{"paper_id":"2c2bbfec-224c-454f-af7a-a9faa3acddb6","body_text":"gIncrease In Hypertension Control Rate following the Training of the Latest National- International Hypertension Management Guidelines for General Practitioners | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article gIncrease In Hypertension Control Rate following the Training of the Latest National- International Hypertension Management Guidelines for General Practitioners Asieh Mansouri, Shaahin Veisi, Somayeh Khodarahmi, Fatemeh Nouri, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7192375/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Given that primary care staff's ignorance of the most recent sources for the prevention, treatment, and management of hypertension (HTN) is one of the identified barriers to HTN control. Aims: We sought to determine the impact of training general practitioners (GPs) on the most recent national and international HTN management guidelines on the HTN control rate among patients. Methods: This before-after investigation was conducted in two parts. In phases I and II of the trial, 31 GPs vs. 886 patients with HTN and 22 GPs versus 656 patients participated. GPs received a training course on the most recent national and international HTN treatment guidelines. Before and after the intervention, the primary outcome was HTN management (systolic blood pressure < 130 and Diastolic < 80 mmHg) Results: Mean ± standard deviation Knowledge, attitudes, and practice scores of GPs before and after the intervention were 12.9 ± 1.9 vs. 13.1 ± 2.6 (P=0.003), 42.5 ± 2.9 vs. 42.9 ± 5.7 (P=0.007), and 14.6 ± 1.6 vs. 14.7 ± 1.3 (P=0.064), respectively. 338(38.1) vs. 376(57.3) patients with managed HTN, using two or more antihypertensive medicines and receiving fixed dosage combination therapy (Losartan/Hydrochlorothiazide) before GP training vs. after training, respectively. Predictors of change in HTN control in the second phase, compared to the first, were age, not adding salt to meals, and the difference in the GPs' practice score, patients' BMI, and the number of antihypertensive medicines. Conclusion: To increase the community's HTN control rate, we propose periodic training programs for GPs and other primary care workers and frequent patient follow-ups. Control Education program General practice Hypertension Management Figures Figure 1 Introduction Following hypertension (HTN), the risk of heart attack, heart failure, stroke, kidney disease, and vision problems increases. ( 1 , 2 ). Although the benefits of controlling HTN have been well-documented in patients ( 3 ). Canada has the highest rate of HTN control among the different countries in the world. This country's control rate of HTN rose from 13% in 1992 to 68% in 2013 ( 3 – 5 ). According to the Isfahan Cohort Study, while 49.6% of hypertensive patients were aware of this disease, only 24.9% had controlled HTN. ( 6 ). In addition, according to a study conducted on data from the Isfahan Healthy Heart Program, the age-adjusted prevalence of HTN control is 20.9% ( 7 ). In a community trial, Khosravi et al . ( 8 ) demonstrated that an integrated intervention program focused on major risk factors for non-communicable diseases (including unhealthy diet, smoking, lack of physical activity, and stress) could have a favorable impact on HTN control rate. The prevalence of HTN control in this study was estimated at 7.1% in 2001 (before intervention) and 15.8% in 2007 (after intervention) ( 8 ). It has been said that the HTN control rate in both developed and developing countries remains low despite widespread advances in treatment. ( 5 ). Therefore, it is essential to identify barriers to improving the HTN control rate by researching hypertensive patients and focusing on these restrictions through interventions. Based on the literature review, considering that personnel unawareness of the latest sources for the prevention, treatment, and management of HTN is one of the known barriers to HTN control ( 9 – 11 ), this study aimed to focus on general practitioners (GPs) by examining the current status of their knowledge, attitude, and practice regarding national and international HTN treatment guidelines and HTN control rate of patients, and changes in these variables after training the latest national and international guidelines to the GPs. Methods Study design In this before-and-after study, the target population was patients with HTN taking medicine and GPs. The source of choice for patients and physicians was the Isfahan Health Care Centers (HCCs). The intervention in this study was to train GPs on the most recent national and international guidelines for HTN. Thus, this study was conducted in two phases: the first phase (the pre-intervention phase) was conducted from November 3 rd , 2018 to February 19 th , 2019, and the second phase (post-intervention phase) was performed from June 19 th to August 27 th , 2019. Selection of patients Due to the rarity of patients aged ≤ 30 years among HTN patients registered in HCCs, the study included patients aged >30 years old with essential HTN, being treated with antihypertensive drugs, being registered in the HCCs affiliated to Isfahan University of Medical Sciences, having at least one visit by the GP in HCCs during the six months preceding to the study, and consent to participate in the study. The exclusion criteria were mental retardation, incurable illnesses (such as hemorrhagic disease, advanced cancers undergoing chemotherapy, etc.), or any disease that would interfere with HTN treatment. Patients were selected by multistage sampling. About 15 centers were selected among Isfahan HCCs, considering the geographical distribution and coverage level of registered patients with HTN in each center. Then, a list of all patients at each center was prepared. After determining the number of patients needed in each center (according to sample size), subjects were selected from the entire list of patients in that center by simple random sampling. Selection of GPs After we randomly selected HCCs, we invited eligible GPs responsible for hypertension management in the selected HCC to participate in our study. Inclusion criteria for GPs included employment in a HCC affiliated with the Isfahan University of Medical Sciences, responsibility for treating patients with HTN referred to them, and consent to participate in the study. Data collection Two questionnaires were used in this study: 1. General Practitioners’ Questionnaire: This instrument was specifically designed for the present study to assess knowledge (21 questions), attitude (11 questions), and practice (11 questions) (KAP) of general practitioners regarding hypertension management guidelines. Table 1 describes these three indicators. The questionnaire underwent a validation process, and the results of this validation are reported in the manuscript. An English version of the questionnaire is provided in Supplementary File 1. 2. Patients’ Questionnaire: This checklist was developed for the current study to record objective patient characteristics and intervention-related outcomes (e.g., smoking status, physical activity, blood pressure measurements). Due to the objective nature of the items, validation was not required. However, patient adherence to antihypertensive therapy was assessed using the Morisky Medication Adherence Scale (MMAS), which has been previously validated. (Moharamzad Y, 2014 Dec 31) Table 1 Description of the questionnaire developed to assess general practitioners' knowledge, attitude, and practice, Isfahan, 2018-2019 Domain Definition Minimum – maximum score Knowledge The score was obtained by the general practitioner from questions on their awareness of the management and treatment of hypertension according to the newest national and international guidelines. 0 - 21 Attitude The score was obtained by the general practitioner from questions about their opinion about the management and treatment of hypertension according to the newest national and international guidelines. 11 - 55 Practice The score obtained by the general practitioner from questions on how they practically manage and treat patients with hypertension according to the newest national and international guidelines. 0 – 20 It was defined as the level of GPs’ awareness of the correct way of managing and treating high blood pressure according to the latest national and international guidelines. Practice was defined as how the GP treats high blood pressure according to the guidelines. For this questionnaire's content validity to be confirmed, a team of cardiologists, epidemiologists, and general practitioners (GPs) scored the questionnaire's clarity, relevance, and completeness. The clarity indices for knowledge, attitude, practice, and the whole questionnaire were 92.5%, 100%, 79.5%, and 90.9%, respectively. Relevance indices for knowledge, attitude, practice, and the entire questionnaire were 90%, 96.6%, 75%, and 87.5%, respectively, and the comprehensiveness index for the whole questionnaire was 87.5%. Questionnaires were completed twice in 14 days by ten non-participating GPs, and the intra-class correlation (ICC) was calculated between the two tests. The ICC for knowledge, attitude, and practice was 0.81, 0.91, and 0.98, respectively; for the whole questionnaire, it was 0.89. A digital sphygmomanometer (Microlife AG 9443) with two cuffs for the right and left arms was used to measure the blood pressure of each patient. The World Health Organization (WHO) standards for taking blood pressure were met. (12). It was ensured that there were no activities such as going up and down the stairs, running, eating, taking drugs, consuming stimulating drinks such as coffee and tea, and psychological stress for half an hour before the measurement. The patient was asked to sit comfortably in a chair for 5 minutes without moving or talking before measurement, and they were in a calm state without talking to the interviewer during the measurement. The sphygmomanometer cuffs were placed on both arms of the patient, and systolic and diastolic blood pressure were measured simultaneously from the left and right hand of the patient three times at 1-minute intervals. Given that all necessary considerations were met, we trusted all three measurements and considered the average of three measurements as the patient's final blood pressure. Variables The outcome variable in this study was the HTN control (yes/no). HTN control is defined as systolic and diastolic blood pressures lower than 130 and 80 mmHg despite taking antihypertensive drugs (13). In this study, the primary explanatory variable was the GPs’ knowledge, attitude, and practice scores on national and international HTN treatment guidelines in phases I and II of the study. Other variables included age (years), sex, education (number of education years successfully passed), occupation (governmental, self-employed, unemployed, homemaker, retired and student), monthly income (less than $154, $154 to $231, $231 to $385, $385 to $769 and over $769), smoking habit (never/yes in the past/yes at the moment), having moderate weekly physical activity (yes/no), adding salt to food while eating (never/yes when food is low salt/yes always before eating), hyperlipidemia (yes/no), diabetes (yes/no), pulmonary disease (yes/no), stroke history (yes/no), heart attack history (yes/no), family history of HTN in the first-degree relatives (yes/no), number of visits by GP for treatment of HTN in the last year to the first phase of the study, number of visits by GP for the treatment of HTN between the first phase and the second phase of the study, using antihypertensive drugs regularly (yes/no), using two or more antihypertensive