Therapeutic decisions in the management of arterial hypertension in Poland - comparison of treatment in primary care and by cardiologists - results of the DETENT study

Abstract

Background Aim of the DETENT study was to assess choices made in antihypertensive pharmacotherapy in Polish population by cardiologists and primary care physicians.
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 of 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 (group A) and 71% (17 363; 51.6% W, 48.4% M) treated by primary care physicians (group B). Mean age was 61,3 years in group A and 60,1 in group B. Most often used in antihypertensive treatment were ACE-Is (84.6% in gr. A vs. 81.2% in gr. B), beta-blockers (84.5% vs. 79.9%) and diuretics (56.4% vs. 52.4%). Differences between groups in the incidence of treatment with specified drugs in general were found to be statistically significant in every case (p < 0.05). Monotherapy was more often found in group B (10.9%) than in group A (6.6%) but in both of them in vast majority of cases polytherapy was implemented (gr. A 93.4%, gr. B 89.1%). Most often used groups of drugs in monotherapy were beta-blockers and ACR-Is. In polytherapy all six basic groups of antihypertensive drugs were more often used by cardiologists and ‘other drugs’ in primary care (p < 0.05). In the first-line treatment in both groups ACE-I and beta-blockers were most often used. In case of second-line treatment beta-blockers and diuretics were most often used by primary care physicians while beta-blockers and ACE-Is by cardiologists. As a third-line treatment diuretics and calcium channel blockers were preferred by specialists, and diuretics and beta-blockers in primary care. Control of BP was achieved in 10.6% of patients in group A and 11.5% of patients in group B (p = 0.051).
Conclusions The pattern of most often used antihypertensive drugs in the treatment regimen was similar in both groups. Polytherapy was preferred in vast majority of hypertensive patients in both groups but particularly in specialist care. Cardiologists seemed to use earlier and more readily ‘newer drugs’ like ACE-Is, Ca-blockers and ARBs, as well as beta-blockers, and primary care physicians ‘older’ ones like diuretics and other from main groups of antihypertensives drugs. Despite that and theoretically wider knowledge of a specialist, a trend towards a better control of BP was found in group treated by primary care physicians. Profile of patients from the DETENT study according to presence of concomitant disorders or hypertensive complications needs to be analyzed to assess whether the higher risk in patients from group A is not responsible for that finding.