DAYAN ARLETH RAMIREZ PEREA

Another modifiable risk factor for coronary heart disease (CHD) is the level of plasma lipoproteins. In hyperlipidemia, elevated levels of lipids or lipoproteins are abnormal because genetic and environmental conditions alter the production, break-down, or clearance of plasma lipoproteins from the circulation.

We compared the results of analyses of the level of cholesterol, low density li-poproteins (LDL), and high density lili-poproteins (HDL) of our respondents with nor-mal reference interval (cholesterol: 3.9–6.0 mmol/L; HDL: 0.9–1.93 mmol/L; LDL:

1.55–4.4 mmol/L) (Figures 3, 4, 5).

Figure 3. The level of cholesterol Holesterīna līmenis

Figure 4. The level of HDL

Augsta blīvuma holesterīna līmenis Holesterīna līmenis

Augsta blīvuma holesterīna līmenis

127 Gunta Tīcmane, Jānis Jirgensons. Management of Risk Factors for Hypertension..

The level of triglycerides. A recent meta-analysis found that hypertriglyceri-demia was an independent risk factor for choronary heart disease (CHD). The level of triglycerides in our patients in comparision with the normal reference interval of triglycerides (0.55–1.9 mmol/L) is shown in Figure 6.

Zema blīvuma holesterīna līmenis .

Figure 5. The level of LDL

Zema blīvuma holesterīna līmenis

Figure 6. The level of triglycerides Triglicerīdu līmenis Triglicerīdu līmenis

Discussion

Figure 3 shows that the level of cholesterol (3.9–6.0 mmol/L) is normal just in 50.8% (64) of the respondents. In 40.2% (62) of the respondents it is higher.

The level of triglycerides is normal in 68.25% (86) of respondents, above the normal rate – in 31.75% (40) of the respondents.

A large part of patients with hypertension evaluate their quality of life as me-dium or low. 19.8% answered that they frequently had disturbance of daily activities, 5.6% regulary had disturbance of daily activities, but 9.5 % of the respondents felt so bad they could not work.

51.6% of the respondents reported that they sometimes had problems with their nervous system, 19% reported having problems frequently, and 7.1% of the respon-dents usually were very irritable.

GPs are the first persons who talk to patients about their state of health, about family habits, addictions, physical activities, ask the patient what they are expecting from the doctor and whether they are ready to collaborate with the GP during treat-ment.

The greatest challenge of a GP during the first visit is to draw patients attention to his/her main health problem, talk to the patient about the possibilities and need to change his/her lifestyle, and only then discuss treatment of hypertension.

Conclusions

Examination of 154 hypertension patients demonstrated that a large number of patients are overweight and suffer from obesity, 50% of the patients have elevated levels of cholesterol. 54.8% of the respondents never do physical activities, 25.4%

do very rarely, 11.9% sometimes, 7.9% – 1 to 2 times a week (but notice that the average age of the patients is 63.1 years, they come from rural area, and usually their daily activities are combined with physical work).

General practitioners are the first who talk to patients and their families about the importance of preventive measures early in life – physical activities in the fa-mily, at school; GPs also assess the socioeconomic situation in a family and help to choose the best way to implement preventive measures, find stimulation that makes patients think about their health. Hence, GPs play an important role in influencing the patients’ lifestyle. GPs never administer treatment in isolation, they assess all the risk factors – smoking, blood pressure, alcohol consumption, diabetes mellitus, and other chronic diseases as well as the family history.

The benefits of treatment must be evaluated in the light of the cost and imposi-tion of diets and medicine taking.

129 Gunta Tīcmane, Jānis Jirgensons. Management of Risk Factors for Hypertension..

References:

1. Hollenberg Steven M., MD, Walker Tracy, MD. Cardiology in Family Practice. 2006, 105–110.

2. Longmore Murray, Wilkinson Ian B., Rajagopalan Supraj R. Oxford Handbook of Clinical Medicine, Sixth Edition. 2004, 140–142, 676–677, 704–705, 714–715.

3. Beers Mark H., Porter Robert S., jones Thomas V., Kaplan justin V., Berkwits Michael. The Merck Manual of Diagnosis and Treatment. Eighteenth Edition. 604–607, 1305–1307.

4. Marshall Martin, Campbell Stephen, Hacker jenny, Roland Martin. Quality Indicators for General Practice. 2003, 22–25, 46–53.

5. Boelen Charles, Haq Cynthia, Hunt Vincent, Rivo Marc, Shahady Edward. Improving Health Systems: The Contribution of Family Medicine. 2002, 37–46.

6. Yearbook of Health Care Statistics in Latvia, 2007, 11, 25, 31.

7. Public Health Analysis in Latvia. 2004, 32–33.

8. South-Paul jeannette E., Matheny Samuel C., Lewis Evelyn L. Current Diagnosis and Treatment in Family Medicine. 2004, 231–252, 411–423.

Kopsavilkums

Latvijā attīstoties ģimenes medicīnai, aktuāls kļūst jautājums par ģimenes ārsta kā speciālista lomu pacientu aprūpē. Publikāciju dati liecina, ka šī problēma ģimenes medicīnas attīstības pirmsākumos ir bijusi aktuāla lielākajā daļā valstu. Pasaules pētījumu dati rāda, ka 70–80%

pacientu aprūpi veic ģimenes ārsti, un tas liecina par šīs specialitātes stabilitāti.

Lai izvērtētu ģimenes ārsta nozīmi savā nozarē, tika veikts pētījums, kurā iesaistīti 154 hipertensijas pacienti no viena Latvijas lauku rajona. Pacientiem tika veikti fizikālie (EKG, svara, auguma mērījumi) un laboratoriskie izmeklējumi (asins analīzes, holesterīns un tā frakcijas, triglicerīdi), kā arī izdalītas aptaujas anketas ar jautājumiem par slimības anamnēzi un pacientu dzīves kvalitāti. Iegūtie rezultāti tika salīdzināti ar vidējiem rādītājiem Latvijā un Eiropas valstīs. Vairumam pacientu tika konstatēts svara palielinājums, holesterīna līmeņa paaugstināšanās, daudzi pacienti maz nodarbojas ar sportu.

Darba nobeigumā apstiprināta izvirzītā hipotēze par ģimenes ārsta lomu un iespējām veikt profilaktiskos pasākumus, kā arī ietekmēt un uzlabot hipertensijas pacientu dzīves kvalitāti.

Atslēgvārdi: hipertensija, kardiovaskulārās slimības, riska faktori, holesterīns, ķermeņa masas indekss.

Summary

Physical and laboratory examinations of 154 hypertension patients in a rural area in Latvia revealed that a large number of patients are overweight and suffer from obesity, 50% of the patients have elevated levels of cholesterol. 54.8% of the respondents never do physical activities, 25.4% do very rarely, 11.9% sometimes, 7,9% – 1 to 2 times a week. General practitioners are the first who talk to patients and their families about the importance of preventive measures early in life – physical activities in the family, at school; GPs also assess the socioeconomic situation in a family and help to choose the best way to implement preventive measures, find stimulation that makes patients think about their health. Hence, GPs play an important role in influencing the patients’ lifestyle. GPs never administer treatment in isolation, they assess all the risk factors – smoking, blood pressure, alcohol consumption, diabetes mellitus, and other chronic diseases as well as the family history.

Nosocomial Infections