medications used to treat HTN (yes/no), the mean systolic and diastolic blood pressure (mmHg), body mass index (BMI) (kg/m 2 ) and waist and hip circumferences (cm). Among these variables, the number of GP visits for treatment of HTN, the use of antihypertensive drugs, systolic and diastolic blood pressure, BMI, and waist and hip circumferences were measured twice (in the first phase and the second phase). (Figure 1) Ethical consideration Informed consent was obtained from all patients and physicians participating in the study. This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (ethical code: IR.MUI.MED.REC.1398.311). Statistical analysis We used SPSS 25 software for data analysis. Continuous and categorical variables were described by mean ± standard deviation (SD) and number (%). We used the Kolmogrov-Smirnov and Shapiro-Wilk tests to check the normality assumption. Within-subject, continuous, and binary variables were compared using the Wilcoxon Signed Ranks and McNemar’s tests, respectively. Multi-nominal logistic regression modeling was used to identify the determinants of the HTN control changes between the study's two phases. The outcome variable in this model was the change in the HTN control at three levels: (I) unchanged (reference group), (II) decreased, and (III) increased. To identify the determinants of HTN control change, the forward strategy introduced by Hosmer and Lemeshow was used. (14). According to this strategy, we first run a simple (univariate) multinominal logistic regression for each of variables of age, sex, education, occupation, monthly income, smoking habit, physical activity, adding salt to meal while eating, hyperlipidemia, diabetes, pulmonary disease, stroke history, heart attack history, family history of HTN, and before-after difference of quantity of antihypertensive drugs regularly used; BMI; weight; waist and hip circumferences; and GPS’s knowledge, attitude and practice. In the second step, all variables with a p-value below 0.2 in univariate models were entered together in the multiple multinomial logistic regression. Finally, variables with a significance level below 0.1 in the second step, including age, not adding salt to meals, and the difference in the GPs' practice score, patients' BMI, and the number of antihypertensive medicines in the second phase, compared to the first phase, were remained at the final model. Results Patients’ characteristics Eight hundred eighty-six patients and 31 physicians participated in the first phase of the trial. In comparison, 656 patients and 22 physicians continued to participate in the second phase (rates of loss to follow-up for patients and physicians were 26% and 29.0%, respectively). The patient’s mean (SD) age was 57.8 (8.8), and their mean (SD) age at diagnosis of HTN was 42.09 (9.9). The range of schooling years completed was 0 to 23 years, with a mean (SD) of 6.4 (5.0) years. Table 2 lists the additional characteristics of the participants. Table 2 Characteristics of patients with hypertension, Isfahan, 2018–2019 Variables Phase I a Phase II b Number (%) or Mean (SD) Number (%) or Mean (SD) Gender Female 637 (71.9) . Male 249 (28.1) . Marital status Married . 572 (87.2) Single . 0 (0.0) Divorced . 2 (0.3) Widowed . 80 (12.2) No answered . 2 (0.3) Job Governmental 23 (2.6) . self-employment 81 (9.1) . Unemployed 14 (1.6) . Homemaker 594 (67.0) . Retired 173 (19.5) . School/university student 1 (0.1) . Monthly income < 20/000/000 IRR 750 (84.7) . 20/000/000–30/000/000 IRR 93 (10.5) . 30/000/000–50/000/000 IRR 40 (4.5) . > 50/000/000 IRR 3 (0.3) . Smoking Never 821 (92.7) . Current Smoker 24 (2.7) . Past smoker 39 (4.4) . Weekly physical activity (yes) 513 (57.9) . Adding salt to foods while eating . Never 695 (78.4) . Yes, when food is low in salt 179 (20.2) . Yes, always before eating 10 (1.1) . Hyperlipidemia (yes) 517 (58.4) . Diabetes (yes) 381 (43.0) . Pulmonary disease (yes) 70 (7.9) . Positive stroke history (yes) 37 (4.2) . Positive heart attack history (yes) 48 (5.4) . Hypertension family history (yes) 673 (76.0) . Body Mass Index (kg/m 2 ) 30.3 (4.9) 29.9 (4.8) Waist circumference 99.2 (11.2) 102.5 (10.2) Hip circumference 102.1 (7.9) 102.4 (8.3) Number of visits to the physician from one year before study 4.2 (4.5) . Number of visits to the physician from Phase I to Phase II . 2.1 (2.30) Taking antihypertensive drugs regularly 832 (93.9) 622 (94.8) Taking 2 or more antihypertensive drugs for hypertension therapy daily (yes) 495 (55.9) 369 (56.3) Type of antihypertensive drug P-value d Angiotensin Receptor Blockers 568 (64.1) 402 (61.3) < 0.001 Beta Blockers 328 (37.0) 213 (24.0) < 0.001 Calcium Chanel Blockers 194 (21.9) 135 (20.6) < 0.001 Diuretics 224 (25.3) 199 (22.5) 0.081 Nitrate 28 (3.2) 2 (0.3) 0.125 Angiotensin-converting enzyme inhibitors 22 (2.5) 14 (2.1) 0.077 a November 2018−February 2019, b June – August 2019 c Marital status was asked only in the second phase (in 656 patients). d McNemar Test. As shown, most of the participants were female, married, homemakers, earning less than $ 154 a month, nonsmokers, and physically active. The majority of respondents said they never add salt to their diet. Although a large proportion of patients had hyperlipidemia, diabetes, and a family history of HTN, the majority of participants lacked pulmonary illness, a history of stroke, and a history of heart attack. During the year before the research, the average number of GP visits for HTN at HCCs was 4.2 (roughly every three months). However, between phase I and phase II (within a 4-month gap), the average number of GP visits for HTN at HCCs was 2.3. (Almost every two months). In all rounds of the trial, the majority of HTN patients reported routinely taking their prescribed medicine. In the second phase, the proportion of patients using two or more antihypertensive medications increased relative to the first. Angiotensin II receptor blockers (ARBs) were the most frequently prescribed medicines in both research periods. Although the use of this type of antihypertensive medication decreased in the second phase compared to the first, the usage of ARB/Thiazide (a Fixed-Dose Combination (FDC) therapy) rose in the second phase compared to the first. Physicians’ characteristics This research included 6 (19.4%) male and 25 (80.6%) female general practitioners. Table 3 contains additional physician traits and their ratings on knowledge, attitude, and practice. Table 3 Physician characteristics and their score on questionnaire, Isfahan, Iran, 2018–2019 Phase I* Phase II ** Variables Mean (SD) or Number (%) Mean (SD) or Number (%) P-value Age (year) 44.5 (8.5) . . Duration of work experience (year) 16.4 (8.8) . . Duration of work experience with HTN therapy (year) 14.4 (8.3) . . Previous familiarity with standard HTN guidelines (yes) 18 (58.1) . . Learning about HTN guidelines via CME (yes) 15 (48.4) . . Applying the acquired training in clinical practice (yes) 20 (64.5) . . Score on questionnaire: Knowledge 12.9 (1.9) 13.1 (2.6) 0.003 † Attitude 42.5 (2.9) 42.9 (5.7) 0.007 † Practice 14.6 (1.6) 14.7 (1.3) 0.064 † HTN: hypertension, CME: continuing medical education * November 2018−February 2019 ** June – August 2019 † From Wilcoxon Signed Ranks Test As shown, the GPs who participated in the research were, on average, middle-aged, had more than 16 years of professional experience, and had more than 14 years of expertise treating HTN. Most of them stated that they had already been familiar with HTN treatment guidelines. About half of them said that they have received training on HTN via continuing medical education (CME) programs, and more than two-thirds of them indicated that they implement the information in their practice. Assessment of the educational program The evaluation of their knowledge, attitude, and practice prior to and after educational intervention revealed that the physicians' knowledge and attitude scores increased significantly. In contrast, their practice scores increased slightly but significantly during the study and after educational intervention (Table 3 ). Hypertension control and its determinants Table 4 shows the mean systolic and diastolic blood pressures of patients' right and left arms throughout the first and second phases of the research. Table 4 Patients’ systolic and diastolic blood pressure in phases I and II of study, Isfahan, Iran, 2018–2019 Variables Phase I * Phase II ** P-value Mean ± SD / N (%) Mean ± SD / N (%) Right arm Systolic Blood Pressure 132.2 ± 17.4 124.9 ± 14.4 < 0.001† Left arm Systolic Blood Pressure 133.9 ± 17.4 125.9 ± 14.9 < 0.001† Right arm Diastolic Blood Pressure 78.4 ± 11.2 74.8 ± 9.9 < 0.001† Left arm Diastolic Blood Pressure 78.9 ± 11.1 74.8 ± 10.1 < 0.001† Patients with Hypertension control 338 (38.1) 376 (57.3) < 0.001‡ SD: standard deviation * November 2018−February 2019 ** June – August 2019 † From Wilcoxon Signed Ranks Test ‡ From McNemar's Test In the second part of the trial, the mean systolic and diastolic blood pressures in both arms were lower than in the first phase. The Wilcoxon test revealed that the systolic and diastolic blood pressures in both groups decreased significantly. In the first and second phases of the trial, there were 338 (38.1%) and 376 (57.3%) HTN-controlled patients, respectively. This rise was statistically significant (P 0.0001), as determined by McNemar's test. In the first phase, the prevalence rates of HTN control in women and men were 41.8% and 30%, respectively (P = 0.001), whereas in the second phase, these rates were 60.9% and 48.4%, respectively (P = 0.003). McNemar's test revealed a substantial rise in the HTN control rate between the first and second phases of the trial (P 0.001) for both men and women. In terms of age groups, the prevalence rates of HTN control in the lower-than-60-year group and equal-or-more-than-60-year group in the first phase were 42.0% and 33.6%, respectively (P = 0.012), whereas, in the second phase, these rates were 55.7% and 59.6%, respectively (P = 0.003). McNemar's test revealed a substantial rise in the HTN control rate between the first and second phases of the trial (P 0.001) for both age groups. A multi-nominal logistic regression model was used to determine the predictors of the change in HTN control in the second phase of the investigation, compared to the first phase of the study. Table 5 shows the finalized model. Age, not adding salt to meals, and the difference in the GPs' practice score, patients' BMI, and the number of antihypertensive medicines in the second phase, compared to the first phase, were among the variables that influenced the change in HTN control in the second phase, compared to the first. Table 5 Determinants of change in hypertension control from Phase I* to Phase II**, identified by multi-nominal logistic regression, Isfahan, Iran, 2018–2019 Variables Unchanged HTN-Control Deteriorated HTN-Control Improved HTN-Control OR CI P-value OR CI P-value OR CI P-value Age (year) 1.00 - - 0.96 0.92–0.99 0.018 1.02 1.00–1.04 0.094 GPs practice score difference 1.00 - - 0.79 0.64–0.97 0.027 1.00 0.89–1.14 0.904 BMI difference 1.00 - - 1.00 0.77–1.30 0.995 0.77 0.65–0.92 0.004 Change in the number of antihypertensive drugs Unchanged 1.00 - - 1.58 0.36–6.97 0.549 0.69 0.38–1.25 0.219 Decreased 1.00 - - 4.63 0.93–23.06 0.061 0.71 0.31–1.61 0.410 Increased 1.00 - - 1.00 - - 1.00 - - Not adding salt to foods while eating (yes) 1.00 - - 0.47 0.24–0.94 0.033 1.23 0.75–2.01 0.403 HTN: hypertension, BMI: body mass index, GP: general practitioner * November 2018−February 2019 ** June – August 2019 † The dependent variable was the change in hypertension control at three levels: unchanged (reference group), decreased, and increased Discussion In this study, the mean systolic and diastolic blood pressures of patients significantly decreased in the second phase of the study, compared to the first phase of the study, and the HTN control rate was significantly increased. There are several reasons for these favorable changes: First, the scores of knowledges and attitudes of GPs were substantially higher after training, and the GPs’ practice scores increased, but it was borderline significant. The majority of GPs participating in this study stated that they are practicing the training they received in the treatment of HTN. Therefore, following the educational intervention in this study, a favorable change in the HTN control rate has occurred. The impact of lack of knowledge, attitude, and poor practice of the treatment team on the inadequate control of HTN has been shown in various studies ( 10 , 11 , 16 ). Myanganbayar et al . ( 17 ), examining the knowledge, attitude, and practice of primary care physicians in Ulaanbaatar, Mongolia, showed that the low level of knowledge and practice of these physicians would be associated with an insufficient level of HTN control in patients ( 17 ). The GPs participating in this study were primarily female. It is due to this reality that the majority of GPs in Isfahan HCCs are women. Considering the better performance of women GPs compared with men GPs is indicated in the previous.