ARB) [19]. In addition to the direct effect of medicine in reducing hypertension, some other factors are effective on hypertension; Such as BMI increasing [20, 21], age increasing [21], shift work [22], and facing high noises in the workplace [23].
This study showed that consumption of anti-hypertensive drugs and the execution of self-care programs lead to control hypertension. In this situation, after reducing monitoring authorities on this project, reducing self-care leads to increasing hypertension. It has a similar trend to the control group. It should be notice that the effect of reducing self-care in the graph of BMI is shown clearly. More results have shown that consumption of medicine to control hypertension is reduced in second to fifth years. It should be noticed that insufficient self-care is an important challenge for the patient with chronic illnesses especially patients with hypertension and by not obeying these treating programs, these patients will have serious outcomes such as extending these illnesses and need to immediate cares and hospitalize. Some outcomes such as brain stroke, Atherosclerosis, a heart attack will threaten them. Medical reports show that failure in hypertension control is not obeying the treatment team's comments [24]. In many surveys, consumption of medicines is so important and results showed that self-care in hypertension by the patient is inappreciable [16, 25-28]. So the execution of self-care programs and persistence in consumption of hypertension medicine are two of the most important basic cases of control hypertension that patients should notice.
One of the most important strengths of this is the high volume of the studied society which led to better matching of the control and case groups—strengths of this study that it was longitudinal. Participants were under long-term care, and during the follow-up period, the individuals having hypertension were identified, and medication interventions were made, which assist the physician in finding the effective medication for the patient. According to the factors affecting hypertension, there are other confounding factors that we did not pay attention to or lack of information in the model. For example, the variables such as quality of life, family history of high blood pressure, history of illness except for hypertension like diabetes.
Conclusion
The workplace Intervention Project is effective in controlling hypertension, and there must be continuity in its implementation. Furthermore, amending lifestyle and diet are recommended along with consumption of anti-hypertensive medications.
Acknowledgments: We gratefully acknowledge the Tarbiat Modares University for Financial support, and the authors wish to thank all the personnel of Mobarakeh steel company for their cooperation throughout the study.
Ethical Permissions: This research was approved by the Medical Ethics Committee of Tarbiat Modares University (IR.TMU.REC.1396.589).
Conflicts of Interests: Authors have no conflict of interests.
Authors' Contribution: Rabiei N. (First author), Introduction author/Assistant researcher/Statistical analyst (40%); Gholami Fesharaki M. (Second author), Original researcher/Discussion author (40%); Rowzati M. (Third author), Methodologist/Discussion author (20%).
Funding/Sources: Tarbiat Modares University.
Article Type: Original Research |
Subject:
Healthy Life Style
Received: 2020/12/1 | Accepted: 2021/02/2 | Published: 2021/05/10
Received: 2020/12/1 | Accepted: 2021/02/2 | Published: 2021/05/10
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