HYPERTENSION AMONG PEOPLE AGED 18 – 69 YEARS OLD AT THU DUC DISTRICT, HO CHI MINH CITY AND INTERVENTION EFFECTIVENESS, 2018 - 2020

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF HYGIENE & EPIDEMIOLOGY TRAN QUOC CUONG HYPERTENSION AMONG PEOPLE AGED 18 – 69 YEARS OLD AT THU DUC DISTRICT, HO CHI MINH CITY AND INTERVENTION EFFECTIVENESS, 2018 - 2020 Major: Public Health Code: 62 72 03 01 SUMMARY OF PhD THESIS ON PUBLIC HEALTH Ha Noi - 2022 THIS THESIS WAS PERFORMED AND COMPLETED AT THE NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY Scientific supervisors: Assoc Prof Le Van Bao, MD Nguyen Anh Tuan, PhD, MD Counter arguer 1: Assoc Prof Hoang Duc Hanh, MD Counter arguer 2: Assoc Prof Tran Thi Thanh Huong, MD Counter arguer 3: Assoc Prof Vu Phong Tuc, MD The doctoral thesis will be defended at the Dissertation Committee of Institutional level at: National Institute of Hygiene & Epidemiology on 9:00 a.m, 22/12/2022 The doctoral thesis can be found at: The National Library The Library of National Institute of Hygiene and Epidemiology LIST OF PUBLISHED SCIENTIFIC ARTICLES RELATED TO THE THESIS Tran Quoc Cuong, Le Van Bao, Nguyen Anh Tuan, Nguyen Van Chuc (2020) Current status of hypertension and its risk factors among people aged 18 69 years old at Thu Duc district, Ho Chi Minh City in 2018 – 2019 Journal of Vietnam Preventive Medicine, Vol 30(6): 17 - 26 Tran Quoc Cuong, Le Van Bao, Nguyen Anh Tuan (2021) The effectiveness of intervention to improve treatment adherence, achieving target blood pressure among hypertension patients at commune health station, Thu Duc district, Ho Chi Minh city Journal of Vietnam Preventive Medicine, Vol 507(2): 50 - 55 INTRODUCTION Hypertension is one of the most common noncommunicable diseases today and its frequency is constantly increasing In 2000, the world had 972 million people with hypertension and it is estimated that by 2025 this number will increase to about 1.56 billion people In Vietnam, in 2000, about 16.3% of adults had hypertension, it increased to 25.4% in 2009 and to 48% in 2016 In 2010, out of the total number of deaths, the deaths due to cardiovascular diseases, including hypertension, were accounted for about 30% There are many risk factors that lead to hypertension that can be controlled when people have the right knowledge and practice about measures to prevent hypertension The project on prevention of hypertension has been implemented since 2011 with the aim of improving people's knowledge about hypertension prevention; training and developing human resources for the prevention and treatment of hypertension at grassroots health levels However, from 2018 to now, due to limited resources of the project, hypertension patients are still mainly examined and treated at the district level; the management and treatment of hypertension at the commune/ward level as well as lifestyle changes in the community have not yet achieved the project's objectives Study objectives: Describe the current situation of hypertension, some related factors among people aged 18 - 69 years old in Thu Duc district, Ho Chi Minh city in 2018 Evaluate the effectiveness of some intervention measures in prevention and treatment of hypertension for people of 18-69 year olds at commune level of Thu Duc district, Ho Chi Minh City, in 2019 - 2020 New contributions and practical value of the thesis: The thesis provides data and information on the status of hypertension among people aged 18 - 69 years old in communes of Thu Duc district, Ho Chi Minh City in 2018 The data and information obtained from the research are the basis for developing solutions/interventions to prevent hypertension for Thu Duc district as well as for other areas with similar factors Study results provide the relationship between some factors, behaviors and hypertension of people aged 18 - 69 years old in research communes including: age group, sex, overweight - obesity, high waist/buttock circumference ratio, smoking, habit of eating animal fat, diabetes; hypercholesterolemia; heart-related diseaes This is important information as a basis for the development of effective interventions for prevention and control of hypertension in the community The thesis also provide data, information on methods, contents, intervention action for prevention and hypertension interventions in the community, interventions on management and treatment of hypertension patients applied in the commune level These in their turn, will help the Department of Health of Ho Chi Minh City, the District Health Center, the Commune Health Stations, the researchers and policy makers to have a basis to choose and make decisions about intervention solutions and models applies to communes/wards with similar conditions STRUCTURE OF THE THESIS Thesis consisted of 127 pages without reference and annex part It included 51 tables, figures The thesis has pages of Introduction part; 28 pages of Literature Review Chapter; 25 pages of Study Subject and Methods Chapter; 32 pages of Result Chapter; 37 pages of Discussion Chapter, pages of Coclusion and page of Recommendation Chapter LITERATURE REVIEW 1.1 Concepts and related content Hypertension (SBP) is diagnosed when systolic blood pressure (SBP) is of ≥140 mmHg and/or diastolic blood pressure (DBP) is of ≥90 mmHg or while being treated with an antihypertensive agent The definitive diagnosis of hypertension is based on the BP measured according to correct BP measurement procedure Table 1.2 Classification of hypertension according to ESC/ESH and Vietnam's Ministry of Health Hypertension classification Optimal BP Normal BP High normal BP Hypertension grade Hypertension grade Hypertension grade Isolated systolic hypertension SBP (mmHg) < 120 120 - 129 130 - 139 140 - 159 160 - 179 ≥ 180 ≥ 140 DBP (mmHg) And And/or And/or And/or And/or And/or And < 80 80 - 84 85 - 89 90 - 99 100 - 109 ≥ 110 < 90 Causes of hypertension: The majority of hypertension in adults is of unknown cause (primary hypertension), only about 10% of cases have a cause (secondary hypertension) Complications of hypertension: stroke, transient ischemic attack, left ventricular hypertrophy, heart failure, myocardial infarction, angina attack, peripheral vascular disease, retinal hemorrhage, papilledema, proteinuria, serum creatinine increased, renal failure, etc 1.2 