Abstract
BackgroundPatients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension.MethodsWe cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥6 months. We compared patients with VKA for ≥3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity.ResultsWe identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9 %) were on Phenprocoumon (VKA) and 3,843 (87.1 %) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of −8.4 mm Hg (95 % CI −9.8 to −7.0 mm Hg) and −1.5 mm Hg (95 % CI −2.3 to −0.7 mm Hg), respectively (p < 0.001 for both).ConclusionsIn a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.
Highlights
Patients requiring anticoagulation suffer from comorbidities such as hypertension
The database covers reasons for encounter according to the ICPC-2 classification (International Classification of Primary Care 2) [8], patient demographics, vital signs, laboratory data and both type and dosage of prescribed medication according to Anatomical Therapeutic Chemical/Defined Daily Dose Classification (ATC/DDD) coding established by the WHO [9]
Both systolic and diastolic blood pressure (BP) were significantly lower in the Vitamin-K Antagonist (VKA) group, and patients in the VKA group were more likely to meet the BP target range of
Summary
Patients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension. There are several reasons why General Practitioners (GPs) may hesitate to switch patients from VKA to NOAC if INR is in therapeutic range: the higher price of NOACs, the greater risk of gastrointestinal bleeding [3], being familiar with perioperative (bridging)-management, and lastly no validated strategies for bleeding complications. Patients requiring anticoagulation often suffer from significant co-morbidities such as hypertension, cardiovascular disease (CVD), diabetes or renal failure [4]. On the occasion of INR monitoring, GPs
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