Retrospective data analysis of patients treated for arterial hypertension within the out-hospital emergency medical service

Arterijska hipertenzija vodeći je uzrok kardiovaskularnih bolesti i bilježi sve veći broj oboljelih unatoč poznatim spoznajama o njezinim uzročnicima. U Hrvatskoj je najveći udio oboljelih od arterijske hipertenzije u ukupnom stanovništvu i s time povezani veći mortalitet zbog posljedica kardiovaskularnih bolesti u usporedbi s ostalim zemljama u Europi. Navedeni problem je prepoznala i Europska komisija koja zagovara uvođenje Nacionalnog programa za prevenciju kardiovaskularnih bolesti u Hrvatskoj s ciljem smanjenja mortaliteta za 1/3 do 2030. godine. Poticanje zdravih životnih navika dovodi do regulacije vrijednosti arterijskog krvnog tlaka, smanjenja potrebnih lijekova za regulaciju arterijskog krvnog tlaka te time i povezanih troškova liječenja. Za potrebe istraživačkog dijela diplomskog rada, potrebni podaci dobiveni su pomoću integriranog sustava e-Hitna uz prethodno odobrenje ravnatelja i etičkog povjerenstva Zavoda za hitnu medicinu Zagrebačke županije. Retrospektivnom analizom podataka pacijenata zbrinutih zbog arterijske hipertenzije kao vodeće dijagnoze u ispostavi Sveti Ivan Zelina od 1.1.2022. do 31.12.2022. godine, uvidjelo se da je u navedenom razdoblju zbrinuto sveukupno 3 306 pacijenata od čega je 222 pacijenata zbog arterijske hipertenzije. Prema ciljevima istraživanja postavljene su četiri hipoteze od kojih su tri potvrđene. Prva hipoteza ukazuje da postoji statistički značajna razlika u broju pacijenata koji su zbrinuti od stane izvanbolničke hitne medicinske službe Sveti Ivan Zelina zbog arterijske hipertenzije i ishoda obrade pacijenata. Veći broj pacijenata je upućeno kući nego što ih je upućeno u objedinjeni hitni bolnički prijem na daljnju obradu. Od 222 pacijenata koji su zbrinuti zbog arterijske hipertenzije, njih 87,7% je upućeno kući nakon zbrinjavanja s obzirom na to da nije bilo znakova oštećenja ciljnih organa, što upućuje na hipertenzivnu urgenciju. Druga hipoteza ukazuje da postoji statistički značajna razlika u broju zbrinutih pacijenata starosne dobi od 41 do 60 godina zbog arterijske hipertenzije u odnosu na pacijente iz ostalih skupina. Odnosno u 69,4% slučajeva se radio o pacijentima starosne dobi 60 godina koji su zbrinuti zbog arterijske hipertenzije, od čega je najveći udio pacijenata bio ženskog spola. Treća, najznačajnija hipoteza ukazuje da postoji statistički značajna razlika u broju zbrinutih pacijenata ovisno o zabilježenom atmosferskome tlaku na te dane. Više pacijenata je zbrinuto zbog arterijske hipertenzije kada je atmosferski tlak bio niži. Kako bi se ustanovila značajna statistička razlika, potrebne podatke o vrijednostima atmosferskoga tlaka ustupio je Državni hidrometeorološki zavod. Vrijednosti atmosferskoga tlaka za područje Svetog Ivana Zeline dobivene su s mjerne postaje Križevci, gdje su mjerene tri puta tijekom dana, odnosno u 7, 14 i 21 sat. Statističkom obradom podataka ustanovljeno je da je 174 pacijenata zbog arterijske hipertenzije zbrinuto za vrijeme nižih vrijednosti atmosferskoga tlaka. Usporedbom prethodnih istraživanja vezanih uz atmosferski tlak i njegovog utjecaja na ljudsko zdravlje i u ovome slučaju je potvrđen utjecaj nižih vrijednosti atmosferskoga tlaka na porast vrijednosti arterijskog krvnog tlaka. Kako je arterijska hipertenzija bez simptoma sve dok ne zahvati ciljne organe, potrebno je djelovati na svim razinama zdravstvene zaštite. Promicanjem zdravih životnih navika, probirom naizgled zdravih osoba, sprječavanjem progresije i nastupa fatalnih posljedica kod oboljelih. Ulogu u promociji zdravlja imaju svakako visoko obrazovane medicinske sestre, koje se na temelju svojih znanja i sposobnosti zalažu za postizanje ciljeva u vidu očuvanja zdravlja sveukupne populacije.Arterial hypertension is the leading cause of cardiovascular diseas and the number of patients is increasing despite the know knowledge about its causes. Croatia has the highest proportion of patients with arterial hypertension in the total population and the associated higher mortality due to the consequences of cardiovascular diseases compared to other countries in Europe. The mentioned problem was also recognized by the European Commission, which is advocating the introduction of the National Program for the Prevention of Cardiovascular Diseases in Croatia with the aim of reducing mortality by 1/3 by 2030. Encouraging healthy lifestyle habits leads to the regulation if arterial blood pressure values, the reduction of necessary drugs for the regulation of arterial blood pressure, and thus the related treatment costs. For the purposes of the research part of the thesis, the necessary data was obtained using the integrated e-Hitna system with the prior approval of the director and the ethics committee of the Institute of Emergency Medicine of the Zagreb County. Using the retrospective analysis of data on patients treated for arterial hypertension as the leading diagnosis in the Sveti Ivan Zelina branch form 1.1.2022. until 31.12.2022. year, it was concluded that a total of 3 306 patients were cared for in that period, of which 222 patients were due to arterial hypertension. According to the objectives of the research, four hypotheses were set, three of which were confirmed. The first hypothesis indicates that there is a statistical significant difference in the number of patients treated at the outpatient emergency medical service of Sveti Ivan Zelina due to arterial hypertension in the outcome of patient treatment. A great number of patients were sent home in comparison the number of people that were sent to the unified emergency hospital admission for further treatment. Of the 222 patients who were treated for arterial hypertension, 87,7% of them were sent home after the treatment, considering that there were no signs of damage to the target organs, which indicates a hypertensive urgency. The second hypothesis indicates that there is a statistically significant difference in the number of treated patients aged 41 to 60 due to the arterial hypertension compared to patients from other groups. That is, in 69,4% of cases, it was patients aged 60 years who were treated for arterial hypertension, of which the largest proportion of patients was female. The third, most significal hypothesis indicates that there is a statistical significant difference in the number of admitted patients depending on the recorded atmospheric pressure on those days. More patients were admitted for arterial hypertension when atmospheric pressure was lower. In order to establish a significant statistical difference, the necessary data on atmospheric pressure values was provided by the State Hydrometeorological Institute. Atmospheric pressure values for the area of Sveti Ivan Zelina were obtained from the Križevci measuring station, where they were measured three times during the day, namely at 7 a.m., 2 p.m. and 9 p.m. through statistical data processing, it was established that 174 patients were treated for arterial hypertension during lower values of atmospheric pressure. By comparing previous research to atmospheric pressure and its impact on human health, the influence of lower values of atmospheric pressure on the increase in arterial blood pressure was confirmed in this case as well. Since arterial hypertension is symptom less until it affects the target organs, it is necessary to act on all levels of health care. By promoting healthy lifestyle habits, screening people that appear healthy. Preventing progression and the occurrence of fatal consequences in patients. A role in health promotion is certainly played by highly educated nurses, who, based on their knowledge and abilities, strive to achive goals in the form of preserving the health of the entire population