Hypertension and related factors - In the world: According to WHO reports in 2013 and 2014, the prevalence of hypertension in adults aged 18 years and over is of about 22% The prevalence of hypertension varies from region to region, with the highest in Africa (30%) and the lowest in the Americas (18%) In Southeast Asia, the proportion of adults with hypertension is about 25% - In Vietnam: Results of the National Health Survey in the period 2001 - 2002 showed the rate of hypertension in adults of 16.9% In 2008, the prevalence of hypertension among people aged 25-64 years old was 25.1% In 2015, the prevalence of hypertension in people aged 25 years old and older was 47.3% According to the data of National Survey on risk factors for noncommunicable diseases in 2015, 18.9% of 18-69 year olds people had hypertension (for male: 23.1%; for female: 14.9%) - Factors related to hypertension: nhóm yếu tố: (1) Personal characteristic factors: Age, gender, education, occupation; genetics/race, family history of hypertension, (2) Lifestyle behavioral factors (also known as risk behavior factors): Smoking, alcohol abuse, eating salty foods, less physical activity, stress, excessive anxiety, (3) Metabolic factors: Hyperglycemia, increased cholesterol, overweight - obesity, 1.3 Intervention solutions on risk factors and management of treatment for hypertention in the community In Vietnam: In 2010 and 2011, the Prime Minister issued Decision 2331/QD-TTg and Decision 2406/QD-TTg about the list of National Target Programs for the period 2012 - 2015, of which there was a “Project on Prevention of Hypertension” The National Program on Hypertension Prevention has proposed a model of hypertension management at the grassroots health level, including fields: (1) Management of hypertension by consulting and coordinating the provision of antihypertension drugs at CHSs of communes/wards; (2) Training to improve the qualifications of health workers and strengthening the facilities and equipment of the grassroots health system; (3) Communication - Health education to raise awareness about hypertension, it’s related risk factors Positive lifestyle change for all people In 2015, the Government issued Decision No 376/QDTTg approving the National Strategy for NCDs Prevention and Control for the period 2015 - 2025 In the specific goals and targets by 2015, there was the target of “reducing the rate of hypertension below 30%; increased hypertension detection and hypertension proper treatment management rate according to professional guidance in community up to 50% In 2017, the Government issued Decision No 1125/QDTTg approving Health - Population Target Program for the 2016-2020 period In which, the target to be achieved for hypertension was 50% people with hypertension could be detected early; 30% of hypertension patients were properly managed and treated according to professional guidelines” - Some intervention studies to reduce risk factors and manage hypertension treatment in the community: The research of Nguyen Kim Ke et al (2013) has used the control model of hypertension in the elderly to intervent the situation of hypertension in Hung Yen town The used intervention measures were strengthening communication health education to prevent hypertension and manage hypertension patients at CHS Results after years of intervention showed that the degree of hypertension in the elderly undergoing intervention has changed from severe to milder, 38% of the elderly have maintained a stable blood pressure Research of Dinh Van Thanh et al in 2015 was conducted to studying the current situation and effectiveness of hypertension management model at the grassroots health level in Bac Giang province using the model piloted in communes and other control communes As a result, the rate of managed hypertension was increased from 20.8% to 70.7%, of which rate of those reaching target blood pressure increased from 7.3% to 68.5% Rate of hypertension managed at CHSs has also been increased from 0% to 26.1% Research conducted by Pham The Xuyen et al in 2019 focusing on the status of hypertension in people aged 45 - 64 years old in Dien Bien district, Dien Bien province and the cost effectiveness of intervention measures has been conducted in commune with other commune used for control The used intervention measures included training knowledge and skills on hypertension management for commune health workers, village health workers and intensive communication - health education on healthy lifestyle, on treatment of hypertension without or with drugs and hypertension monitoring, management, Results of 12 months of intervention showed the increased rate of hypertension patients achieving blood pressure of target level with an intervention index of 29.6% Chapter STUDY SUBJECTS AND METHODS 2.1 Study subjects, place and time 2.1.1 Study subjects For Objective 1: People of 18 - 69 years old that having permanent residence and have been living in the study area for at least 12 months, consenting and voluntary For Objective 2: Subjects of community-based hypertension prevention were people aged 18 - 69 years old enrolled in Objective The subjects for intervention were those aged 18 - 69 years old, diagnosed with hypertension of grade 1, grade 2, undergoing interventional hypertension treatment at CHS and voluntarily accepted to participate in the study 2.1.2 Study site and time Study site: At communes: Linh Xuân, Tam Phu, Hiep Binh Chanh, Thu Duc district, Ho Chi Minh city Study time: From August 2018 till Decmber 2019 2.2 Research methods 2.2.1 Research design For Objective 1: Cross-sectional description design with analysis, combined with using retrospective data For Ojective 2: Including designs: (1) Community preventive intervention using control, and (2) Treatment intervention without control 2.2.2 Sample size and sampling method For Objective 1: Applying the formula calculating sample size for descriptive research to estimate a proportion, n was found of 575 people/ward x wards = 1,725 people In fact, 2,203 people were surveyed (Linh Xuan ward: 581 people; Tam Phu ward: 789 people and Hiep Binh Chanh ward: 833 people) wards were selected by simple random method (drawing from a total of 12 commune/wards of Thu Duc district) In each commune, households were selected according to the “door to