ASSOCIATIONS BETWEEN BLOOD PRESSURE CONTROL AND WELLBEING IN PRIMARY CARE PRACTICE: PP.33.325

Abstract

Introduction: Among hypertensive patients under treatment, less than half achieve blood pressure (BP) control. Against the background of conflicting evidence, this study explores the changes in patients’ wellbeing during antihypertensive treatment, and the influence of such changes on BP control in the primary care practice of India. Design and Methods: A representative sample of physicians from 32 cities across India recruited 1545 patients between 40–70 years with untreated or uncontrolled hypertension. IndapamideSR 1.5 mg a day was prescribed as monotherapy, or in addition to existing treatment for 90 days. The Nottingham Health Profile Questionnaire was used to assess wellbeing. Primary outcomes were the mean changes from baseline in BP and wellbeing scores. Results: Mean age of patients (64.1% men) was 56.8 ± 8.6 years. BP was elevated to grade 1 in 26.6%, to grade 2 in 48.8%, and to grade 3 in 24.7%. Mean(95% Confidence interval, CI) systolic blood pressure of 164.6(163.8–165.4) decreased to 133.6(133.0–134.2)mmHg, and diastolic blood pressure from 98.2(97.8–98.6) to 83.6(83.3–83.9)mmHg after treatment. This BP response was accompanied by a mean (95%CI) improvement in patients’ perception of lack of energy by 34.3%(32.2–36.5,P < 0.001); emotional problems by 17.1%(16.1–18.6,P < 0.001); and disturbed sleep, by 15.4%(14.1–16.8, P < 0.001). On an intention to treat basis, 842 patients(54.5%; 95%CI, 52.0–57.0) achieved blood pressure control. On average (95%CI), patients who achieved BP control (compared to those who did not), felt more energetic by 6.3%(8.2–4.3, P < 0.0001); emotionally better by 5%(6.3–3.6, P < 0.0001); and had improved sleep by 5.6%(7.4–4.1, P < 0.001). Conclusions: In primary care, hypertensive patients perceive a serious loss of wellbeing. IndapamideSR 1.5 mg controlled blood pressure in most patients, and significantly improved their wellbeing. This impact on wellbeing was also significantly associated with achieving short term BP control. Whether wellbeing is sustained long term, and pertains to other agents as well, needs elucidation. Preferential selection of antihypertensive agents which also improve wellbeing could help improve BP control rates in the community.