Do primary care physicians follow the current recommendations for hypertensive pharmacotherapy?

Abstract

In 2007, the joint recommendations of the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) were announced. The aim of this survey was to evaluate the implementation rate of the new ESC/ESH recommendations by primary care physicians and to assess the effectiveness of antihypertensive therapy. Data concerning pharmacotherapy, blood pressure (BP) measurements, and compliance with the guidelines were collected in 10,880 hypertensive patients during 3 subsequent follow-up visits. Combined antihypertensive treatment (angiotensin converting enzyme inhibitors with β-blocker, diuretic, or calcium-channel blocker) was used in 69.2% of the patients at baseline. A combination of β-blocker with diuretic was prescribed in 7.4% of the patients. In 71% of these patients no history of cardiovascular events was reported (myocardial infarction, revascularization, or heart failure). Diuretics were not used in 20.7% of the patients receiving a 3-drug regimen and in 6.7% of those receiving a 4-drug regimen. BP target levels set by individual physicians were frequently lower than those recommended by the guidelines. The percentage of patients who reached the recommended BP target increased during the survey to 25.3%. A combination of β-blocker and diuretic is still commonly used in the treatment of hypertension in patients without coronary artery disease and heart failure. Despite the use of combination treatment in about 90% of hypertensive patients and attempts at reaching lower target BP values than those recommended by the guidelines, treatment targets were achieved only in one-fourth of the patients.