THERAPEUTIC DECISIONS IN THE MANAGEMENT OF ARTERIAL HYPERTENSION IN POLAND - THE INFLUENCE OF COMPLICATIONS AND CHOSEN COMPELLING INDICATIONS - RESULTS OF THE DETENT STUDY: PP.19.257

Abstract

Objective: The aim of the DETENT study was to assess the influence of concomitant diseases and hypertensive complications on the choices made by cardiologists and primary care physicians (PCP) in antihypertensive pharmacotherapy in Polish population. Design and Method: Study was designed as an all-Poland epidemiological survey in which 177 cardiologists and 434 PCP took part. Every participant filled in a form for 40 consecutive patients with arterial hypertension (AH). Results: Data was collected for 24451 patients (49.8%M). 29% (7088; 53.1%M) treated by cardiologists and 71% (17363; 48.4%M) treated by PCP. Mean age 60.4 ± 12 years. The incidence of coexisting diseases: hypercholesterolemia 63.4%, diabetes 27.4%, obesity (BMI >29,9 kg/m2) 29.5%, ischemic heart disease 40.9%, myocardial infarction 21.4%, stroke 6.4%, heart failure 17.8%, kidney dysfunction 7.5%, chronic kidney disease 4.8%, benign prostate hyperplasia 10.1%, hyperthyroidism 4.7%. 8.5% of patients had uncomplicated AH. Most often used groups of antihypertensive drugs in the whole study population were ACE-Is (80.8%), beta-blockers (75.2%) and diuretics (51.3%). Depending on type and number of coexisting states incidence of treatment with groups of antihypertensives, sequence of their implementation, range of doses (min./medium/max.) and achieved BP control (acc.to ESC/ESH2007) were assessed. Conclusions: In the DETENT study the 3 most often used groups of drugs were ACE-Is, beta-blockers and diuretics, regardless of type of coexisting disease. Only patients with prostate hyperplasia (alpha-blockers were third), hyperthyroidism or with uncomplicated AH (beta-blockers were most often used) were the exception. Observed trends of drug choice seem to follow the guidelines, but still too high percentage of patients is not given drugs basic for important concomitant diseases. Relatively small number of patients was given drugs in maximum doses. Goal values of BP were achieved only in 11.2%. BP values <130/80 mmHg in case of concomitant diseases bound up with high and very high cardiovascular risk were achieved in less then 6% of patients. Increasing number of complications and concomitant diseases lowered the percentage of patients with BP control.