The Republic of Georgia High Blood Pressure Control Program.
BACKGROUND
52% of adults have uncontrolled hypertension in the Republic of Georgia. We incorporated a blood pressure control program into an existing primary healthcare system in an attempt to improve the rate of blood pressure control.


METHODS
We conducted standardized trainings of rural primary care providers--doctors and nurses--in accurate measurement of blood pressure according to the Shared Care Method of Training and Certification. Our attention was focused especially on patient management based on Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines. Antihypertensive treatment was implemented by a stepped-care approach; hydrochlorothiazide and atenolol were given to patients at follow-up visits at no cost. The treatment goal was < 140/ 90 mm Hg based on the office blood pressure.


RESULTS
A total of 251 patients with uncontrolled hypertension were enrolled in the program; 32% had stage I hypertension, 41% had stage II hypertension, and 27% had stage III, as defined by JNC VI. During the first 30 months of followup, blood pressure decreased gradually from 170/95 to 140/ 82 mm Hg. The rate of high blood pressure control increased progressively up to 59%.


CONCLUSIONS
We conclude that hypertension control can be improved in all groups of patients, even in a healthcare system with limited resources. We emphasize that Georgia or any other healthcare system should not wait for universal health care to improve high blood pressure control. It can be incorporated into whatever system exists today.
Barbakadze
Vakhtang Y
VY
Union of Laboratory Diagnostic, National Center of Therapy, Tbilisi, Georgia. vakhtangh@hotmail.com
Koblianidze
Levan G
LG
Kipshidze
Nodar N
NN
Grim
Clarence E
CE
Grim
Carlene M
CM
Tavill
Frederick
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004517:Education, Professional / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D005846:Georgia (Republic); D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D015397:Program Evaluation; D019035:Rural Health Services
D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide