Uso da monitoração residencial da pressão arterial (MRPA) na avaliação do controle de hipertensos, após implementação de programa educativo, em unidades básicas de saúde

Colósimo, Flávia Cortez

Introdução:

A hipertensão arterial apresenta controle insatisfatório em todo o mundo, fazendo-se necessária a busca de estratégias que incrementem seu controle. Neste contexto inserem-se a educação em saúde e a medida residencial da pressão arterial.

Objetivos:

Identificar o controle da hipertensão arterial em Unidades Básicas de Saúde antes e após implementação de programa educativo aos hipertensos; comparar o controle obtido pela medida casual com o controle pela medida residencial; e associar o controle com as demais variáveis do estudo.

Casuística e Método:

O estudo foi realizado com hipertensos de duas Unidades Básicas de Saúde da região oeste da cidade de São Paulo divididos em dois grupos, um que participou de programa educativo em hipertensão (grupo I) e outro que não participou (grupo II). A pressão arterial foi verificada antes e depois do programa educativo na unidade de saúde por enfermeiro e na residência pelo próprio paciente. Utilizou-se para medida da pressão arterial aparelho automático validado (OMROM-HEM 705 CP). O nível de significância adotado foi de 0,05.

Resultados:

Foram estudados 82 hipertensos com as seguintes características: sexo feminino (56,1%), cor branca (63,0%), com companheiro (68,0%), com ensino fundamental (70,7%), com renda familiar até 3 salários mínimos (56,1%) idade de 60,0±10,8 anos, índice de massa corporal (IMC) 29,4±5,4 Kg/m2 e circunferência da cintura 99,9±13,9 cm. Eram tabagistas 8,5% dos hipertensos, 24,4%consumiam bebida alcoólica, 40,7% foram considerados \"com presença\" de transtornos mentais comuns e 30,4% praticavam exercícios físicos. Quanto a atitudes frente ao tratamento 76,9 % relataram ter o hábito de medir a pressão, 74,4% afirmaram não interromper o tratamento e 75,6% referiram não faltar às consultas médicas. Foram classificados como não aderentes, pelo Teste de Morisky e Green 69,3% da amostra e 29,9% ) apresentaram moderada ou muita dificuldade de aderir ao tratamento. A MRPA dos pacientes que participaram do programa educativo (grupo I) apresentou significativo decréscimo ao término das intervenções (131,4±15,6 vs 127,3±17,4 para pressão sistólica; 79,2±12,2 vs 74,7±9,7 para pressão diastólica, p.

Introduction:

The hypertension presents unsatisfactory control in the whole world, becoming necessary the search of strategies that develop its control. In this context it insert health education and home blood pressure measurement.

Objectives:

To identify the control of hypertension in Health Basic Units before and after implementation of educative program to hypertensive patients; to compare the control gotten for the casual measurement with the control for the home measurement; to associate the control with the variables studied.

Material and Method:

The study was carried out with patients of two Health Basic Units of the city of São Paulo divided in two groups, one that participated of educative program in hypertension (group I) and another who did not participate (group II). The blood pressure was measured before and after the educative program in the health unit for nurse and at home for the own patient. Validated automatic device was used for measuring blood pressure (OMROM-HEM 705 CP). The significant level adopted 0,05.

Results:

82 patients with the following characteristics had been studied: feminine sex (56.1%), white (63.0%), married (68.0%), with primary school level (70.7%), with familiar income until 3 minimum wages (56.1%) age of 60,0±10,8 years, index body mass of 29,4±5,4 Kg/m2 and waist circumference of 99,9±13,9 cm. 8.5% were smokers, 24.4% alcohol consumers , 40.7% had been considered \"with presence\" of common mental disturbs and 30.4%practiced physical exercises. About the attitudes face to treatment 76.9% had told to have the habit to measure the pressure, 74.4% had affirmed not to interrupt the treatment and 75.6% had related not to absent to the medical visits. They had been classified as not adherent, by the Test of Morisky and Green, 69.3% of sample and 29.9% had presented moderate or much difficulty to adhere to the treatment. The HBPM of the patients who had participated of the educative program (group I) presented significant decrease to the ending of the interventions (131,4±15,6 versus 127,3±17,4 for systolic pressure; 79,2±12,2 vs 74,7±9,7 for diastolic pressure, p< 0,05). The control of blood pressure increased in the two groups of the study by measurement carried through in the health unit (62.0% vs 71.0%, for group I and 40.0% vs 50.0% for group II). The control by pressure measurement in the health unit was similar to the home control for patients of group I (71.0% versus 68.3%) and minor of home one for patients of group II (50.0% versus 62.5%). The control of the blood pressure evaluated in the health unit was associated (p< 0,05) with feminine sex, wage income above of three salaries and pratice of physical exercise. Higher values of HBPM was associated with minor wage income, presence of common mental disturbs, interruption of the treatment, and moderate or much difficulty to adhering to the treatment. The effect of the white coat was bigger in the patients who had notparticipated of the educative interventions.

Conclusion:

Hypertensive control increased after educative program for hypertensive patients and HBPM can be used for this evaluation. The influence of the observer was more intense for patients of group II, which did not have interaction professional-patient.