MAPEC-Salta Project: A New Care Model for Hypertensive Patients in Primary Health Care in the City of Salta, Argentina

Carlos D. Lacunza, Liliana D. Reales, Analia V. Duré, Verónica C. Reyes, Fabiana L. Lobos, Emilia M. Aramburu, Carina F. Tapia


Background: Hypertension (HT) is the first cause of worldwide cardiovascular morbidity and mortality. However, it is often a poorlycontrolled disease, mainly because health care systems are oriented to the attention of acute diseases. The Argentine Ministry ofHealth proposed a new model for the care of hypertensive patients called MAPEC, based on the Chronic Care Model.Objective: The aim of this study was to evaluate the impact of MAPEC implementation to improve blood pressure (BP) control,changes in lifestyle, disease knowledge and treatment adherence in hypertensive patients treated in three primary health care centersof the City of Salta, Argentina.Methods: Blood pressure was measured with a digital blood pressure monitor and the Batalla and Morisky-Green-Levine tests wereused to evaluate disease knowledge and adherence to treatment, respectively.Results: The study included 232 patients. After model implementation, significant differences (p<0.0001) were found in bloodpressure control, disease understanding, treatment adherence and changes in hygienic-dietary measures. There was a decrease inmean BP with a reduction of 12.97 (95% CI: 9.52-16.42) mm Hg and 6.93 (95% CI: 4.70-9.16) mm Hg in systolic and diastolic BP,respectively.Conclusions: There was evident improvement in the analyzed health parameters after MAPEC implementation. This model canbe easily adapted to primary health care centers at a low cost. In addition, it agrees with the 25×25 WHO targets to reduce 25%cardiovascular premature deaths by 2025.


Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors

and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet 2012; 380: 2224-60.

C.K. Chow, K.K. Teo, S. Rangarajan, S. Islam, R. Gupta, Avezum, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310: 959-68.

Delucchi AM., Majul CR., Vicario A., Cerezo GH, Fábregues G. Registro Nacional

de Hipertensión Arterial. Características epidemiológicas de la hipertensión arterial en Argentina. Estudio RENATA 2. Rev Fed Arg Cardiol 2017;46: 91-5.

Ministerio de Salud de la Nación. Argentina. Manual para el cuidado de personas con enfermedades crónicas no transmisibles: manejo integral en el primer nivel de atención.

Dirección de Promoción de La Salud y Control de Enfermedades No Transmisibles. Buenos Aires: Ministerio de Salud de la Nación; 2016 (citado 24 de febrero de 2020). Disponible en:

Wagner, EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. The Milbank Quarterly 1996: 511-449

Allaire BT, Trogdon JG, Egan BM, Lackland DT, Masters D. Measuring the impact of a continuing medical education program on patient blood pressure. The Journal of Clinical

Hypertension 2011; 13: 517-22.

Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a

systematic review. BMC Health Services Research 2015; 15: 194-204.

Reynolds R, Dennis S, Hasan I, Slewa J, Chen W, Tian D et al. A systematic review of chronic disease management interventions in primary care. BMC Family Practice 2018;


OMS. Manual Nacional de Abordaje del Tabaquismo en el Primer Nivel de Atención. Montevideo; 2015 (citado 24 de febrero de 2020). Disponible en:

Organización Panamericana de la Salud. Prevención clínica. Guía para médicos. Washington DC: Organización Panamericana de la Salud; 1998, 334 p. Publicación científica; 568.

Batalla C, Blanquer A, Ciurana R, García M, Jordi E, Pérez A. Cumplimiento de la

prescripción farmacológica en pacientes hipertensos. Aten primaria 1984; 1(4): 185-91.

Morisky, D. E., Green, L. W., Levine, D. M. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care 1986; 24: 67-74.

OMS. Prevención de las enfermedades cardiovasculares. OMS; Ginebra 2008: 20 p.

(citado 24 de febrero de 2020). Disponible en:

Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease. Am J Cardiology. 1971;27: 335–45.

Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and metaregression

analyses of randomized trials. J Hypertens 2014;32: 2285–95.

Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic

review and meta-analysis. Lancet 2016;387: 957–67.

Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F et al. Effect of pay for performance on the management and outcomes of hypertension in the United

Kingdom: interrupted time series study. BMJ 2011;342:d108. (citado 24 de febrero de 2020). Disponible en:

Santos-Ramos, B., Otero López, M. J., Galván-Banqueri, M., Alfaro-Lara, E. R., Vega-Coca, M. D., Nieto-Martín, M. D., & Ollero Baturone, M. Modelos de atención al paciente

pluripatológico y el papel de la farmacia hospitalaria. Farm Hosp 2012;36:506-17.

Epping-Jordan JE, Bengoa R, Yach D. Chronic conditions: the new health challenge. S

Afr Med J. 2003;93: 585-90.

World Health Organization. Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases. (Citado 24 de febrero de 2020). Disponible en:

Organización Panamericana de la Salud. 28° Conferencia Sanitaria Panamericana.Organización Panamericana de la Salud /OMS 2012 (citado 24 de febrero de 2020).

Disponible en:

Ministerio de Salud de Argentina. Proyecto de protección de la población vulnerable contra las enfermedades crónicas no transmisibles (PROTEGER). Ministerio de Salud de

Argentina 2015 (citado 24 de febrero de 2020). Disponible en:

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