( 18 )In our study, we can conclude that women GPs may be exceptionally proficient at achieving better outcomes in HTN care. The baseline blood pressures before the educational intervention were, on average, very close to guideline-recommended blood pressure targets (in Europe, systolic BP was < 140 mmHg, and in the U.S., < 130 mmHg). We can undoubtedly attribute this observation to two reasons: I) All participants in this study were HTN patients who consume medical treatment for their disease. So, closing their blood pressure levels to guideline-recommended blood pressure targets is partly due to their hypertension drug use. II) the existence of a comprehensive and accurate program for the regular follow-up of patients with high blood pressure registered in Isfahan healthcare centers is another reason for this finding. Another reason for observing improvements in the control of HTN in this study is that the number of visits to the GP in HCC for HTN treatment increased from the first to the second phase of the study compared to the number of visits in the year before the survey. As such, the more patients have contact with the physician, the better the opportunity to review their blood pressure status in an attempt to improve it. Increment in patients taking ARB/Thiazide compound during the study is another potential contributor to the improved HTN control rate in this study. The emphasis of the new national and international standard guidelines for HTN on the use of combination therapy justifies this. ( 19 ). In low-dose combination therapy, there is a greater adherence to treatment because of the minimization of drug side effects and the maintenance of beneficial drug effects. ( 20 ). In addition, the percentage of patients taking two or more antihypertensive drugs increased slightly during the study. Since mono-drug therapy has poor potency in controlling HTN ( 20 ), the improvement in the control of HTN may be partly attributed to the increased number of medications used during the study. The comparison of the HTN control rate between males and females showed that despite the improved HTN status in both sexes, females had more control over blood pressure than males in both phases of the study. This sex difference has been observed in different studies on the HTN control rate. According to Marques et al. ( 21 ) In general, because drug adherence is more prevalent in women than men, and alcohol consumption as one of the barriers to control of HTN is more prevalent in men, therefore women are expected to be more responsive to the control of HTN, compared to men. ( 21 ). Reckelhoff ( 22 ) argues that sex differences in the control of HTN depend on a variety of mechanisms, such as sex differences in the renin-angiotensin system, sympathetic activity, sleep apnea, and the effect of the relaxin hormone. One of the factors influencing the improvement in the HTN control rate in this study was age. As the age of patients increased, the odds of improving the HTN control were increased. Although other studies have shown that the control of HTN in older people is lower due to a multitude of tasks, burdensome responsibilities, and lack of adequate support from family and medical team ( 16 ), these findings are inconsistent with the present study, which can be attributed to the greater interest of older people in participating in the research and their more significant attention to the researchers' recommendations than younger individuals. Another influential factor in this model was a change in GPs' practice scores following the training of national and international HTN treatment guidelines. As noted above, other studies have also shown the effect of this agent on improving HTN control. ( 17 , 23 ). Another factor was the change in BMI during the study. As demonstrated in the results section, the mean BMI of patients slightly decreased during the study. Given that the mean BMI in both study phases is more than 25 kg/m 2 , and having a BMI of more than 25 kg/m 2 is an independent risk factor for HTN ( 24 )Therefore, it can be said that the decrease in BMI during the study was not sufficient to have a favorable effect on improving the HTN control rate. The next factor identified in this model was the change in the number of antihypertensive drugs during the study. Those who reduced their drug intake during the study had increased odds of not controlling HTN, and their odds of improving the HTN control rate decreased. Although monotherapy is the most common current therapy for the treatment of HTN worldwide, evidence suggests that this treatment has poor potency in controlling HTN, even at high doses. ( 20 ). According to the results of a meta-analysis, a two-drug combination therapy with a low-to-standard dosage is more effective in controlling HTN than a standard single-dose treatment. ( 25 )The last identified factor contributing to the improved HTN control rate in this model was not adding salt to the food while eating. People who were prevented from adding salt when eating had greater odds of improving their HTN control rate. This study had remarkable strengths in that it was a nationwide study performed on representative samples of GPs and HTN patients from 15 centers. Sampling was conducted entirely at random, and centers were selected based on socio-economic and geographical maximum variation in Isfahan Metropolitan. So, our findings can be generalizable to the broad HTN community. Detailed training of interviewers and supervision of their work throughout the study, use of accurate and calibrated anthropometric tools, and standardization of the questionnaire before measuring GPs' knowledge, attitude, and practice are other advantages of this study. However, we had some limitations in this study. We asked about the status of health behaviors, i.e., smoking, physical activity, and so on, only in the first phase of the study, assuming no significant changes in them during the short period of study. We suggest considering changes in all essential health behaviors, even if we are talking about a brief observation period in future studies. We also recommend a more extended study to see the effect of GP training on HTN control. As another limitation, poor adherence by patients to their medication-taking and inadequate prescribing by physicians are among the most important affecting factors on HTN control that were ignored in this study. It is suggested that they be considered in future studies. Conclusion This study showed that following training the latest national and international guidelines on HTN management to GPs, there was a significant shift in their knowledge, attitude, and practice in the management of HTN and a significant increase in the HTN control rate in patients. Therefore, it seems that periodic training sessions for PHC staff, as well as regular follow-up of patients with HTN and examining their blood pressure, type and number of medications, and lifestyle over time, are effective ways to improve the HTN control rate in society. Declarations Conflicts of Interest: No conflict of interest exists. Funding: The costs of data collection and training programs in this research were supported entirely by COBEL DAROU company. Ethics approval: All procedures performed were under the institutional and/or national research committee's ethical standards, the 1964 Helsinki Declaration and later amendments, or comparable ethical standards. Isfahan University neurosurgery department board members supervised and approved this report on behalf of the Ethical Committee of Isfahan University of Medical Sciences (ethical code: IR.MUI.MED.REC.1398.311). Consent to participate: Informed consent was obtained from all individual participants included in the Study. Consent for publication: Informed written consent was obtained from the patient. Availability of data and material: The data that support the findings of this study are available from the corresponding author upon reasonable request. Some data may not be made available because of privacy or ethical restrictions. Data and original images in the current study are available from the corresponding author upon reasonable request. Authors can confirm that all relevant data are included in the article and/or its supplementary information files. Acknowledgments: The author would like to thank the patients and their families for their trust. The authors would like to thank Nigan for his valuable time helping us prepare this manuscript. References Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: rationale, methods and main findings. Journal of human hypertension. 2011;25(9):545-53. Sarrafzadegan N, Hassannejad R, Marateb HR, Talaei M, Sadeghi M, Roohafza HR, et al. PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region. PloS one. 2017;12(12):e0189389. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. 2013;310(9):959-68. Schiffrin EL, Campbell NR, Feldman RD, Kaczorowski J, Lewanczuk R, Padwal R, et al. Hypertension in Canada: past, present, and future. 2016;82(2):288-99. Hien HA, Tam NM, Tam V, Derese A, Devroey DJIjoh. Prevalence, awareness, treatment, and control of hypertension and its risk factors in (Central) Vietnam. 2018;2018. Talaei M, Sadeghi M, Mohammadifard N, Shokouh P, Oveisgharan S, Sarrafzadegan NJJoh. Incident hypertension and its predictors: the Isfahan Cohort Study. 2014;32(1):30-8. Gharipour M, Khosravi A, Sadeghi M, Roohafza H, Hashemi M, Sarrafzadegan NJAa. Socioeconomic characteristics and controlled hypertension: evidence from Isfahan Healthy Heart Program. 2013;9(1):77. Khosravi A, Mehr GK, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program. 2010;10(1):61. Heinert S, Escobar-Schulz S, Jackson M, Del Rios M, Kim S, Kahkejian J, et al. Barriers and Facilitators to Hypertension Control Following Participation in a Church-Based Hypertension Intervention Study. American Journal of Health Promotion. 2019:0890117119868384. Gupta R, Khedar RS, Panwar RBJJAPI. Strategies for better hypertension control in India and other lower middle income countries. 2016;64(9):58-64. Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach. 2015;15(1):254. Eghbali M, Khosravi A, Feizi A, Mansouri A, Mahaki B, Sarrafzadegan N. Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran. Epidemiology and health. 2018;40:e2018020. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2018;71(19):e127-e248. Jewell NP. Statistics for epidemiology: Chapman and Hall/CRC; 2003. Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. Jama. 2013;310(7):699-705. Gholamnejad H, Darvishpoor Kakhki A, Ahmadi F, Rohani CJWwOP. Barriers to self-care in elderly people with hypertension: a qualitative study. 2018;22(4):243-51. Myanganbayar M, Baatarsuren U, Chen G, Bosurgi R, So G, Campbell NR, et al. Hypertension, knowledge, attitudes, and practices of primary care physicians in Ulaanbaatar, Mongolia. 2018;20(8):1187-92. Delpech R, Bloy G, Panjo H, Falcoff H, Ringa V, Rigal L. Physicians’ preventive practices: more frequently performed for male patients and by female physicians. BMC Health Services Research. 2020;20(1):331. Rea F, Corrao G, Merlino L, Mancia GJEHJ. Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension. 2018;39(40):3654-61. Chow CK, Thakkar J, Bennett A, Hillis G, Burke M, Usherwood T, et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet (London, England). 2017;389(10073):1035-42. Marques-Vidal P, Arveiler D, Amouyel P, Bingham A, Ferrières JJJoh. Sex differences in awareness and control of hypertension in France. 1997;15(11):1205-10. Reckelhoff JFJCoin, hypertension. Gender differences in hypertension. 2018;27(3):176-81. Redon J, Erdine S, Böhm M, Ferri C, Kolloch R, Kreutz R, et al. Physician attitudes to blood pressure control: findings from the Supporting Hypertension Awareness and Research Europe-wide survey. 2011;29(8):1633-40. Hamano T, Shiotani Y, Takeda M, Abe T, Sundquist K, Nabika T. Is the Effect of Body Mass Index on Hypertension Modified by the Elevation? A Cross-Sectional Study of Rural Areas in Japan. 2017;14(9):1022. Salam A, Kanukula R, Atkins E, Wang X, Islam S, Kishore SP, et al. Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials. 2019;37(9):1768-74. Additional Declarations No competing interests reported. Supplementary Files EPIBEFORETranslated.docx EPIPatientsAFTERTranslated.docx EPIPhysician.questionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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11:29:28\",\"extension\":\"docx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":49131,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"EPIPhysician.questionnaire.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7192375/v1/ebfb83faad8b82b101b05963.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003egIncrease In Hypertension Control Rate following the Training of the Latest National- International Hypertension Management Guidelines for General Practitioners\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eFollowing hypertension (HTN), the risk of heart attack, heart failure, stroke, kidney disease, and vision problems increases. (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Although the benefits of controlling HTN have been well-documented in patients (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Canada has the highest rate of HTN control among the different countries in the world. This country's control rate of HTN rose from 13% in 1992 to 68% in 2013 (\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAccording to the Isfahan Cohort Study, while 49.6% of hypertensive patients were aware of this disease, only 24.9% had controlled HTN. (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). In addition, according to a study conducted on data from the Isfahan Healthy Heart Program, the age-adjusted prevalence of HTN control is 20.9% (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn a community trial, Khosravi \\u003cem\\u003eet al\\u003c/em\\u003e. (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e) demonstrated that an integrated intervention program focused on major risk factors for non-communicable diseases (including unhealthy diet, smoking, lack of physical activity, and stress) could have a favorable impact on HTN control rate. The prevalence of HTN control in this study was estimated at 7.1% in 2001 (before intervention) and 15.8% in 2007 (after intervention) (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIt has been said that the HTN control rate in both developed and developing countries remains low despite widespread advances in treatment. (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Therefore, it is essential to identify barriers to improving the HTN control rate by researching hypertensive patients and focusing on these restrictions through interventions.\\u003c/p\\u003e\\u003cp\\u003eBased on the literature review, considering that personnel unawareness of the latest sources for the prevention, treatment, and management of HTN is one of the known barriers to HTN control (\\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e), this study aimed to focus on general practitioners (GPs) by examining the current status of their knowledge, attitude, and practice regarding national and international HTN treatment guidelines and HTN control rate of patients, and changes in these variables after training the latest national and international guidelines to the GPs.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy design\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn this before-and-after study, the target population was patients with HTN taking medicine and GPs. The source of choice for patients and physicians was the Isfahan Health Care Centers (HCCs). The intervention in this study was to train GPs on the most recent national and international guidelines for HTN. Thus, this study was conducted in two phases: the first phase (the pre-intervention phase) was conducted from November 3\\u003csup\\u003erd\\u003c/sup\\u003e, 2018 to February 19\\u003csup\\u003eth\\u003c/sup\\u003e, 2019, and the second phase (post-intervention phase) was performed from June 19\\u003csup\\u003eth\\u003c/sup\\u003e to August 27\\u003csup\\u003eth\\u003c/sup\\u003e, 2019.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSelection of patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDue to the rarity of patients aged \\u0026le; 30 years among HTN patients registered in HCCs, the study included patients aged \\u0026gt;30\\u0026nbsp;years old with essential HTN, being treated with antihypertensive drugs, being registered in the HCCs affiliated to Isfahan University of Medical Sciences, having at least one visit by the GP in HCCs during the six months preceding to the study, and consent to participate in the study. The exclusion criteria were mental retardation, incurable illnesses (such as hemorrhagic disease, advanced cancers undergoing chemotherapy, etc.), or any disease that would interfere with HTN treatment.\\u003c/p\\u003e\\n\\u003cp\\u003ePatients were selected by multistage sampling. About 15 centers were selected among Isfahan HCCs, considering the geographical distribution and coverage level of registered patients with HTN in each center. Then, a list of all patients at each center was prepared. After determining the number of patients needed in each center (according to sample size), subjects were selected from the entire list of patients in that center by simple random sampling.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSelection of GPs\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAfter we randomly selected HCCs, we invited eligible GPs responsible for hypertension management in the selected HCC to participate in our study. Inclusion criteria for GPs included employment in a HCC affiliated with the Isfahan University of Medical Sciences, responsibility for treating patients with HTN referred to them, and consent to participate in the study.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTwo questionnaires were used in this study:\\u003c/p\\u003e\\n\\u003cp\\u003e1. General Practitioners\\u0026rsquo; Questionnaire: This instrument was specifically designed for the present study to assess knowledge (21 questions), attitude (11 questions), and practice (11 questions) (KAP) of general practitioners regarding hypertension management guidelines. Table 1 describes these three indicators. The questionnaire underwent a validation process, and the results of this validation are reported in the manuscript. An English version of the questionnaire is provided in Supplementary File 1.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e2. Patients\\u0026rsquo; Questionnaire: This checklist was developed for the current study to record objective patient characteristics and intervention-related outcomes (e.g., smoking status, physical activity, blood pressure measurements). Due to the objective nature of the items, validation was not required. However, patient adherence to antihypertensive therapy was assessed using the Morisky Medication Adherence Scale (MMAS), which has been previously validated.\\u0026nbsp;(Moharamzad Y, 2014 Dec 31)\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1 Description of the questionnaire developed to assess general practitioners\\u0026apos; knowledge, attitude, and practice, Isfahan, 2018-2019\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"690\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003eDomain\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 428px;\\\"\\u003e\\n \\u003cp\\u003eDefinition\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eMinimum \\u0026ndash; maximum score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003eKnowledge\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 428px;\\\"\\u003e\\n \\u003cp\\u003eThe score was obtained by the general practitioner from questions on their awareness of the management and treatment of hypertension according to the newest national and international guidelines.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0 - 21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003eAttitude\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 428px;\\\"\\u003e\\n \\u003cp\\u003eThe score was obtained by the general practitioner from questions about their opinion about the management and treatment of hypertension according to the newest national and international guidelines.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e11 - 55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003ePractice\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 428px;\\\"\\u003e\\n \\u003cp\\u003eThe score obtained by the general practitioner from questions on how they practically manage and treat patients with hypertension according to the newest national and international guidelines.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0 \\u0026ndash; 20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eIt was defined as the level of GPs\\u0026rsquo; awareness of the correct way of managing and treating high blood pressure according to the latest national and international guidelines. Practice was defined as how the GP treats high blood pressure according to the guidelines. For this questionnaire\\u0026apos;s content validity to be confirmed, a team of cardiologists, epidemiologists, and general practitioners (GPs) scored the questionnaire\\u0026apos;s clarity, relevance, and completeness. The clarity indices for knowledge, attitude, practice, and the whole questionnaire were 92.5%, 100%, 79.5%, and 90.9%, respectively. Relevance indices for knowledge, attitude, practice, and the entire questionnaire were 90%, 96.6%, 75%, and 87.5%, respectively, and the comprehensiveness index for the whole questionnaire was 87.5%. Questionnaires were completed twice in 14 days by ten non-participating GPs, and the intra-class correlation (ICC) was calculated between the two tests. The ICC for knowledge, attitude, and practice was 0.81, 0.91, and 0.98, respectively; for the whole questionnaire, it was 0.89.