Treatment of hypertension at an outpatient hypertension clinic. Blood pressure control, dropout rate, and side effects

Abstract

Long-term results from an outpatient hypertension clinic concerning blood pressure (BP) control, dropout rate, and adverse effects of treatment in a random population sample are presented. Six hundred eighty-six men, aged 47–54 years, and recruited from a screening examination with casual systolic BP > 175 mm Hg or diastolic BP > 115 mm Hg on two occasions or already on antihypertensive therapy, were treated and followed for 5 years. The 5-year dropout rate of patients refusing to participate or lost for unknown reasons was low (4.2%), with the highest incidence during the first year (2.2%). The most commonly used drugs were beta-adrenoceptor blocking agents (69%), thiazide diuretics (62%), and hydralazine (34%). After 5 years' follow-up 58% of the patients had BP below 160 mm Hg systolic and 95 mm Hg diastolic, 33% had BP between 160–170 mm Hg systolic or 95–105 mm Hg diastolic, and 9% remained above 170 mm Hg systolic and/or 105 mm Hg diastolic. This blood pressure control was in many cases achieved first after several years of treatment and with the frequent use of combination drug therapy (66%). Patients who remained above 170 mm Hg systolic and/or 105 mm Hg diastolic after 5 years were characterized by higher initial BPs, more frequent eye—ground changes, heart enlargement, and more frequent alcohol problems, but also by being on more aggressive treatment. After the initial treatment phase, the frequency of adverse effects necessitating drug withdrawal was low, approximately 3% per year. These promising results are attributed to the clinical routine used and thus point to a potential benefit of structured care for the management of large patient populations.