Korean J Fam Pract. 2018; 8(2): 175-181  https://doi.org/10.21215/kjfp.2018.8.2.175
Factors Related to Blood Pressure Control and the Effect of an Education Program Performed by Family Physicians on Patients with Hypertension
Jang Wook Choi, Jeong Ho Shin*, Min Jun Kim, Kye Seon Park, Kyo Il Song, In Chul Hur
Department of Family Medicine, Osan Hankook Hospital, Osan, Korea
Jeong Ho Shin
Tel: +82-31-379-8399, Fax: +82-31-379-8534
E-mail: immortalsoul@hanmail.net
ORCID: http://orcid.org/0000-0002-3354-8107
Received: March 9, 2017; Revised: September 30, 2017; Accepted: October 7, 2017; Published online: April 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Hypertension is a known risk factor of cerebrovascular and cardiovascular disease. For the treatment of hypertension, lifestyle modification is as essential as pharmacological therapy. This study was performed to investigate the factors related to blood pressure control and confirm the effect of an education program in enabling lifestyle modification on patients with hypertension.
Methods: We enrolled 65 subjects who had been diagnosed with hypertension for the first time and had initiated medication at the family medicine department of Osan Hankook Hospital from March 2016 to November 2016. 35 subjects completed an education program performed by their family physicians. The systolic blood pressure (SBP) was compared between the medication only group and the added education program group. Data were analyzed using univariate analysis and multiple logistic regression.
Results: The comparison of SBP between the medication only group (mean±standard deviation [SD] SBP 143.17±11.78 mmHg) and the added education program group (mean±SD SBP 133.57±10.54 mmHg) revealed a statistically significant difference (P=0.005). In multiple logistic regression analysis, occupation (odds ratio [OR], 7.257; 95% confidence interval [95% CI], 1.682 to 31.310), nonsmoking status (OR, 6.011; 95% CI, 1.143 to 31.600), and education program completion (OR, 3.703; 95% CI, 1.015 to 13.513) were found to be related to lower SBP.
Conclusion: This study reveals several factors that are associated with blood pressure control. Among these factors, education on life-style modification was seen to be the factor that had the most effect. Therefore, we can conclude that an education program combined with antihypertensive medication is a more effective and beneficial way to improve blood pressure control.
Keywords: Hypertension; Life Style; Health Education; Antihypertensive Agents
References
  1. Lim S, Lee EJ, Koo BK, Cho SI, Park KS, Jang HC, et al. Increasing trends of metabolic syndrome in Korea -based on Korean national health and nutrition examination surveys-. J Korean Diabetes Assoc 2005; 29: 432-9.
  2. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000; 356: 1955-64.
    CrossRef
  3. Burnier M. Blood pressure control and the implementation of guidelines in clinical practice: can we fill the gap? J Hypertens 2002; 20: 1251-3.
    Pubmed CrossRef
  4. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144: 485-95.
    Pubmed CrossRef
  5. Wilber JA, Barrow JG. Hypertension--a community problem. Am J Med 1972; 52: 653-63.
    CrossRef
  6. Cross BW, Kirby MG, Miller S, Shah S, Sheldon DM, Sweeney MT. A multicentre study of the safety and efficacy of amlodipine in mild to moderate hypertension. Br J Clin Pract 1993; 47: 237-40.
    Pubmed
  7. Kario K, Robbins J, Jeffers BW. Titration of amlodipine to higher doses: a comparison of Asian and Western experience. Vasc Health Risk Manag 2013; 9: 695-701.
    Pubmed KoreaMed CrossRef
  8. Jeffers BW, Bhambri R, Robbins J. Incremental blood pressure-lowering effect of titrating amlodipine for the treatment of hypertension in patients including those aged ≥55 years. Am J Ther 2015; 22: 278-87.
    Pubmed KoreaMed CrossRef
  9. Kim HC, Oh SM. Noncommunicable diseases: current status of major modifiable risk factors in Korea. J Prev Med Public Health 2013; 46: 165-72.
    Pubmed KoreaMed CrossRef
  10. Park JK, Kim CB, Kim KS, Kang MG, Jee SH. Meta-analysis of hypertension as a risk factor of cerebrovascular disorders in Koreans. J Korean Med Sci 2001; 16: 2-8.
    Pubmed KoreaMed CrossRef
  11. Jee SH, Appel LJ, Suh I, Whelton PK, Kim IS. Prevalence of cardiovascular risk factors in South Korean adults: results from the Korea Medical Insurance Corporation (KMIC) Study. Ann Epidemiol 1998; 8: 14-21.
    CrossRef
  12. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean national health and nutrition examination survey for 1998-2007. Diabetes Care 2011; 34: 13238.
    Pubmed KoreaMed CrossRef
  13. Cha MJ, Lee HY, Ahn SV, Han KR, Park JB, Lim SJ, et al. Prevalence and clinical characteristics of metabolic syndrome in Korean hypertensive patients. J Korean Soc Hypertens 2009; 15: 37-44.
  14. Park SE, Rhee EJ, Park CY, Oh KW, Park SW, Kim SW, et al. Impact of hyperinsulinemia on the development of hypertension in normotensive, nondiabetic adults: a 4-year follow-up study. Metabolism 2013; 62: 532-8.
    Pubmed CrossRef
  15. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560-72.
    Pubmed CrossRef
  16. Sacks FM, Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, et al. A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clin Cardiol 1999; 22(7 Suppl): III6-10.
    Pubmed CrossRef
  17. Svetkey LP, Harsha DW, Vollmer WM, Stevens VJ, Obarzanek E, Elmer PJ, et al. Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics. Ann Epidemiol 2003; 13: 462-71.
    CrossRef
  18. Cakir H, Pinar R. Randomized controlled trial on lifestyle modification in hypertensive patients. West J Nurs Res 2006; 28: 190-209.
    Pubmed CrossRef
  19. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000; 321: 694-6.
    Pubmed KoreaMed CrossRef
  20. Simons-Morton DG, Mullen PD, Mains DA, Tabak ER, Green LW. Characteristics of controlled studies of patient education and counseling for preventive health behaviors. Patient Educ Couns 1992; 19: 175-204.
    CrossRef
  21. Rogers A, Kennedy A, Nelson E, Robinson A. Uncovering the limits of patientcenteredness: implementing a self-management trial for chronic illness. Qual Health Res 2005; 15: 224-39.
    Pubmed CrossRef
  22. Lee BK, Song YM, Kim DJ, Ko SH. Compliance with lifestyle modification in patients with hypertension. Korean J Fam Med 1999; 20: 1709-20.
  23. Cho JJ, Kwon YJ, Jung SH. Community based health care service design on chronic disease for enhancing primary care and the status of community based primary care project. Korean J Fam Pract 2015; 5: 173-8.

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives