Title Liječenje arterijske hipertenzije u veterana oboljelih od posttraumatskog stresnog poremećaja u ordinacijama obiteljske medicine : povijesna prospektivna kohortna studija
Title (english) Treatment of arterial hypertension in veterans with post-traumatic stress disorder in family medicine practice : historical prospective cohort study
Author Stjepan Radić
Mentor Ivančica Pavličević (mentor)
Committee member Ivana Mudnić (predsjednik povjerenstva)
Committee member Joško Božić (član povjerenstva)
Committee member Renata Pecotić (član povjerenstva)
Granter University of Split School of Medicine (Family medicine) Split
Defense date and country 2018, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Public Health and Health Care Family Medicine
Abstract Cilj istraživanja: Cilj je ovoga istraživanja odrediti ishode liječenja arterijske hipertenzije u veterana oboljelih od posttraumatskog stresnog poremećaja nakon godine dana od postavljanja dijagnoze.
Ispitanici i metode: U istraživanje je uključeno sto pacijenata kojima je u razdoblju od 2008. do 2012. godine po prvi puta dijagnosticiran povišeni arterijski tlak. Polovica pacijenata imala je dijagnozu PTSP-a (n=50) i činili su ispitivanu skupinu, a druga polovica nije imala dijagnozu PTSP-a te su činili kontrolnu skupinu (n=50). Uključivanje pacijenata nije bilo istodobno a svakoga se pratilo jednako, tj. godinu dana.
Rezultati: Srednja dob u vrijeme dijagnoze u glavnoj skupini iznosila je 55,31 ± 9,42 g, a u kontrolnoj skupini 53,82 ± 8,84. U vrijeme postavljanja dijagnoze u kontrolnoj skupini najveći broj ispitanika je bio zaposlen (44%) dok su glavnu skupinu većinom činili umirovljenici (19%). U kontrolnoj skupini najveći broj ispitanika je bio u braku (80%), a u skupini ispitanika s PTSP-om najzastupljeniji su bili također pacijenti u braku, ali sa proporcijom od 54%. PTSP nije imao utjecaja na vrijednost sistoličkog i dijastoličkog tlaka pri postavljanju dijagnoze. Srednja vrijednost na temelju koje je dijagnosticirana arterijska hipertenzija bila je za sistolički tlak 160 (150-170) mm Hg za obje skupine, dok je srednja vrijednost dijastoličkog tlaka u skupini ispitanika s PTSP-om bila 95 (90-100) mm Hg, a u kontrolnoj 100 (90-100) mm Hg. U najvećeg broja ispitanika arterijsku hipertenziju je dijagnosticirao liječnik obiteljske medicine te je liječenje započeto higijensko dijetetskim mjerama, a prvi propisani lijek je bio ACE inhibitor. Pacijenti kontrolne skupine imali su veći broj posjeta ordinacijama obiteljske medicine zbog hipertenzije u godini dana nakon dijagnoze (7,49 ± 4,38) u odnosu na pacijente testne skupine (6,17 ± 3,24). Pacijenti iz skupine ispitanika s PTSP-om trošili su dnevno više lijekova koji nisu antihipertenzivi (4 (3+6)) u odnosu na kontrolnu skupinu (2 (1+1)). Kod obje skupine većini pacijenata nije mijenjana doza ni vrsta lijeka, te nije utvrđena ovisnost promjene doze i vrste lijeka s PTSP-om. Većina pacijenata nije koristila bolovanje i nije utvrđena ovisnost korištenja bolovanja s PTSP-om (p>0,050). Utvrđena je ovisnost između drugih bolesti i PTSP-a gdje su pacijenti sa PTSP-om imali veći broj kroničnih bolesti u odnosu na kontrolnu skupinu (p<0,001). Šećerna bolest je bila statistički značajno bio zastupljenija među pacijentima oboljelim od PTSP-a.
