3. Aim
The overall purpose of this
project is to improve the
quality of treatment and
thus, increase the life
expectancy of hypertensive
patients being treated at
CHC Suyalbari.
4. Objectives
● Identification of comorbidites
and high risk patients
● Correct drug prescription
according to risk and
comorbidites
● Frequent follow up for
reassessment
5. Standards (WHO guidelines 2021)
After diagnosis of hypertension the following lab test should be done to identify
comorbidites and secondary hypertension:
● Serum electrolytes
● Serum Creatinine
● Lipid profile
● HbA1C or fasting glucose
● Urine analysis
● ECG
6. After the diagnosis of hypertension, cardiovascular risk assessment of the patient
should be done based on the following criteria:
● Age
● Sex
● BMI
● Smoking History
● Diabetis Mellitus
● Previous history of Cardiovascular Disease
7. Drug to be used as first class agents are:
● Diuretics
● Calcium Channel Blockers
● ACE inhibitors or ARBs
Two drug combination therapy is advised, preferably in a single pill.
Medications should be adjusted according to any comorbidity or risk factor found.
8. Target Blood Pressure:
● Without comorbidites - SBP<140 and DBP<90
● In High risk patient- SBP<130 and DBP<90
9. Frequency of Follow up visits to check for control of BP
● Monthly untill target BP is reached. If target BP is not reached, check for
patient compliance or change medication doses or drug class.
● 3-6 monthly for patients with BP under control
11. Population under Survey
● This is a prospective audit which surveyed randomly 20 patients who visited
the OPD from 15/11/2022 to 31/12/2022, with diagnosed hypertension and
are on anti hypertensive medication.
● The patients were identified in the OPD on the basis of who reported history of
intake of antihypertensive medication.
12. Data Collection
Data was collected at OPD during patient visits by asking them to fill up a survey form
containing the following questions:
● ‘ Have you ever given a blood sample for testing of the following laboratory
parameters after you were diagnosed with hypertension?
KFT
Lipid profile
Fasting Glucose
● Have you ever given a urine sample for a urine routine and microscopy test, after
you were diagnosed with hypertension?
13. ● Have you ever been subjected to an ECG test after you were diagnosed with
hypertension?
● Have you been evaluated for cardiovascular risk based on age, sex , smoking,
BMI and history of cardiovascular disease, after you were diagnosed with
hypertension?
● Which antihypertensive medication are you currently on?
● What was your blood pressure as assessed today?
● How frequently do you visit the hospital for follow-up? ‘
14. Data Analysis
Have you ever given a blood sample for testing of the following laboratory
parameters after you were diagnosed with hypertension?
KFT, Lipid profile and Fasting Glucose
No of Patients
Surveyed
No of Patients who
have had KFT done
No of Patients who
have had Lipid
profile done
No of Patients who
have had Fasting
Glucose done (not
RBS)
20 11 7 10
15. Have you ever given a urine sample for a urine routine and microscopy test, after
you were diagnosed with hypertension?
No of Patients Surveyed No of Patients who have had Urine
Analysis done
20 6
16. Have you ever been subjected to an ECG test after you were diagnosed with
hypertension?
No of Patients Surveyed No of Patients who have had ECG done
20 9
17. Have you been evaluated for cardiovascular risk based on age, sex , smoking, BMI
and history of cardiovascular disease, after you were diagnosed with hypertension?
No of Patients Surveyed No of Patients who were asked their age,
sex, BMI, history of smoking and history of
heart disease? (All of the above)
20 2
18. Which antihypertensive medication are you currently on?
No of Patients Surveyed No of Patients who were on
one of the first line
medication
No of Patients on
combination therapy
20 14 3
19. What was your blood pressure as assessed today?
No of Patients who No of Patients who had
blood pressure below
140/90
20 6
20. How frequently do you visit the hospital for follow-up? ‘
No of Patients Surveyed No of Patients who follow
within a month
No of Patients who follow
up within 2-6 months
20 11 7
22. ● Percentage of patients who have had KFT done- 11/20 - 55%
● Percentage of patients who have had Lipid profile done - 7/20- 35%
● Percentage of patients who have had Fasting Glucose done - 10/20- 50%
● Percentage of Patients who have had Urinalysis done- 6/20- 30%
● Percentage of Patients who have had ECG done- 9/20- 45%
● Percentage of Patients who were risk evaluated based on age , sex ,BMI and
history of smoking and heart disease - 2/20- 10%
23. ● Percentage of Patients on first line medication- 14/20- 70%
● Percentage of Patients on combination therapy- 3/20- 15%
● Percentage of patients with current BP less than 140/90- 6/20- 30%
● Percentage of patients coming for monthly follow up -. 11/20- 55%
● Percentage of Patients coming for 2-6 monthly follow up - 7/20- 35%
25. Currently, the majority of patients being
treated for hypertension at CHC Suyalbari
are not receiving the appropriate
treatment according to latest guidelines by
WHO.
An action plan needs to be set and
followed to correct this.
27. Investigations and Risk assessment
● Every new patient of hypertension should be advised KFT, Lipid Profile, Fasting
Glucose, Urinalysis and ECG after diagnosis.
● Every old patient should be asked whether they have had these investigations
done and to bring them to OPD in their next visit. If these investigations haven't
been done, they should be advised immediately.
● Every new patient of hypertension should have their risk assessment done
based on age , sex , BMI, history of smoking and heart disease.
● Every old patient should be asked if they have had this assessment done and if
not, it should be done immediately.
28. Antihypertensive medication
● If possible, patients should be switched to first line medications.
It is inadvisable to stop beta blockers immediately, as it can lead to rebound
hypertension. They should be stopped slowly in a step wise method
● Combination therapy is preferred to simply increasing the dose of current
medication.
● If target BP is not reached, check for patient compliance or change medication
doses or drug class.
29.
30. Target Blood Pressure and Follow up
● Patients without any comorbidites should have the target BP of 140/90 mm hg
and should be made aware of it.
● High risk patients should have the target BP of 130/90 mm hg and should be
made aware of it.
● Patients whose office blood pressure reading is more than target BP should be
followed up on monthly basis untill target BP is reached
● Patients whose office blood pressure reading is less than the traget BP should
be followed 3-6 monthly.
31. Review and Reassessment
● Reassessment would be done by repeating the patient survey with 20 random
patients after 3 months to check the improvement in treatment of
Hypertensive patients .
● The goal of this project is to achieve atleast 80% of hypertensive patients
receiving appropriate care in all aspects, according to the guidelines.
