On-target antihypertensive treatment in Italy: The ISPIT (Indagine Sicoa Paziente Iperteso a Target) survey study

Abstract

Hypertension represents the most important risk factor forincident cardiovascular events [1], and as such it represents a majorproblem for the National Health Care systems. However, 30–40% ofhypertensivepatientslackanadequatebloodpressure(BP)control,asdefined by BP values b140/90 mm Hg [1], in spite of therapy.Notwithstanding optimal BP control represents the goal of treatmentindependently on drugs administered, the results of recent RCT gaveindications for using specific classes of drugs in specific patients'population[1]andthisshouldbeconsidered.Inaddition,otherfactorswhich have been poorly investigated systematically might beimplicated in the lack of adequate BP control, such as the presenceof risk factors, the frequency and modalities of BP measurements, lifestyle etc. The present survey was conceived to provide an overallpicture on the extent to which BP is at target in the Italian populationof hypertensive patients, and to ascertain what are the conditionslinked to the lack (or achievement) of BP control.29 cardiology units located in different Italian areas belonging toSICOA Association (Societa Italiana Cardiologia Ospedalita Accred-itata)onlyparticipatedtothestudythatincludedconsecutivepatientsreferred in a 3-month period. All information were collected at thetime of enrollment using a questionnaire. Target BP was defined as BPb140/90 mm Hg, as measured by sphygmomanometry at the time ofenrollment [1]. Patients were considered physically active if theyreferredtoperformregularaerobicphysicalactivityforatleast30 minatleast3 daysperweek.Agewassummarizedinthreeclasses(18 –65;66–75; ≥76), and drugs assumption in three categories (1, 2 and 3 or moredrugs). Group comparisons were performed using univariate non-parametric statistics. The association between failure in achieving BPcontrol and potential explanatory variables was modelled by means ofunconditional logistic regression. All estimates were adjusted forconfounders,e.g.,age,gender,etc.[2].APvalueofb0.05wasconsideredsignificant.TheauthorscompliedwiththePrinciplesofEthicalPublishingin the International Journal of Cardiology.The population consisted in 1539 patients, 45% females and 55%males. No significant difference in BP between center–south and northItalywasfound.ThepercentageofpatientsachievingtargetBPwas60%independently on geographic distribution and age class. SBP and DBPvalues were 127.5 ± 11.7/76.7 ± 7.4 mm Hg in patients at target vs152.4 ± 16.8/87.1 ± 9.7 mmHg in patients not at target, respectively.75%ofpatientsfeaturedatleastoneriskfactor,and36%twoormoreriskfactors. The most common was the lack of physical activity (70%).Diabetes and dyslipidemia were present in 48% and 24% of patients,respectively.17%ofpatientsweresmokers. Table1 summarizessignificantassociations from logistic regression analysis. Among all variablesinvestigated, diabetes and overweight were the only predictors of thelack of BP control. Odds ratio (OR) for BP not at target was 1.44 (IC 1.13 –1.82, P = 0.003) in patients with diabetes and 1.40 (IC 1.08 –1.82,P=0.01)and1.80(IC1.32–2.39, P = 0.001) in overweight and obesepatients, respectively. The lack of physical activity showed a strong trendforBPnotattarget,(OR0.81,IC0.64–1.02, P = 0.06).Fig.1 illustrates the modality and frequency of BP measurements.The majority of patients (67%) declared to measure BP by themselves,with a most common frequency of once a week (41%). Only a smallpercentage had BP measured by a specialist and a relatively largepercentage measured BP occasionally (8%). The univariate analysisrevealed as BP self-measurement was associated to a significantlygreater probability to reach BP target (56 vs 37%, P = 0.008). Beta-blockers were the drugsmore frequently prescribed(44%),followedbyACE-inhibitors (33%), ARBs (29%) and calcium channel blockers (28%).No relationship was found between the class of drugs or their numberand the achievement of target BP.ThissurveyconfirmsthatalsoinItalytheproportionofhypertensivepatients not at target for BP is around 40% [1], without differencesrelatedtogeographicaldistribution[3].Italsoconfirmsthatcomorbidity