Therapeutic decisions in the management of arterial hypertension in Poland - results of the DETENT study

Abstract

Background Appropriate control of arterial blood pressure remains a problem in patients with systemic hypertension. According to recent studies normalization of blood pressure has been achieved in case of 10-15% of hypertensive patients in Polish population. There is a need for assessment of the quality and effectiveness of antihypertensive treatment in order to establish successful therapeutic strategies for the future. The aim of the DETENT study was to assess the choices made in the antihypertensive pharmacotherapy in Polish population and potential differences between therapeutic regimens used 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 expected to fill in a form for 40 consecutive patients with arterial hypertension taken care in physician’s clinical practice.
Results Data concerning antihypertensive treatment in case of 24 451 patients (50.2% women, 49.8% men) - 7088 (29%) from cardiologists (group A) and 17 363 (71%) from primary care physicians (group B) was collected. Mean age was 60.4 years. Incidence of treatment with specified groups of antihypertensive drugs were as follows: ACE-I - 82.2%, β-blockers - 81.2%, diuretics - 53.6%, calcium channel blockers - 31.4%, angiotensin receptor blockers - 24.5%, α-blockers - 9.7%, other antihypertensives - 17.7%. Monotherapy was a treatment in case of 9.7% patients and at least 2 drugs at a time were used in 90.3% of patients. Target values of blood pressure were achieved in 11.2% of hypertensive patients.
Conclusions ACE-I, β-blockers and diuretics were used in case of more than 50% of patients. Monotherapy was a treatment in case of 9.7% patients, mostly with the use of β-blockers or ACE-I. ACE-I were a first line therapy in more than 50% of cases. Beta-blockers were used usually as a first or second line treatment. Diuretics and calcium channel blockers were implemented mainly as a second or third line antihypertensive treatment. Normalization of blood pressure in the DETENT study was achieved in case of 11,2% patients with hypertension.