open access

Vol 13, No 5 (2009)
Prace oryginalne
Published online: 2009-12-04
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Therapeutic decisions in the management of arterial hypertension in Poland - coexistence of complications and other chosen compelling indications and their influence on therapeutic decisions. Results of the DETENT study

Ludwina Szczepaniak-Chicheł, Andrzej Tykarski
Nadciśnienie tętnicze 2009;13(5):300-319.

open access

Vol 13, No 5 (2009)
Prace oryginalne
Published online: 2009-12-04

Abstract


Background 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 in antihypertensive pharmacotherapy in Polish population.
Material and methods The DETENT study was designed as an all-Poland epidemiological survey in which 177 cardiologists and 434 primary care physicians took part. Every participant was supposed to fill in a form for 40 consecutive patients with hypertension taken care in participant’s own medical practice. Results Data concerning antihypertensive treatment was collected for 24 451 patients (50.2% W, 49.8% M) - 29% (7088; 46.9% W, 53.1% M) treated by cardiologists and 71% (17 363; 51.6% W, 48.4% M) treated by primary care physicians. Mean age was 60.4 ± 12 years. The commonest coexisting state was hypercholesterolemia (63.4%). Diabetes was present in 27.4% of patients, obesity (BMI ≥ 30 kg/m2) in 29.5%, ischemic heart disease in 40,9%, previous myocardial infarction in 21.4%, previous stroke in 6.4% and heart failure in 17.8%. Kidney dysfunction and chronic kidney disease were present in case of 7.5% and 4.8% of patients, benign prostate hyperplasia in 10.1% and hyperthyroidism in 4.7%. 8.5% of patients had uncomplicated arterial hypertension. Most often used groups of antihypertensive drugs in the whole study population were ACE-Is (80.8%), β-blockers (75.2%) and diuretics (51.3%). Not only the incidence of treatment with main groups of antihypertensive drugs was assessed, but also the sequence of their implementation in the treatment regimen, range of doses used (minimal, medium, maximal) and achieved control of blood pressure values depending on the type and number of coexisting diseases, in accordance with the recent guidelines of the ESC/ESH for the management of arterial hypertension.
Conclusions In the DETENT study the 3 most often used groups of antihypertensive drugs were ACE-I, β-blockers and diuretics regardless of the type of coexisting diseases. Only the patients with prostate hyperplasia (α-blockers were the third group), with hyperthyroidism and with uncomplicated hypertension (β-blockers were most often used) were the exception. Observed trends in the choices done in the antihypertensive therapy seem to follow the guidelines, but still too high percentage of patients is not given as a part of the antihypertensive treatment drugs basic for important concomitant diseases. Relatively small number of patients is given antihypertensive drugs in maximal doses. Goal values of blood pressure were achieved only in case of 11.2% of patients in the whole DETENT population. Blood pressure control in patients with complicated hypertension is highly unsatisfactory. Values of BP < 130/80 mm Hg in case of concomitant diseases bound up with high and very high cardiovascular risk were achieved in less than 6% of patients. Increasing number of complications and concomitant diseases lowered the percentage of patients with blood pressure control.

Abstract


Background 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 in antihypertensive pharmacotherapy in Polish population.
Material and methods The DETENT study was designed as an all-Poland epidemiological survey in which 177 cardiologists and 434 primary care physicians took part. Every participant was supposed to fill in a form for 40 consecutive patients with hypertension taken care in participant’s own medical practice. Results Data concerning antihypertensive treatment was collected for 24 451 patients (50.2% W, 49.8% M) - 29% (7088; 46.9% W, 53.1% M) treated by cardiologists and 71% (17 363; 51.6% W, 48.4% M) treated by primary care physicians. Mean age was 60.4 ± 12 years. The commonest coexisting state was hypercholesterolemia (63.4%). Diabetes was present in 27.4% of patients, obesity (BMI ≥ 30 kg/m2) in 29.5%, ischemic heart disease in 40,9%, previous myocardial infarction in 21.4%, previous stroke in 6.4% and heart failure in 17.8%. Kidney dysfunction and chronic kidney disease were present in case of 7.5% and 4.8% of patients, benign prostate hyperplasia in 10.1% and hyperthyroidism in 4.7%. 8.5% of patients had uncomplicated arterial hypertension. Most often used groups of antihypertensive drugs in the whole study population were ACE-Is (80.8%), β-blockers (75.2%) and diuretics (51.3%). Not only the incidence of treatment with main groups of antihypertensive drugs was assessed, but also the sequence of their implementation in the treatment regimen, range of doses used (minimal, medium, maximal) and achieved control of blood pressure values depending on the type and number of coexisting diseases, in accordance with the recent guidelines of the ESC/ESH for the management of arterial hypertension.
Conclusions In the DETENT study the 3 most often used groups of antihypertensive drugs were ACE-I, β-blockers and diuretics regardless of the type of coexisting diseases. Only the patients with prostate hyperplasia (α-blockers were the third group), with hyperthyroidism and with uncomplicated hypertension (β-blockers were most often used) were the exception. Observed trends in the choices done in the antihypertensive therapy seem to follow the guidelines, but still too high percentage of patients is not given as a part of the antihypertensive treatment drugs basic for important concomitant diseases. Relatively small number of patients is given antihypertensive drugs in maximal doses. Goal values of blood pressure were achieved only in case of 11.2% of patients in the whole DETENT population. Blood pressure control in patients with complicated hypertension is highly unsatisfactory. Values of BP < 130/80 mm Hg in case of concomitant diseases bound up with high and very high cardiovascular risk were achieved in less than 6% of patients. Increasing number of complications and concomitant diseases lowered the percentage of patients with blood pressure control.
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Keywords

arterial hypertension; concomitant diseases; hypertensive complications; pharmacological management; choice of agent; epidemiology

About this article
Title

Therapeutic decisions in the management of arterial hypertension in Poland - coexistence of complications and other chosen compelling indications and their influence on therapeutic decisions. Results of the DETENT study

Journal

Arterial Hypertension

Issue

Vol 13, No 5 (2009)

Pages

300-319

Published online

2009-12-04

Bibliographic record

Nadciśnienie tętnicze 2009;13(5):300-319.

Keywords

arterial hypertension
concomitant diseases
hypertensive complications
pharmacological management
choice of agent
epidemiology

Authors

Ludwina Szczepaniak-Chicheł
Andrzej Tykarski

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