You are here

  • Home
  • Archive
  • Volume 6, Issue 4
  • Factors associated with visit-to-visit variability of blood pressure in hypertensive patients at a Primary Health Care Service, Tabanan, Bali, Indonesia

Article Text

Article menu

Download PDFPDF

Original Research
Factors associated with visit-to-visit variability of blood pressure in hypertensive patients at a Primary Health Care Service, Tabanan, Bali, Indonesia
  1. Gusti Ayu Riska Pertiwi1,
  2. Anak Agung Ngurah Aryawangsa1,
  3. I Putu Yuda Prabawa2,
  4. Ida Bagus Amertha Putra Manuaba3,4,
  5. Agha Bhargah1,
  6. Ni Wayan Sri Ratni5 and
  7. I Putu Gede Budiana6
  1. 1.Faculty of Medicine, Udayana University, P.B. Sudirman Street, Dangin Puri Klod, West Denpasar, Denpasar City, Bali 80232, Indonesia
  2. 2.Biomedicine Magister Program, Post Graduate Program, Faculty of Medicine, Udayana University, P.B. Sudirman Street, Dangin Puri Klod, West Denpasar, Denpasar City, Bali 80232, Indonesia
  3. 3.Medical and Health Education, Faculty of Medicine, Udayana University, P.B. Sudirman Street, Dangin Puri Klod, West Denpasar, Denpasar City, Bali 80232, Indonesia
  4. 4.International Program in Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City 110, Taiwan, China
  5. 5.Tabanan III Primary Health Care Service, Bali, Indonesia
  6. 6.Department of Cardiovascular Medicine, Mangusada General Hospital, Badung, Bali, Indonesia
  1. Corresponding author: Gusti Ayu Riska Pertiwi Faculty of Medicine, Udayana University, P.B. Sudirman Street, Dangin Puri Klod, West Denpasar, Denpasar City, Bali 80232, Indonesia E-mail: pertiwiayuriska{at}gmail.com

Abstract

Background An increasing number of valid and well-designed trials have demonstrated a positive correlation between visit-to-visit variability (VVV) in systolic blood pressure (SBP) and increased risk of stroke and coronary heart disease among hypertensive patients.

Methods A cross-sectional study was conducted that involved 74 patients who visited the outpatient clinic at the Tabanan III Primary Health Care Service during April to May 2017. Blood pressure was retrospectively obtained from medical records. VVV was classified as low or high on the basis of the standard deviation of SBP. Antihypertensive medication adherence was expressed as the percentage of days covered, and sodium intake was measured with 24-hour food recall. Bivariate analysis was performed, followed by multivariate analysis for significant variables.

Results Among the participants, 67.6% were female, with a mean (standard deviation [SD]) age of 62.70 (10.00) years. Blood pressure was measured 4.82±0.78 times during the period, and the mean (SD) SBP was 139.65 (10.57) mm Hg. Nonadherence and sodium intake were significantly higher in the high-VVV group than in the low-VVV group (nonadherence 13.5% vs. 37.8%, P=0.033; sodium intake 1278.44±43.02 mg vs. 1495.85±45.26 mg, P=0.038). After adjustment for other covariates, the differences remained significant only for nonadherence (model I exp β=3.89 [95.0% confidence interval 1.23–12.34, P<0.05], model II exp β=3.9 [95.0% confidence interval 1.12–14.15, P<0.05]). The area under the curve was 0.636 (P<0.05), with sensitivity of 67.6% and specificity of 51.4%.

Conclusion Nonadherence to antihypertensive medication was significantly associated with higher VVV of SBP. Further study is needed to assess whether improving adherence could reduce VVV and improve cardiovascular outcomes.

Significance statement This study provides an overview of visit-to-visit variability (VVV) in hypertension blood pressure management in a primary health care service setting. In this study there was a significant relationship between the use of antihypertensive drugs and VVV. This finding illustrates that VVV can be used as an additional factor in considering the target of controlling blood pressure in primary health services, given that hypertension has many complications that can arise if management is not done properly.

  • Blood pressure
  • visit-to-visit-variability
  • nonadherence
  • sodium intake
  • hypertension

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.15212/FMCH.2018.0124

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.