Long-term evaluation of systolic blood pressure and prescription of antihypertensive agents. Results from the DMP coronary artery disease (CAD), North Rhine, Germany

Abstract

Purpose: The disease management programme (DMP) CAD was initiated to improve secondary prevention among CAD patients. Patients with diabetes mellitus, myocardial infarction, or heart failure constitute important subgroups of the patients inscribed. Long-term analysis of systolic blood pressure (SBP) and prescriptions of antihypertensive agents (AHA) especially in these patients are crucial with respect to the programme's evaluation. Population and methods: In 2011 a total of 5013 physicians had inscribed 222573 patients into the DMP (63.1% men, age 71.3±10.6, DMP participation 4.0±2.1 yrs.). Of these 20755 patients with diabetes, 17208 patients with myocardial infarction, and 11871 with heart failure were available for long-term analysis (2004/05-2011). Time differences were analysed by multivariate repeated measurements analysis (SBP) and nonparametric change tests for related samples (AHA). Results: Main results with regard to SBP and AHA prescription are given in Table 1. View this table: Table 1 Conclusions: During the time course of the DMP CAD significant decreases of SBP in patients suffering additionally from diabetes, myocardial infarction, or heart failure can be demonstrated. Simultaneously in these patient groups prescription of AHA steadily increases between 2004/05 and 2011. The results show that there was an improvement of quality of secondary prevention of CAD inside the DMP. Regarding the magnitude of change it is difficult to differentiate between effects of the DMP or secular trends, for which similar magnitudes of change have been reported.