IMPLEMENTATION OF THE 2018 ESC/ESH GUIDELINES FOR THE TREATMENT AND CONTROL OF HYPERTENSION IN PRIMARY CARE IN GREECE: THE HYPEDIA STUDY

Abstract

Objective: To evaluate office blood pressure (OBP) levels for antihypertensive drug treatment initiation/intensification, drug choices, and hypertension control in primary care in Greece. Design and method: A prospective nationwide non-interventional single-visit study was performed in consecutive untreated or treated hypertensives recruited by primary care doctors and hospital clinics. Participants’ characteristics, OBP measurements (triplicate; automatically transferred to PC; Microlife BPA3 PC) and treatment changes were recorded using an online cloud system. The study was supported by Menarini Hellas S.A. Results: A total of 3,122 patients were analyzed (mean age 64 ± 12.5 [SD] years, 52% males, 25% untreated). In untreated hypertensives (N = 772), drug treatment was initiated with monotherapy in 53% and with two-drug combination in 36%. ARB monotherapy was used for treatment initiation in 30%, ARB/CCB 20%, ARB/Thiazide 8%, ACEI-based 19%. Of the combinations used, single-pill were 97%. Among treated hypertensives aged <65 years (N = 977), 79% had OBP > = 130/80 mmHg (systolic and/or diastolic), whereas among those aged > = 65 years (N = 1,373) 66% had OBP > = 140/80 mmHg. ARBs were used in 69% of treated hypertensives, ACEIs 19%, CCBs 47%, diuretics 39%, b-blockers 19%. Single-pill combinations were administered in 85% of patients receiving drug combinations. Treatment intensification (mainly dose increase or drug addition) was performed in 54% of treated hypertensives aged <65 years with OBP > = 130/80 mmHg (systolic and/or diastolic), and in 62% of those > = 65 years with OBP > = 140/80 mmHg. Binary logistic regression in treated hypertensives aged <65 years showed that age (OR 3.2, 95% CI 1.0–9.9), BMI (OR 7.9, 2.8–22.8), male gender (OR 1.6, 1.1–2.2) and primary care (vs. hospital) setting (OR 1.5, 1.0–1.8) predicted OBP > = 130/80 mmHg. In treated hypertensives > = 65 years, BMI (OR 2.5, 1.1–5.7), primary care setting (OR 1.4, 1.0–1.7) and male gender (OR 1.3, 1.0–1.6) predicted OBP > = 140/80 mmHg. Conclusions: RAS blocker-based therapy, mainly ARBs, is the basis of antihypertensive drug treatment in the vast majority of patients in primary care, with single-pill combinations being widely used. In almost half of treated uncontrolled hypertensives treatment is not intensified (physician inertia), suggesting suboptimal implementation of the 2018 ESC/ESH targets in primary care.