Applying scientific innovation to improve the quality of medical examination and treatment

(Baonghean) -Associate Professor, Dr. Cao Truong Sinh - Vice Principal of Vinh Medical Universityhad an interview with Nghe An Newspaper reporter about applying scientific research results to improve the quality of medical examination and treatment for people.

PV:Dear Associate Professor, Dr. Cao Truong Sinh, could you tell us what motivated you to carry out the scientific topic "Research on blood pressure changes and treatment effectiveness of Lercanidipine in patients with cerebral infarction and hypertension using 24-hour ambulatory blood pressure monitoring"?

Assoc.Prof.Dr. Cao Truong Sinh:It comes from a passion for scientific research, always wanting to find new things and also from witnessing the situation of patients, especially those with cerebrovascular accidents, including cerebral infarction leading to sequelae of hemiplegia, difficulty in walking and daily activities, some people lying in one place with painful ulcers and plaques, leaving a burden on their families and society.

My colleagues and I decided to carry out the topic "Research on blood pressure changes and treatment effectiveness of Lercanidipine in patients with cerebral infarction and hypertension by 24-hour ambulatory blood pressure monitoring" with the hope that through this measurement method, we can predict for patients with hypertension who have not had a stroke to have preventive measures against stroke, and for patients who have had a stroke to avoid recurrence by monitoring and using long-acting blood pressure medications.

The surgical team removing foreign objects from a child patient at the Practical Clinic (Vinh Medical University) was highly appreciated by public opinion.

PV:During the process of implementing this scientific topic, you and your colleagues must have experienced many difficulties?

Assoc.Prof.Dr. Cao Truong Sinh:Yes! We have worked very hard to implement the topic. Determining that for a scientific topic to be successful, the practical factor is put first, we have organized the implementation at the Vinh Medical University Clinic and the Neurology Department of Nghe An General Hospital from 2009 to present by having patients with acute cerebral infarction with hypertension wear a 24-hour ambulatory blood pressure monitor.

From the blood pressure changes after wearing the machine, the patient will be able to predict whether to continue treatment, stay in hospital, intervene or transfer to a higher level. Use blood pressure medication for patients during and after the acute phase depending on the patient's blood pressure level after excluding reactive hypertension and cases requiring emergency treatment of hypertension. After 6 years of implementation, the results are as follows:

Firstly, the scientific value has proven and determined the rate of reactive hypertension in patients with cerebral infarction. Determine the fluctuations of blood pressure in patients with cerebral infarction. Determine the changes in 24-hour ambulatory blood pressure parameters in patients with cerebral infarction with hypertension such as the rate of dipping, non-dipping, early morning blood pressure surge and blood pressure overload.

Proving that the phenomenon of early morning blood pressure spike is the cause of cerebral infarction. Evaluating the effectiveness of Lercanidipine compared with Amlodipine by 24-hour ambulatory measurement method, determining the peak-trough ratio, and the drug's smoothness index to recommend its use. Determining the appropriate time to take the drug through blood pressure changes during the day.

Second, in terms of practical application capability and scale: 24-hour ambulatory blood pressure monitoring is a non-invasive but easy-to-use high-tech cardiovascular test, requiring only a device worn on the arm for 24 hours and a software with a total cost of about 70 million VND.

In addition to being applied to monitor blood pressure changes in patients with cerebral infarction, it is also more widely indicated in a number of other diseases such as cerebral hemorrhage, primary hypertension, newly diagnosed hypertension, pregnant women, diabetic patients, especially the most important is to identify patients with white coat hypertension and white coat effect to decide whether to use drugs or adjust lifestyle in patients with white coat hypertension and whether to increase the dose or combine drugs in patients with white coat effect.

Third, the scale of application: The 24-hour ambulatory blood pressure monitoring technique, in addition to being applied at the Vinh Medical University Clinic and the Neurology Department of Nghe An General Hospital, is also applied at the Cardiology Department, the Diabetes Endocrinology Department, the Obstetrics Department, the Nephrology Department and the Internal Medicine Department of district hospitals and regional general clinics. In particular, this technique is taught at Vinh Medical University for general practitioners and nurses.

PV:Can you give specific results before and after applying 24-hour ambulatory blood pressure monitoring technique in patients with cerebral infarction and hypertension?

Assoc.Prof.Dr. Cao Truong Sinh:Before applying, doctors did not know the patient's blood pressure changes during the day; they only knew roughly through a few measurements or through monitors but could not know some biological characteristics of blood pressure, so choosing the time to give the medicine, choosing which medicine, whether to give or not to lower blood pressure by how much is enough to not cause hypotension affecting the patient's life.

Therefore, there is no theoretical and practical basis for prescribing antihypertensive drugs to patients with cerebral infarction. As a result, some patients have had excessive hypotension without knowing it, or the drug dosage must be increased, and the antihypertensive effect of the drug is not properly assessed, so the treatment time is longer, causing costs for patients and hospitals in terms of bed days.

In particular, it is impossible to know which patients with cerebral infarction have hypertension, which patients have real hypertension, which patients have transient reactive hypertension when having cerebral infarction, so most patients use drugs to treat hypertension in the acute phase as well as after the acute phase and after discharge from the hospital. In addition, patients with difficult-to-treat hypertension with a history of cerebral infarction often have to go to Hanoi to bring a machine to determine blood pressure changes and blood pressure biorhythms, which is costly for patients and their families.

After applying the topic, more than 11% of patients with reactive hypertension when having cerebral infarction or cerebral hemorrhage do not need to use antihypertensive drugs in the acute phase as well as after the acute phase. The number of patients with reactive hypertension has a better prognosis so the hospital stay is shortened, on average each patient shortens the treatment time by 1/3. The important thing is that it has benefited the State by hundreds of millions of dong.

Currently, the topic is still being applied at the General Clinic of Vinh Medical University. At the clinic, about 300 people have been wearing the monitor and it has proven to be very useful for patients with high blood pressure, because only this method can monitor blood pressure during the day and at night and detect high blood pressure attacks to prevent stroke.

The project not only contributes to improving the quality of people's health care through the application of high technology but also contributes to the teaching and training of Vinh Medical University.

PV:Thank you, Associate Professor, for the discussion!

Thanh Thuy - Luong Mai