Abstract
SummaryBackgroundIn Austria only 41% of patients with treated hypertension (HTN) have their blood pressure (BP) controlled. This study investigated a strategy to improve BP control in primary care.MethodsGeneral practitioners (GPs) were randomized to interventional care vs. standard care and included patients with uncontrolled office BP > 140/90 mm Hg. In interventional care, antihypertensive therapy was up-titrated using a single pill combination (olmesartan, amlodipine and/or hydrochlorothiazde) in 4‑week intervals. In standard care, physicians were encouraged to treat according to the 2013 European Society of Cardiology guidelines for the management of arterial hypertension. The primary endpoint was the proportion of patients with controlled office BP < 140/90 mm Hg at 6 months. The main secondary endpoint was the improvement in 24 h ambulatory BP (ABPM, Clinicaltrials.gov NCT02377661).ResultsBetween 2015–2017, 20 GPs contributed to patient recruitment. The trial was discontinued due to slow recruitment after inclusion of 139 eligible patients, 54 of whom were included in the interventional group. A significantly larger proportion of patients in interventional vs. standard care achieved the office BP target (67% ± 26% vs. 39% ± 29%, respectively, mean difference −27.9%, 95% confidence interval CI −54.0%; −1.7%, p = 0.038). The proportion of patients with controlled 24 h ABPM (<130/80 mm Hg) was similar between groups (49% ± 33% vs. 40% ± 34%, respectively, mean difference −8.8%, 95% CI −40.7%; 23.1%, p = 0.57). At baseline, pretreated patients received an average of 1.5 ± 0.8 vs. 1.7 ± 0.9 antihypertensive prescriptions. At 6 months, the respective BP reductions were achieved with 1.2 ± 0.5 prescriptions in interventional vs. 2.0 ± 1.0 in standard care (p < 0.01).ConclusionIn both groups statistically and clinically significant BP reductions were observed after 6 months. In the interventional care group, a larger proportion of patients achieved the office BP target compared to standard care. The 24 h ambulatory blood pressure levels were controlled in 44% of patients at 6 months, without significant differences between groups. The respective BP reductions were achieved with a significantly lower medication burden in interventional care.Electronic supplementary materialThe online version of this article (10.1007/s00508-018-1374-4) contains supplementary material, which is available to authorized users.
Highlights
In Europe only 30–50% of diagnosed and treated patients with arterial hypertension (HTN) have their blood pressure (BP) controlled [1, 2]
A significantly larger proportion of patients in interventional vs. standard care achieved the office BP target (67% ± 26% vs. 39% ± 29%, respectively, mean difference –27.9%, 95% confidence interval CI –54.0%; –1.7%, p = 0.038)
At 6 months, the respective BP reductions were achieved with 1.2 ± 0.5 prescriptions in interventional vs. 2.0 ± 1.0 in standard care (p < 0.01)
Summary
In Europe only 30–50% of diagnosed and treated patients with arterial hypertension (HTN) have their blood pressure (BP) controlled [1, 2]. K original article tomatic nature of the condition combined with frequent adverse effects of antihypertensive drugs lead to therapy discontinuation in up to 50% of patients within 1 year of treatment [3] Another barrier to adequate BP control is physician’s inertia, i.e. the lack of therapy intensification in cases of insufficient BP. This group recently performed a cross-sectional study in Austria, showing that only 41% out of 4303 predominantly adherent, diagnosed and treated patients had their BP controlled. These patients received an average of 1.8 different antihypertensive drugs, suggesting sufficient room for therapy intensification, rather than treatment resistance [4]. The study investigated a strategy to improve BP control in primary care, comparing standard treatment to a prespecified titration regimen with single pill combinations (SPCs)
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