1. Audit on Hypertension in Northwest Russia Архангельск Ingvar Ovhed, MD, PhD, family physician, Competence Center, Blekinge County Council 2008

2. Archangelsk region The structure of this regional report is built up from a Powerpoint presentation with comparative graphs. You will find blue graphs showing the results from the whole of NWR and green graphs from the regional registration. Notice! – The comments below the pictures are made according to the results of the whole audit group of 146 family doctors in Northwest Russia. The results from the regional (green) audit may differ. Make that an reason for discussing interesting regional specific clinical policies.

3. all Audit on Hypertension in Northwest Russia Distribution of age groups Archangelsk Age: mean values for men: 54,4 years and for women 58,6 years Comments: When looking on the distribution of the age groups it’s obvious that the family doctors control and treat men at a younger ages than for women.

4. all Audit on Hypertension in Northwest Russia Number of patients in each age group Archangelsk However, the distribution up to absolute numbers (figure 2) tells us that in spite of this the female patients are more numerous in each age group. Question: Where are the men checked up? Nowhere or by cardiologists?

5. all Audit on Hypertension in Northwest Russia Systolic blood pressure Archangelsk

6. all Audit on Hypertension in Northwest Russia Diastolic blood pressure Archangelsk Comments: For both systolic and diastolic blood pressure women have a somewhat bigger proportion of high values. This may be due to that women are older, but among those with very high blood pressure (>200/110) there are more men. Question: Discuss your techniques for measuring blood pressure.

7. all Audit on Hypertension in Northwest Russia Mean blood pressure by gender Archangelsk Comments: Most obvious are the similarities, but it is important to notice that women as a group is older and when you get old your blood pressure will raise. Goal BP for all: For those <60 years old 37,3% men and 38,8% women have reached the goal; ≤140/90. For those ≥60 years old 59,6% men and 56,3% women have reached the goal; ≤160/90. In Vologda the figures for those <60 years were 127/249 (51%) for men and 259/485 (53%) women and still higher for those ≥60 years or 81/123 (66%) for men and 232/310 (75%) for women Question Is it even in Vologda possible /desirable to increase the proportion who reach their goal BP?

8. all Audit on Hypertension in Northwest Russia Who measures the blood pressure BP? Archangelsk Comments: Obviously the doctor measure the patients BP almost every time. Would it be possible to change such routines? Question: Advantages or disadvantages with a doctor who trusts the BP measured by the nurse?

9. all Audit on Hypertension in Northwest Russia Riskfactors by gender Murmansk Comments: There is no differences between men and women up to heredity – and heredity for CVD is common - 60%. Smoking women are less than 20%, but they have more over weight and more diabetes, while men have more of cardiovascular disease other than diabetes. Question: Why these differences between men and women? Do you meet men before or after their first acute heart attack?

10. all Audit on Hypertension in Northwest Russia Smoking and x-smoking by age and gender Archangelsk Comments: Smoking is a world-wide epidemic now increasing especially among young women. Figure 8 shows that the young women now increase smoking. Noteworth is that there are 25% (61/244)X-smokers among men below 50 years of age but only 14% (49/358) among women. It is a well known fact that women seem to have more difficulties to stop smoking. Question: The youngest men smoke a little less than those between 40 and 60 years. Is there a tendency towards more healthy lifestyle among young Russian men

11. all Audit on Hypertension in Northwest Russia Medication by gender Archangelsk Comments: Females patients have more of diuretics and less of betablockers, while men have more of ASA and statins. This could perhaps be rational up to that women as a group are older and men have more of CVD

12. all Audit on Hypertension in Northwest Russia Choice of drugs due to risk factors Archangelsk Comments: Patients with CVD or Diabetes have got a more intense medication and all different drugs are used for this. This result indicate that the family doctors really try to give these patients as efficient therapy as possible. Question: Discuss the different medication to men and women as well as the differences up to those with complicating disease. Could it be better?

13. all Audit on Hypertension in Northwest Russia Medication due to dr’s satisfaction Archangelsk Comments: It is obvious that if the family doctors are not satisfied with the therapy they will increase medication.

14. all Audit on Hypertension in Northwest Russia Dr’s evaluation of therapy and check up Archangelsk Comments: Change of therapy is carried out as often for men as for women. Question: Discuss the problematic patients – what different problems do you meet when deciding about medication?

15. all Audit on Hypertension in Northwest Russia Dr’s satisfaction and change of therapy Archangelsk Comments: Doctors are satisfied to the same extent up to men and women, but less often for those patients with complicating diabetes and/or CVD. For these patients the family doctors take an active role and more often change medication. This is of great importance out of a public health and preventive care perspective. Question: Discuss what priority you have personally, up to what drugs you choose and in what order you use them. What different drugs do you give priority for men or for women, for old people or for young ones, for uncomplicated and for complicated diseases?

16. all Audit on Hypertension in Northwest Russia Comparison of risk factors - men Archangelsk

17. all Audit on Hypertension in Northwest Russia Comparison of risk factors - women Archangelsk Comments: There is a lower proportion of smokers among those with CVD and diabetes. Especially among women this might be explained by the age factor. There is no obvious difference up to hypercholesterolemia but to over weight and low physical activity. Both men and women of those with complicated diseases have a higher proportion of negative lifestyle risk factors. However even here the higher age among those with complications will be important, but it makes it reasonable to invest resources on preventive care also for these very sick people. Question: In what way and for what groups could preventive care be most effective do you think?

18. all Audit on Hypertension in Northwest Russia One or multiple drug therapy by gender Archangelsk

19. all Audit on Hypertension in Northwest Russia Archangelsk One or multiple drug therapy by risk Comments: When we look at high risk patients we can see that only a few of those patients with Diabetes or CVD have just one antihypertensive drug. Question: What is your own additional drugs to prescribe when you meet a patient with diabetes or CVD? What is your own opinion – low doses of two or three drugs or higher doses of one or two?

20. Audit on Hypertension in Northwest Russia Mean values With St; M: 6,76 W: 6,58 Without St: M: 6,24, W: 6,43 Гиперхолестеринемия С или Без Статина 19 график. Комментарии: как у мужчин, так и женщин, употребляющих лекарства Статин более высокие показатели, чем у тех, которые Статин не употребляют. Вопрос: Какие выводы из этого Вы можете сделать? Гиперхолестеринемия С или Без Статина Comments: For both men and women those with Statin medication have higher values than those without Statin. Question: What is your conclusion of this fact? All men All women