Zaključci: PTSP nije imao utjecaj na vrijednost tlaka pri postavljanju dijagnoze. Ispitanici s PTSP-om su u manjem broju bili u braku, te su češće u mirovini u donosu na kontrolnu skupinu. Dijagnozu arterijske hipertenzije u većini slučajeva postavio je liječnik obiteljske medicine. Ispitanici s PTSP-om imali su više komorbiditeta i uzimali su više lijekova dnevno nego ispitanici iz kontrolne skupine. Nakon jednogodišnjeg razdoblja, normotenzija je slabije postignuta u skupini ispitanika s PTSP-om kojima su vrijednosti sistoličkog tlaka bile statistički značajno veće nego u kontrolnoj skupini ispitanika.
Abstract (english) Objectives: The aim of this research was to determine the outcomes of treatment of arterial hypertension in veterans suffering from posttraumatic stress disorder after one year from the diagnosis.
Patients and methods: In the examined period from 2008 to 2014. the study included one hundred patients who were first diagnosed with arterial hypertension at the time. Half of the patients had PTSD diagnosis and they do the main group of the examinees, and the other half had no PTSD diagnosis, and they make the control group. Involvement of patients was not at the same time and everyone was followed equally, one year.
Results: The mean age at the time of diagnosis in the main group was 55.31 (9.42) years; and in the control group 53.82 (8.84) years. At the time of diagnosis, in the control group, the majority of respondents were employed (44%), while the main group was mostly retired (19%). In the control group, the highest number of subjects was married (n = 40, 80%), and in the test group the most common were also married, but only 54%. PTSD had no influence on the value of systolic and
diastolic pressure when setting the diagnosis. The median value based on which the diagnosed arterial hypertension was for systolic pressure of 160 (150-170) mm Hg for both groups, while mean diastolic blood pressure in the test group was 95 (90-100) mm Hg and in control group 100 (90-100) mm Hg. In the largest number of subjects, hypertension was diagnosed by a family medicine practitioner and treatment started with hygienic dietary measures, and the first prescribed drug was ace inhibitor. Patients of the control group came more often to family medicine clinics due to hypertension in the year after diagnosis (7,49 ± 4,38) compared to patients in the test group (6,17 ± 3,24). Patients in the test group spent more medicaments, that were not antihypertension medicaments daily (4 (3+6)), over the control group ((2 (1+1)) per day. In both groups, most of the patients did not change the dose or type of antihypertensive medicament, and no dose or type dependence with PTSD drug was established. Most patients were not on sick leave, and there was no dependence between the use of sick leave and PTSD (p> 0.05) Most of the patients achieved normotension and no dependence on
normotensis and PTSD disease (p> 0) was established. Dependence between other diseases and PTSD disease was established where patients with PTSD had a greater number of other diseases compared to the control group (p <0.001). Diabetes mellitus was statistically significantly more prevalent among patients with PTSD. In the second consecutive measurement, systolic pressure was statistically significantly lower in the control group relative to the test group. The conclusion was made on the basis of an empirical p value of 0.035.
Conclusion: PTSD had no influence on the pressure value when setting the diagnosis. Respondents from the test group were in a smaller number of marriages than those in the control group. Respondents from the control group were employed in larger number than test subjects. The diagnosis of arterial hypertension has in most cases been made by a family medicine physician. Respondents from the control group visited the family medicine physician more frequently due to the diagnosis of elevated arterial pressure. The first therapy for arterial hypertension was hygienic-dieting measures
and the first drug ace inhibitor. PTSD-treated subjects had more comorbidity and took more medications daily than those in the control group. After a one-year period, the systolic pressure in subjects with PTSD was statistically significantly higher in the second consecutive measurement than in the control group. The percentage of normotensive subjects was statistically significantly higher in the control group.
Keywords
Hipertenzija
Posttraumatski stresni poremećaj
Veterani
Keywords (english)
Hypertension
Stress Disorders Post-Traumatic
Veterans
Language croatian
URN:NBN urn:nbn:hr:171:731535
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
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Created on 2018-11-15 14:24:19