BACKGROUND: High-risk hypertensive patients often need immediate and more aggressive treatment to achieve adequate blood pressure (BP) control. There is currently no available Philippine data on the level of BP control and management specific to high-risk patients.
OBJECTIVE: Primary Objective: To determine the prevalence of BP control in high-risk hypertensive patients.
Secondary Objectives:
1. To observe treatment pattern prescribed for high-risk hypertensive patients with uncontrolled BP.
2. To observe the change in BP after eight weeks of planned treatment modification.
METHODS: This was a multicenter, observational disease registry of high-risk hypertensive patients based on the 2007 European Society of Hypertension/European Society of Cardiology guidelines. The study had two cross-sectional phases. Patient data, including level of BP control and any prescribed treatment modification, were collected on the first visit (V1). A second evaluation was done after eight weeks for patients with planned treatment modification (V2).
RESULTS: In 804 patients with high-risk hypertension included in V1, only 37 patients (4.6%) had a baseline BP <130/80 mmHg. Treatment modification was planned in most patients by switching (352/804, 44%), adding antihypertensive agents (193/804, 24%) or increasing the treatment dose (33/804, 4.10%). Of the 325 patients with planned treatment modification evaluated at V2, 112 (34%) had no change in baseline treatment. After a mean treatment period of 5.66 weeks, there was a significant decrease from baseline in mean systolic (-23.95 mmHg) and diastolic (-9.26 mmHg) BP (both p<0.0001). Among patients followed-up, 90% (294/325) achieved target systolic or diastolic BP levels, while 70% (228/325) achieved both target systolic and diastolic BP levels at study completion.
CONCLUSION: BP control in high-risk hypertensive Filipinos is low. Most physicians modified treatment in patients with uncontrolled BP and this was effective in significantly lowering BP. However, larger trials based on current treatment guidelines for hypertension are needed to compare the relative benefits of different types of treatment modification.

Human ; Male ; Female ; Antihypertensive Agents ; Blood Pressure ; Prevalence ; Hypertension ; Systole ; Treatment Outcome ; Physicians ; Registries

Background and Objectives: Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes. Methods: This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given. Results: Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus. Conclusion The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.
Quality Improvement ; Critical Pathways