\\u003c/p\\u003e\\n\\u003cp skip=\\\"true\\\"\\u003eA digital sphygmomanometer (Microlife AG 9443) with two cuffs for the right and left arms was used to measure the blood pressure of each patient. The World Health Organization (WHO) standards for taking blood pressure were met. (12). It was ensured that there were no activities such as going up and down the stairs, running, eating, taking drugs, consuming stimulating drinks such as coffee and tea, and psychological stress for half an hour before the measurement. The patient was asked to sit comfortably in a chair for 5 minutes without moving or talking before measurement, and they were in a calm state without talking to the interviewer during the measurement. The sphygmomanometer cuffs were placed on both arms of the patient, and systolic and diastolic blood pressure were measured simultaneously from the left and right hand of the patient three times at 1-minute intervals. Given that all necessary considerations were met, we trusted all three measurements and considered the average of three measurements as the patient\\u0026apos;s final blood pressure.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eVariables\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe outcome variable in this study was the HTN control (yes/no). HTN control is defined as systolic and diastolic blood pressures lower than 130 and 80 mmHg despite taking antihypertensive drugs (13).\\u003c/p\\u003e\\n\\u003cp\\u003eIn this study, the primary explanatory variable was the GPs\\u0026rsquo; knowledge, attitude, and practice scores on national and international HTN treatment guidelines in phases I and II of the study.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOther variables included age (years), sex, education (number of education years successfully passed), occupation (governmental, self-employed, unemployed, homemaker, retired and student), monthly income (less than $154, $154 to $231, $231 to $385, $385 to $769 and over $769), smoking habit (never/yes in the past/yes at the moment), having moderate weekly physical activity (yes/no), adding salt to food while eating (never/yes when food is low salt/yes always before eating), hyperlipidemia (yes/no), diabetes (yes/no), pulmonary disease (yes/no), stroke history (yes/no), heart attack history (yes/no), family history of HTN in the first-degree relatives (yes/no), number of visits by GP for treatment of HTN in the last year to the first phase of the study, number of visits by GP for the treatment of HTN between the first phase and the second phase of the study, using antihypertensive drugs regularly (yes/no), using \\u0026nbsp;two or more antihypertensive medications used to treat HTN (yes/no), the mean systolic and diastolic blood pressure (mmHg), body mass index (BMI) (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e) and waist and hip circumferences (cm).\\u003c/p\\u003e\\n\\u003cp\\u003eAmong these variables, the number of GP visits for treatment of HTN, the use of antihypertensive drugs, systolic and diastolic blood pressure, BMI, and waist and hip circumferences were measured twice (in the first phase and the second phase). (Figure 1)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical consideration\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInformed consent was obtained from all patients and physicians participating in the study. This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (ethical code: IR.MUI.MED.REC.1398.311).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe used SPSS 25 software for data analysis. Continuous and categorical variables were described by mean \\u0026plusmn; standard deviation (SD) and number (%). We used the Kolmogrov-Smirnov and Shapiro-Wilk tests to check the normality assumption. Within-subject, continuous, and binary variables were compared using the Wilcoxon Signed Ranks and McNemar\\u0026rsquo;s tests, respectively. Multi-nominal logistic regression modeling was used to identify the determinants of the HTN control changes between the study\\u0026apos;s two phases. The outcome variable in this model was the change in the HTN control at three levels: (I) unchanged (reference group), (II) decreased, and (III) increased. \\u0026nbsp;To identify the determinants of HTN control change, the forward strategy introduced by Hosmer and Lemeshow was used. (14). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAccording to this strategy, we first run a simple (univariate) multinominal logistic regression for each of variables of age, sex, education, occupation, monthly income, smoking habit, physical activity, adding salt to meal while eating, hyperlipidemia, diabetes, pulmonary disease, stroke history, heart attack history, family history of HTN, and before-after difference of quantity of antihypertensive drugs regularly used; BMI; weight; waist and hip circumferences; and GPS\\u0026rsquo;s knowledge, attitude and practice. In the second step, all variables with a p-value below 0.2 in univariate models were entered together in the multiple multinomial logistic regression. Finally, variables with a significance level below 0.1 in the second step, including age, not adding salt to meals, and the difference in the GPs\\u0026apos; practice score, patients\\u0026apos; BMI, and the number of antihypertensive medicines in the second phase, compared to the first phase, were remained at the final model.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cimg 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\\\"\\u003e\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePatients\\u0026rsquo; characteristics\\u003c/h2\\u003e\\u003cp\\u003eEight hundred eighty-six patients and 31 physicians participated in the first phase of the trial. In comparison, 656 patients and 22 physicians continued to participate in the second phase (rates of loss to follow-up for patients and physicians were 26% and 29.0%, respectively). The patient\\u0026rsquo;s mean (SD) age was 57.8 (8.8), and their mean (SD) age at diagnosis of HTN was 42.09 (9.9). The range of schooling years completed was 0 to 23 years, with a mean (SD) of 6.4 (5.0) years. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e lists the additional characteristics of the participants.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eCharacteristics of patients with hypertension, Isfahan, 2018\\u0026ndash;2019\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" morerows=\\\"1\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePhase I\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003ePhase II\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eNumber (%) or\\u003c/p\\u003e\\u003cp\\u003eMean (SD)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003eNumber (%) or Mean (SD)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eGender\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e637 (71.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e249 (28.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eMarital status\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eMarried\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e572 (87.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSingle\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0 (0.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eDivorced\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e2 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eWidowed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e80 (12.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNo answered\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e2 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eJob\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eGovernmental\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e23 (2.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eself-employment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e81 (9.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eUnemployed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e14 (1.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHomemaker\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e594 (67.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eRetired\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e173 (19.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSchool/university student\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1 (0.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eMonthly income\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;20/000/000 IRR\\u003c/p\\u003e \\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e750 (84.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e20/000/000\\u0026ndash;30/000/000 IRR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e93 (10.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e30/000/000\\u0026ndash;50/000/000 IRR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e40 (4.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026gt;\\u0026thinsp;50/000/000 IRR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSmoking\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNever\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e821 (92.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eCurrent Smoker\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24 (2.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePast smoker\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e39 (4.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eWeekly physical activity (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e513 (57.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAdding salt to foods while eating\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNever\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e695 (78.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eYes, when food is low in salt\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e179 (20.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eYes, always before eating\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e10 (1.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHyperlipidemia (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e517 (58.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eDiabetes (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e381 (43.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePulmonary disease (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e70 (7.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePositive stroke history (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e37 (4.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePositive heart attack history (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e48 (5.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHypertension family history (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e673 (76.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eBody Mass Index (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30.3 (4.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e29.9 (4.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eWaist circumference\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e99.2 (11.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e102.5 (10.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHip circumference\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e102.1 (7.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e102.4 (8.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNumber of visits to the physician from one year before study\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.2 (4.