Abstract
ObjectiveThis study evaluates the actual blood pressure control rate and its estimation by general practitioners, the use of single-pill or free combinations, and the attitude towards single-pill combinations in primary care.MethodsCross-sectional observational survey in primary care between January 2015 and September 2016 in Belgium and Luxembourg. The participating general practitioners enrolled hypertensive patients taking at least 2 antihypertensive molecules (as fixed or free associations).Results742 general practitioners included a total of 8,006 patients, with a mean age of 66 ± 12 years. Systolic blood pressure and diastolic blood pressure were respectively 141 ± 17 mmHg and 82 ± 10 mmHg (means ± SD). These patients had a blood pressure control rate of 45%, whereas it was estimated by general practitioners to be 60%. General practitioners with 11–25 years’ experience performed better than general practitioners with 36–51 years’ experience in the evaluation of blood pressure control. Combinations used were free in 39%, single-pill in 34% and mixed in 27% of the patients. Patients receiving single-pill combinations were younger than those treated with free combinations (63 ± 12 vs. 68 ± 12 years, p < 0.001), with fewer comorbidities (39 vs. 55%, p < 0.001). In patients treated solely with free pill associations, 66% of patient cases, general practitioners were willing to switch to a single-pill combination. The main reasons were improved adherence (76%) and better blood pressure control (64%).ConclusionIn patients requiring at least two antihypertensive drugs, blood pressure control rate remains low and is overestimated by general practitioners. Free combinations remain largely used although many general practitioners seem willing to shift to single-pill combinations. Treatment simplification could improve adherence and blood pressure control rate, which has been shown to lead to reduced morbidity and mortality.
Highlights
Arterial hypertension is one of the main modifiable risk factors for cardiovascular diseases worldwide [1, 2]
Systolic blood pressure and diastolic blood pressure were respectively 141 ± 17 mmHg and 82 ± 10 mmHg. These patients had a blood pressure control rate of 45%, whereas it was estimated by general practitioners to be 60%
Free combinations remain largely used many general practitioners seem willing to shift to single-pill combinations
Summary
Arterial hypertension is one of the main modifiable risk factors for cardiovascular diseases worldwide [1, 2]. Since monotherapy is only effective in a limited number of patients, the use of combination therapy is recommended because it is more effective and better tolerated than high-dose monotherapy. Combination therapy could even be considered as the initial approach in patients with marked blood pressure elevation and/or high cardiovascular risk [1]. It has been shown that more than 50% of the treated patients receive an inappropriate prescription [4]. Inappropriate use of antihypertensive agents is important when patients are treated with more than one antihypertensive agent. Up to 40% of patients treated with combination therapy receive inappropriate combinations or dosages [5]
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