RESUMO
BACKGROUND: In Mexico, hypertension is a major cause of disability and death in the elderly, but the most effective way to promote behaviour change in old people is unknown. Low resource interventions that are effective in normal healthcare settings are urgently needed. We report the results of a randomized trial of nurse-provided health and lifestyle advice during home visits to elderly people with hypertension in Mexico City. METHODS: Subjects were 718 people with hypertension aged > or =60 years, who were residents of Mexico City and were registered with the Family Medicine Clinics of the Mexican Institute of Social Security (IMSS). A randomized controlled trial was carried out in which the intervention group was offered nurse visits over 6 months with blood pressure checks and negotiated lifestyle changes. The control group continued to receive usual care. RESULTS: After 6 months, 36.5% of the intervention versus 6.8% of the control group had a blood pressure of <160/90 mmHg. The difference in the mean change in systolic blood pressure was 3.31 mmHg (P = 0.03, 95% CI : 6.32, 0.29) and the same difference in diastolic blood pressure was 3.67 mmHg (P = 0.00, 95% CI : 5.22, 2.12). Weight and sodium excretion fell more in the intervention group, but the difference was not significant. CONCLUSIONS: Nurse home visits are effective in reducing blood pressure in hypertensive patients aged > or =60 years.
Assuntos
Hipertensão/enfermagem , Idoso , Aconselhamento , Feminino , Visita Domiciliar , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
OBJECTIVE: To assess the prevalence and treatment of high blood pressure among elderly people in Mexico. MATERIAL AND METHODS: A cross-sectional study was conducted from February to July 1998 among the elderly people covered by the Instituto Mexicano del Seguro Social (IMSS) healthcare services in Mexico City. The study population consisted of 4,777 subjects aged 60 years and over, selected from a cohort of 5,433 people, representative of the population of Mexico City. Trained nurses carried out three blood pressure measurements at home. Diagnosis of high blood pressure was established if systolic pressure was equal to or higher than 160 mmHg, and/or diastolic pressure was equal or higher than 90 mmHg, or by self-report of a medical diagnosis of hypertension. Demographic and risk factor information was also collected. RESULTS: A total of 4,777 subjects were screened; 2,036 (43%) of them reported that they had been previously diagnosed as hypertensive. Of these, 1,954 (96%) were already on pharmacological treatment. A further 273 (5.7%) subjects were found to be hypertensive at screening. Among those receiving treatment, 1,399 (68.5%) had a blood pressure reading of less than 160/90 mmHg, and this was also the case for 59 (72%) of the known hypertensives not on treatment. A single drug was used by 1,556 (79.6%) of those on treatment. Risk factors for hypertension were more frequent in the hypertensive group (p 0.05 Pound). CONCLUSIONS: Almost half of the elderly population is hypertensive, most of them are already on treatment, but about one third of those on treatment do not have an adequate control of high blood pressure.