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNumber of visits to the physician from Phase I to Phase II\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e2.1 (2.30)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eTaking antihypertensive drugs regularly\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e832 (93.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e622 (94.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eTaking 2 or more antihypertensive drugs for hypertension therapy daily (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e495 (55.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e369 (56.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eType of antihypertensive drug\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eP-value\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAngiotensin Receptor Blockers\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e568 (64.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e402 (61.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBeta Blockers\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e328 (37.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e213 (24.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCalcium Chanel Blockers\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e194 (21.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e135 (20.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDiuretics\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e224 (25.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e199 (22.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.081\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNitrate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e28 (3.2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2 (0.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.125\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAngiotensin-converting enzyme inhibitors\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e22 (2.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e14 (2.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.077\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e November 2018\\u0026minus;February 2019,\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003e June \\u0026ndash; August 2019\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003e Marital status was asked only in the second phase (in 656 patients).\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003ed\\u003c/sup\\u003e McNemar Test.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eAs shown, most of the participants were female, married, homemakers, earning less than \\u003cspan\\u003e$\\u003c/span\\u003e154 a month, nonsmokers, and physically active. The majority of respondents said they never add salt to their diet. Although a large proportion of patients had hyperlipidemia, diabetes, and a family history of HTN, the majority of participants lacked pulmonary illness, a history of stroke, and a history of heart attack. During the year before the research, the average number of GP visits for HTN at HCCs was 4.2 (roughly every three months). However, between phase I and phase II (within a 4-month gap), the average number of GP visits for HTN at HCCs was 2.3. (Almost every two months).\\u003c/p\\u003e\\u003cp\\u003eIn all rounds of the trial, the majority of HTN patients reported routinely taking their prescribed medicine. In the second phase, the proportion of patients using two or more antihypertensive medications increased relative to the first. Angiotensin II receptor blockers (ARBs) were the most frequently prescribed medicines in both research periods. Although the use of this type of antihypertensive medication decreased in the second phase compared to the first, the usage of ARB/Thiazide (a Fixed-Dose Combination (FDC) therapy) rose in the second phase compared to the first.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePhysicians\\u0026rsquo; characteristics\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis research included 6 (19.4%) male and 25 (80.6%) female general practitioners. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e contains additional physician traits and their ratings on knowledge, attitude, and practice.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePhysician characteristics and their score on questionnaire, Isfahan, Iran, 2018\\u0026ndash;2019\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePhase I*\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePhase II **\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMean (SD) or Number (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMean (SD) or Number (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eP-value\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge (year)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e44.5 (8.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eDuration of work experience (year)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16.4 (8.8)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eDuration of work experience with HTN therapy (year)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14.4 (8.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003ePrevious familiarity with standard HTN guidelines (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e18 (58.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eLearning about HTN guidelines via CME (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15 (48.4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eApplying the acquired training in clinical practice (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20 (64.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eScore on questionnaire:\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eKnowledge\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12.9 (1.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e13.1 (2.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.003 \\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAttitude\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e42.5 (2.9)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e42.9 (5.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.007 \\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePractice\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14.6 (1.6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e14.7 (1.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.064 \\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHTN: hypertension, CME: continuing medical education\\u003c/p\\u003e\\u003cp\\u003e* November 2018\\u0026minus;February 2019\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003e**\\u003c/sup\\u003e June \\u0026ndash; August 2019\\u003c/p\\u003e\\u003cp\\u003e\\u0026dagger; From Wilcoxon Signed Ranks Test\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eAs shown, the GPs who participated in the research were, on average, middle-aged, had more than 16 years of professional experience, and had more than 14 years of expertise treating HTN. Most of them stated that they had already been familiar with HTN treatment guidelines. About half of them said that they have received training on HTN via continuing medical education (CME) programs, and more than two-thirds of them indicated that they implement the information in their practice.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eAssessment of the educational program\\u003c/h2\\u003e\\u003cp\\u003eThe evaluation of their knowledge, attitude, and practice prior to and after educational intervention revealed that the physicians' knowledge and attitude scores increased significantly. In contrast, their practice scores increased slightly but significantly during the study and after educational intervention (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eHypertension control and its determinants\\u003c/h2\\u003e\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e shows the mean systolic and diastolic blood pressures of patients' right and left arms throughout the first and second phases of the research.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePatients\\u0026rsquo; systolic and diastolic blood pressure in phases I and II of study, Isfahan, Iran, 2018\\u0026ndash;2019\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePhase I *\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePhase II **\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eP-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD / N (%)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD / N (%)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight arm Systolic Blood Pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e132.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e124.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLeft arm Systolic Blood Pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e133.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e125.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRight arm Diastolic Blood Pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e78.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e74.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLeft arm Diastolic Blood Pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e78.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e74.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u0026dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePatients with Hypertension control\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e338 (38.1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e376 (57.3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u0026Dagger;\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eSD: standard deviation\\u003c/p\\u003e\\u003cp\\u003e* November 2018\\u0026minus;February 2019\\u003c/p\\u003e\\u003cp\\u003e** June \\u0026ndash; August 2019\\u003c/p\\u003e\\u003cp\\u003e\\u0026dagger; From Wilcoxon Signed Ranks Test\\u003c/p\\u003e\\u003cp\\u003e\\u0026Dagger; From McNemar's Test\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eIn the second part of the trial, the mean systolic and diastolic blood pressures in both arms were lower than in the first phase. The Wilcoxon test revealed that the systolic and diastolic blood pressures in both groups decreased significantly.\\u003c/p\\u003e\\u003cp\\u003eIn the first and second phases of the trial, there were 338 (38.1%) and 376 (57.3%) HTN-controlled patients, respectively. This rise was statistically significant (P 0.0001), as determined by McNemar's test.\\u003c/p\\u003e\\u003cp\\u003eIn the first phase, the prevalence rates of HTN control in women and men were 41.8% and 30%, respectively (P\\u0026thinsp;=\\u0026thinsp;0.001), whereas in the second phase, these rates were 60.9% and 48.4%, respectively (P\\u0026thinsp;=\\u0026thinsp;0.003). McNemar's test revealed a substantial rise in the HTN control rate between the first and second phases of the trial (P 0.001) for both men and women.\\u003c/p\\u003e\\u003cp\\u003eIn terms of age groups, the prevalence rates of HTN control in the lower-than-60-year group and equal-or-more-than-60-year group in the first phase were 42.0% and 33.6%, respectively (P\\u0026thinsp;=\\u0026thinsp;0.012), whereas, in the second phase, these rates were 55.7% and 59.6%, respectively (P\\u0026thinsp;=\\u0026thinsp;0.003). McNemar's test revealed a substantial rise in the HTN control rate between the first and second phases of the trial (P 0.001) for both age groups.\\u003c/p\\u003e\\u003cp\\u003eA multi-nominal logistic regression model was used to determine the predictors of the change in HTN control in the second phase of the investigation, compared to the first phase of the study. