THERAPEUTIC APPROACH FOR HYPERTENSION MANAGEMENT AND CONTROL IN PATIENTS RECEIVING OLMESARTAN-BASED TREATMENT: THE “FAMILY” NON-INTERVENTIONAL STUDY IN PRIMARY CARE IN GREECE

Abstract

Objective: To evaluate the characteristics, office blood pressure (OBP) levels and usual treatment strategies of hypertensive patients receiving olmesartan-based therapy in general practice. Design and method: A nationwide non-interventional survey was performed by primary-care doctors who assessed consecutive hypertensives on stable (> = 4 weeks) olmesartan-based therapy. Patients’ characteristics, OBP levels and treatment changes were reported. Results: A total of 4,883 hypertensives on olmesartan-based therapy (age 66.5 ± 11.2 years, men 54%, diabetics 26%, smokers 23%) were assessed by 491 doctors (48% cardiologists, 39% internists, 12% general practitioners, 1% others). Average OBP was 137.6 ± 16.0/82.4 ± 9.8 mmHg (systolic/diastolic) and 56% had controlled OBP (<140/90 mmHg). Participants were receiving 2.2 ± 0.8 antihypertensive drugs (olmesartan monotherapy 21%; 2 drugs 44%; 3 drugs 30%; > = 4 drugs 5%). Of subjects on olmesartan combinations (79%), 89% used fixed-dose pills (37% olmesartan-amlodipine; 28% olmesartan-hydrochlorothiazide; 35% olmesartan-amlodipine-hydrochlorothiazide). Cardiologists prescribed fixed-dose combinations more frequently than general practitioners or internists (77/75/72% respectively, p < 0.01). 13% of patients reported missing at least one dose per week, with most common reported cause the complexity of treatment regimen (75%). OBP control was (i) higher in nondiabetics than diabetics (58% vs. 52%, p < 0.01), despite using fewer drugs (2.2 ± 0.8 vs. 2.4 ± 0.8 drugs, p < 0.01), (ii) lower in patients on monotherapy compared to 2, 3 or > = 4 drugs (53/56/59/57% respectively, p < 0.05) and (iii) higher in patients on fixed-dose than free combinations (58% vs. 53%, p < 0.01). In cases with uncontrolled OBP the following actions were decided: dose increase 18%; drug addition 17%; drug substitution 3%; treatment simplification using fixed-dose combination 7%; no change 55%. Conclusions: Combination therapy and particularly fixed-dose combinations are widely prescribed in primary care. However, uncontrolled OBP is common, even in patients on monotherapy, and is worse in diabetics. Physicians’ inertia and complexity of regimen are major barriers in achieving optimal control. More intense and simpler therapy, with wider use of triple fixed-dose combinations and second-line drugs, are necessary to improve the control of hypertension in primary care.