Identification and Management of Patients With Hypertension in the Polyclinic System of the Russian Federation

BACKGROUND: Cardiovascular diseases, including hypertension and type 2 diabetes mellitus, are the major determinants of poor health in the Russian Federation. METHODS: This study assessed the feasibility of establishing a program to identify and manage hypertension and associated cardiovascular risk factors in an outpatient clinic within the Russian polyclinic system. In urban polyclinic in Kazan, Tatarstan, which is responsible for 77,000 covered lives, we enrolled 192 patients with hypertension of whom 68 had type 2 diabetes mellitus screened from various clinics within the polyclinic. After collection of baseline data, patients were treated for hypertension and those risk factors amenable to pharmaceutic intervention and counseled on those that required behavior modification. RESULTS: Baseline blood pressure was 173.9+/-20.7/104.2+/-15.3 mm Hg in those with hypertension only (n=124) and 172.9+/-26.0/97.9+/-16.4 mm Hg in those with both hypertension and type 2 diabetes mellitus. More than 80% of the entire group had a body mass index >25 kg/m2 and left ventricular hypertrophy. Nearly 70% had total cholesterol >5.2 mmol/L. Of the diabetics, more than 50% had glycosylated hemoglobin (HbA1c)>or=8%. Less than 10% of this self-selected population smoked. Blood pressure decreased modestly, but significantly, in both groups of patients. There were no significant changes in obesity, cholesterol, smoking, or HbA1c in the diabetics. CONCLUSIONS: Identification, recruitment, management, and follow-up of patients with chronic disorders is feasible within the Russian polyclinic system. However, to have a more profound effect on risk factor profiles, a wider effort is needed than one restricted to the clinic itself.