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e shows the finalized model.\\u003c/p\\u003e\\u003cp\\u003eAge, not adding salt to meals, and the difference in the GPs' practice score, patients' BMI, and the number of antihypertensive medicines in the second phase, compared to the first phase, were among the variables that influenced the change in HTN control in the second phase, compared to the first.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eDeterminants of change in hypertension control from Phase I* to Phase II**, identified by multi-nominal logistic regression, Isfahan, Iran, 2018\\u0026ndash;2019\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"11\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eVariables\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c5\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003eUnchanged HTN-Control\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c8\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003eDeteriorated HTN-Control\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c11\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003eImproved HTN-Control\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eP-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eCI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eP-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003eOR\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003eCI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003eP-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge (year)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.92\\u0026ndash;0.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.018\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e1.00\\u0026ndash;1.04\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.094\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eGPs practice score difference\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.64\\u0026ndash;0.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.027\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.89\\u0026ndash;1.14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.904\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eBMI difference\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.77\\u0026ndash;1.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.995\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.65\\u0026ndash;0.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.004\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003eChange in the number of antihypertensive drugs\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eUnchanged\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.58\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.36\\u0026ndash;6.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.549\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.38\\u0026ndash;1.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.219\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDecreased\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e4.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.93\\u0026ndash;23.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.061\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.31\\u0026ndash;1.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.410\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIncreased\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eNot adding salt to foods while eating (yes)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.24\\u0026ndash;0.94\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.033\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.75\\u0026ndash;2.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.403\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"11\\\" nameend=\\\"c11\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eHTN: hypertension, BMI: body mass index, GP: general practitioner\\u003c/p\\u003e\\u003cp\\u003e* November 2018\\u0026minus;February 2019\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003e**\\u003c/sup\\u003e June \\u0026ndash; August 2019\\u003c/p\\u003e\\u003cp\\u003e\\u0026dagger; The dependent variable was the change in hypertension control at three levels: unchanged (reference group), decreased, and increased\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, the mean systolic and diastolic blood pressures of patients significantly decreased in the second phase of the study, compared to the first phase of the study, and the HTN control rate was significantly increased. There are several reasons for these favorable changes: First, the scores of knowledges and attitudes of GPs were substantially higher after training, and the GPs\\u0026rsquo; practice scores increased, but it was borderline significant.\\u003c/p\\u003e\\u003cp\\u003eThe majority of GPs participating in this study stated that they are practicing the training they received in the treatment of HTN. Therefore, following the educational intervention in this study, a favorable change in the HTN control rate has occurred. The impact of lack of knowledge, attitude, and poor practice of the treatment team on the inadequate control of HTN has been shown in various studies (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Myanganbayar \\u003cem\\u003eet al\\u003c/em\\u003e. (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e), examining the knowledge, attitude, and practice of primary care physicians in Ulaanbaatar, Mongolia, showed that the low level of knowledge and practice of these physicians would be associated with an insufficient level of HTN control in patients (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe GPs participating in this study were primarily female. It is due to this reality that the majority of GPs in Isfahan HCCs are women. Considering the better performance of women GPs compared with men GPs is indicated in the previous.(\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e)In our study, we can conclude that women GPs may be exceptionally proficient at achieving better outcomes in HTN care.\\u003c/p\\u003e\\u003cp\\u003eThe baseline blood pressures before the educational intervention were, on average, very close to guideline-recommended blood pressure targets (in Europe, systolic BP was \\u0026lt;\\u0026thinsp;140 mmHg, and in the U.S., \\u0026lt; 130 mmHg). We can undoubtedly attribute this observation to two reasons: I) All participants in this study were HTN patients who consume medical treatment for their disease. So, closing their blood pressure levels to guideline-recommended blood pressure targets is partly due to their hypertension drug use. II) the existence of a comprehensive and accurate program for the regular follow-up of patients with high blood pressure registered in Isfahan healthcare centers is another reason for this finding.\\u003c/p\\u003e\\u003cp\\u003eAnother reason for observing improvements in the control of HTN in this study is that the number of visits to the GP in HCC for HTN treatment increased from the first to the second phase of the study compared to the number of visits in the year before the survey. As such, the more patients have contact with the physician, the better the opportunity to review their blood pressure status in an attempt to improve it.\\u003c/p\\u003e\\u003cp\\u003eIncrement in patients taking ARB/Thiazide compound during the study is another potential contributor to the improved HTN control rate in this study. The emphasis of the new national and international standard guidelines for HTN on the use of combination therapy justifies this. (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). In low-dose combination therapy, there is a greater adherence to treatment because of the minimization of drug side effects and the maintenance of beneficial drug effects. (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn addition, the percentage of patients taking two or more antihypertensive drugs increased slightly during the study. Since mono-drug therapy has poor potency in controlling HTN (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), the improvement in the control of HTN may be partly attributed to the increased number of medications used during the study.\\u003c/p\\u003e\\u003cp\\u003eThe comparison of the HTN control rate between males and females showed that despite the improved HTN status in both sexes, females had more control over blood pressure than males in both phases of the study. This sex difference has been observed in different studies on the HTN control rate. According to Marques \\u003cem\\u003eet al.\\u003c/em\\u003e(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e) In general, because drug adherence is more prevalent in women than men, and alcohol consumption as one of the barriers to control of HTN is more prevalent in men, therefore women are expected to be more responsive to the control of HTN, compared to men. (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). Reckelhoff (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e) argues that sex differences in the control of HTN depend on a variety of mechanisms, such as sex differences in the renin-angiotensin system, sympathetic activity, sleep apnea, and the effect of the relaxin hormone.\\u003c/p\\u003e\\u003cp\\u003eOne of the factors influencing the improvement in the HTN control rate in this study was age. As the age of patients increased, the odds of improving the HTN control were increased. Although other studies have shown that the control of HTN in older people is lower due to a multitude of tasks, burdensome responsibilities, and lack of adequate support from family and medical team (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e), these findings are inconsistent with the present study, which can be attributed to the greater interest of older people in participating in the research and their more significant attention to the researchers' recommendations than younger individuals.\\u003c/p\\u003e\\u003cp\\u003e Another influential factor in this model was a change in GPs' practice scores following the training of national and international HTN treatment guidelines. As noted above, other studies have also shown the effect of this agent on improving HTN control. (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAnother factor was the change in BMI during the study. As demonstrated in the results section, the mean BMI of patients slightly decreased during the study. Given that the mean BMI in both study phases is more than 25 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e, and having a BMI of more than 25 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e is an independent risk factor for HTN (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)Therefore, it can be said that the decrease in BMI during the study was not sufficient to have a favorable effect on improving the HTN control rate.\\u003c/p\\u003e\\u003cp\\u003eThe next factor identified in this model was the change in the number of antihypertensive drugs during the study. Those who reduced their drug intake during the study had increased odds of not controlling HTN, and their odds of improving the HTN control rate decreased. Although monotherapy is the most common current therapy for the treatment of HTN worldwide, evidence suggests that this treatment has poor potency in controlling HTN, even at high doses. (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). According to the results of a meta-analysis, a two-drug combination therapy with a low-to-standard dosage is more effective in controlling HTN than a standard single-dose treatment. (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)The last identified factor contributing to the improved HTN control rate in this model was not adding salt to the food while eating. People who were prevented from adding salt when eating had greater odds of improving their HTN control rate.