Abstract
Most patients with arterial hypertension are treated in primary care. The objective is to assess characteristics of patients with uncontrolled arterial hypertension and its associated determinants in Swiss primary care. Data on 122 adult patients with uncontrolled hypertension (mm Hg >140 systolic and/or >90 diastolic) was collected from the baseline data of the on-going randomised controlled "CoCo" trial: Colour-coded Blood Pressure Control. Patient and general practitioner characteristics were analysed to investigate the relationship between BP and patient characteristics. From October 2009 to March 2011 30 general practitioners recruited 122 patients; median age 64 years (IQR 54.8-72), 50% male, median BMI 28.3 kg/m2 (IQR 25.3-31.7), 21.5% smokers. 65.6% performed home blood pressure measurement, 88.5% received pharmacological treatment, 41.8% mono-therapy. Most frequent dual drug combinations: diuretics/angiotensin-receptor-blockers (33.3%), angiotensin-converting-enzyme-inhibitors/beta blockers (both 28.1%). BMI, smoking and age were independent predictors for elevated systolic blood pressure when controlled for gender, home blood pressure measurement, education, pulse rate and number of antihypertensive substances. We found a significant non-linear association between systolic blood pressure and number of antihypertensive substances. Age and any amount of antihypertensive substances were independently and inversely correlated with diastolic blood pressure. The findings did not change when additionally controlled for general practitioner clustering effect. Smoking and high BMI are strong and independent factors associated with higher blood pressure levels in patients with uncontrolled arterial hypertension. A high rate of monotherapy and a decrease in the incremental gain on blood pressure control when more antihypertensive agents are used highlight the importance of adequate pharmacological treatment as well as risk factor control.
Highlights
Data on patients with arterial hypertension (AH) from the US and Europe show insufficient blood pressure (BP) control, even though effective antihypertensive treatments as well as guideline recommendations are available [1]
Considering that AH is the most prevalent cardiovascular risk factor worldwide [2] and that even mild AH is associated with increased risk of cardiovascular morbidity and mortality [3, 4], it is important to emphasise the need for strict BP control [5] and to get deeper insight into factors that hinder its achievement
Most of the international data on BP control originate from national surveys, population based studies or secondary care, despite the fact that the majority of patients are treated in a primary care (PC) setting
Summary
Data on patients with arterial hypertension (AH) from the US and Europe show insufficient blood pressure (BP) control, even though effective antihypertensive treatments as well as guideline recommendations are available [1]. Most of the international data on BP control originate from national surveys, population based studies or secondary care, despite the fact that the majority of patients are treated in a primary care (PC) setting. Even the studies performed in the PC setting of countries in which the general practitioner (GP) holds a strong gate-keeping function [8, 9] are often restricted to certain ages or to already existing antihypertensive medications. Since the gate-keeping system in Switzerland is not generally established and is limited to certain insurance models which are currently chosen by the minority of the population, direct knowledge transfer is limited.
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