TREATMENT OF HYPERTENSION IN PRIMARY CARE

Abstract

Objective: Drug utilization and clinical outcomes in hypertensive patients are suboptimal in different Countries, including Italy, leaving a large proportion of patients not at target blood pressure (BP). Design and method: We designed an observational study to define the number of patients diagnosed as hypertensive within the general adult population, the number of drugs prescribed to each patients and the number of hypertensive patients who were effectively treated. To this aim, clinical data collected by 150 General Practitioners (GPs) from 228.406 subjects living in the province of Verona (approximately 30% of the adult population) were analyzed after anonymization. Data retrieved from GPs official database concerned age, gender, number of antihypertensive agents prescribed at the same time over a period of 24 months, BP defined as categorical variable (cutoff 140/90 mmHg). Results: Data concerning the number of prescribed antihypertensive agents and BP control in relation to age are shown in the graph. A total of 43.526 subjects had a diagnosis of arterial hypertension (19% of the entire population, females 53%), 66% of them were aged 65 years or more and 86% received antihypertensive medications in the previous 2 years. The number of prescriptions increased with age. BP recordings were missing in 38% of cases. One third of all patients did not reach normal BP. Approximately 15% of patients could be considered as having resistant hypertension since requiring 4 drugs or not reaching normal BP with 3 drugs. Younger subjects (less than 65 years) more likely had BP not recorded (46%) and often received 1 or 2 antihypertensive agents, whether or not BP was controlled. Elderly patients (65 years or more) often required complex antihypertensive treatment (29% received 3–4 drugs) and their BP, in spite of a more stringent clinical follow up (66% had BP recorded), was uncontrolled in 48% of cases.Conclusions: BP control is not achieved in a large proportion of hypertensives, particularly the elderly patients although receiving a larger number of antihypertensive drugs. The present investigation helps to define the patients who may benefit from active monitoring and intervention aimed at improving the clinical outcomes.