\\u003c/p\\u003e\\u003cp\\u003eThis study had remarkable strengths in that it was a nationwide study performed on representative samples of GPs and HTN patients from 15 centers. Sampling was conducted entirely at random, and centers were selected based on socio-economic and geographical maximum variation in Isfahan Metropolitan. So, our findings can be generalizable to the broad HTN community. Detailed training of interviewers and supervision of their work throughout the study, use of accurate and calibrated anthropometric tools, and standardization of the questionnaire before measuring GPs' knowledge, attitude, and practice are other advantages of this study. However, we had some limitations in this study. We asked about the status of health behaviors, i.e., smoking, physical activity, and so on, only in the first phase of the study, assuming no significant changes in them during the short period of study. We suggest considering changes in all essential health behaviors, even if we are talking about a brief observation period in future studies. We also recommend a more extended study to see the effect of GP training on HTN control. As another limitation, poor adherence by patients to their medication-taking and inadequate prescribing by physicians are among the most important affecting factors on HTN control that were ignored in this study. It is suggested that they be considered in future studies.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003e This study showed that following training the latest national and international guidelines on HTN management to GPs, there was a significant shift in their knowledge, attitude, and practice in the management of HTN and a significant increase in the HTN control rate in patients. Therefore, it seems that periodic training sessions for PHC staff, as well as regular follow-up of patients with HTN and examining their blood pressure, type and number of medications, and lifestyle over time, are effective ways to improve the HTN control rate in society.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eConflicts of Interest:\\u003c/strong\\u003e No conflict of interest exists.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding: \\u003c/strong\\u003eThe costs of data collection and training programs in this research were supported entirely by COBEL DAROU company.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll procedures performed were under the institutional and/or national research committee\\u0026apos;s ethical standards, the 1964 Helsinki Declaration and later amendments, or comparable ethical standards. Isfahan University neurosurgery department board members supervised and approved this report on behalf of the Ethical Committee of Isfahan University of Medical Sciences (ethical code: IR.MUI.MED.REC.1398.311).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent to participate:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInformed consent was obtained from all individual participants included in the Study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInformed written consent was obtained from the patient.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and material:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request. Some data may not be made available because of privacy or ethical restrictions.\\u003c/p\\u003e\\n\\u003cp\\u003eData and original images in the current study are available from the corresponding author upon reasonable request. Authors can confirm that all relevant data are included in the article and/or its supplementary information files.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe author would like to thank the patients and their families for their trust.\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to thank Nigan for his valuable time helping us prepare this manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: rationale, methods and main findings. Journal of human hypertension. 2011;25(9):545-53.\\u003c/li\\u003e\\n\\u003cli\\u003eSarrafzadegan N, Hassannejad R, Marateb HR, Talaei M, Sadeghi M, Roohafza HR, et al. PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region. PloS one. 2017;12(12):e0189389.\\u003c/li\\u003e\\n\\u003cli\\u003eChow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. 2013;310(9):959-68.\\u003c/li\\u003e\\n\\u003cli\\u003eSchiffrin EL, Campbell NR, Feldman RD, Kaczorowski J, Lewanczuk R, Padwal R, et al. Hypertension in Canada: past, present, and future. 2016;82(2):288-99.\\u003c/li\\u003e\\n\\u003cli\\u003eHien HA, Tam NM, Tam V, Derese A, Devroey DJIjoh. Prevalence, awareness, treatment, and control of hypertension and its risk factors in (Central) Vietnam. 2018;2018.\\u003c/li\\u003e\\n\\u003cli\\u003eTalaei M, Sadeghi M, Mohammadifard N, Shokouh P, Oveisgharan S, Sarrafzadegan NJJoh. Incident hypertension and its predictors: the Isfahan Cohort Study. 2014;32(1):30-8.\\u003c/li\\u003e\\n\\u003cli\\u003eGharipour M, Khosravi A, Sadeghi M, Roohafza H, Hashemi M, Sarrafzadegan NJAa. Socioeconomic characteristics and controlled hypertension: evidence from Isfahan Healthy Heart Program. 2013;9(1):77.\\u003c/li\\u003e\\n\\u003cli\\u003eKhosravi A, Mehr GK, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program. 2010;10(1):61.\\u003c/li\\u003e\\n\\u003cli\\u003eHeinert S, Escobar-Schulz S, Jackson M, Del Rios M, Kim S, Kahkejian J, et al. Barriers and Facilitators to Hypertension Control Following Participation in a Church-Based Hypertension Intervention Study. American Journal of Health Promotion. 2019:0890117119868384.\\u003c/li\\u003e\\n\\u003cli\\u003eGupta R, Khedar RS, Panwar RBJJAPI. Strategies for better hypertension control in India and other lower middle income countries. 2016;64(9):58-64.\\u003c/li\\u003e\\n\\u003cli\\u003eRisso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F, et al. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach. 2015;15(1):254.\\u003c/li\\u003e\\n\\u003cli\\u003eEghbali M, Khosravi A, Feizi A, Mansouri A, Mahaki B, Sarrafzadegan N. Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran. Epidemiology and health. 2018;40:e2018020.\\u003c/li\\u003e\\n\\u003cli\\u003eWhelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2018;71(19):e127-e248.\\u003c/li\\u003e\\n\\u003cli\\u003eJewell NP. Statistics for epidemiology: Chapman and Hall/CRC; 2003.\\u003c/li\\u003e\\n\\u003cli\\u003eJaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. Jama. 2013;310(7):699-705.\\u003c/li\\u003e\\n\\u003cli\\u003eGholamnejad H, Darvishpoor Kakhki A, Ahmadi F, Rohani CJWwOP. Barriers to self-care in elderly people with hypertension: a qualitative study. 2018;22(4):243-51.\\u003c/li\\u003e\\n\\u003cli\\u003eMyanganbayar M, Baatarsuren U, Chen G, Bosurgi R, So G, Campbell NR, et al. Hypertension, knowledge, attitudes, and practices of primary care physicians in Ulaanbaatar, Mongolia. 2018;20(8):1187-92.\\u003c/li\\u003e\\n\\u003cli\\u003eDelpech R, Bloy G, Panjo H, Falcoff H, Ringa V, Rigal L. Physicians\\u0026rsquo; preventive practices: more frequently performed for male patients and by female physicians. BMC Health Services Research. 2020;20(1):331.\\u003c/li\\u003e\\n\\u003cli\\u003eRea F, Corrao G, Merlino L, Mancia GJEHJ. Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension. 2018;39(40):3654-61.\\u003c/li\\u003e\\n\\u003cli\\u003eChow CK, Thakkar J, Bennett A, Hillis G, Burke M, Usherwood T, et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet (London, England). 2017;389(10073):1035-42.\\u003c/li\\u003e\\n\\u003cli\\u003eMarques-Vidal P, Arveiler D, Amouyel P, Bingham A, Ferri\\u0026egrave;res JJJoh. Sex differences in awareness and control of hypertension in France. 1997;15(11):1205-10.\\u003c/li\\u003e\\n\\u003cli\\u003eReckelhoff JFJCoin, hypertension. Gender differences in hypertension. 2018;27(3):176-81.\\u003c/li\\u003e\\n\\u003cli\\u003eRedon J, Erdine S, B\\u0026ouml;hm M, Ferri C, Kolloch R, Kreutz R, et al. Physician attitudes to blood pressure control: findings from the Supporting Hypertension Awareness and Research Europe-wide survey. 2011;29(8):1633-40.\\u003c/li\\u003e\\n\\u003cli\\u003eHamano T, Shiotani Y, Takeda M, Abe T, Sundquist K, Nabika T. Is the Effect of Body Mass Index on Hypertension Modified by the Elevation? A Cross-Sectional Study of Rural Areas in Japan. 2017;14(9):1022.\\u003c/li\\u003e\\n\\u003cli\\u003eSalam A, Kanukula R, Atkins E, Wang X, Islam S, Kishore SP, et al. Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials. 2019;37(9):1768-74.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Control, Education program, General practice, Hypertension, Management\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7192375/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7192375/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eBackground: Given that primary care staff's ignorance of the most recent sources for the prevention, treatment, and management of hypertension (HTN) is one of the identified barriers to HTN control.\\u003c/p\\u003e\\n\\u003cp\\u003eAims: We sought to determine the impact of training general practitioners (GPs) on the most recent national and international HTN management guidelines on the HTN control rate among patients.\\u003c/p\\u003e\\n\\u003cp\\u003eMethods: This before-after investigation was conducted in two parts. In phases I and II of the trial, 31 GPs vs. 886 patients with HTN and 22 GPs versus 656 patients participated. GPs received a training course on the most recent national and international HTN treatment guidelines. Before and after the intervention, the primary outcome was HTN management (systolic blood pressure \\u0026lt; 130 and Diastolic \\u0026lt; 80 mmHg)\\u003c/p\\u003e\\n\\u003cp\\u003eResults: Mean ± standard deviation Knowledge, attitudes, and practice scores of GPs before and after the intervention were 12.9 ± 1.9 vs. 13.1 ± 2.6 (P=0.003), 42.5 ± 2.9 vs. 42.9 ± 5.7 (P=0.007), and 14.6 ± 1.6 vs. 14.7 ± 1.3 (P=0.064), respectively. 338(38.1) vs. 376(57.3) patients with managed HTN, using two or more antihypertensive medicines and receiving fixed dosage combination therapy (Losartan/Hydrochlorothiazide) before GP training vs. after training, respectively. Predictors of change in HTN control in the second phase, compared to the first, were age, not adding salt to meals, and the difference in the GPs' practice score, patients' BMI, and the number of antihypertensive medicines.\\u003c/p\\u003e\\n\\u003cp\\u003eConclusion: To increase the community's HTN control rate, we propose periodic training programs for GPs and other primary care workers and frequent patient follow-ups.\\u003c/p\\u003e\",\"manuscriptTitle\":\"gIncrease In Hypertension Control Rate following the Training of the Latest National- International Hypertension Management Guidelines for General Practitioners\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-11 11:13:24\",\"doi\":\"10.21203/rs.3.rs-7192375/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4829c573-ff95-4228-a014-e5c3cf38d664\",\"owner\":[],\"postedDate\":\"September 11th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-10T08:23:18+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-09-11 11:13:24\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7192375\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7192375\",\"identity\":\"rs-7192375\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}