Antihypertensive treatment among 75 thousand patients in primary care settings - POZ-NAD study

Abstract

Background It has been reported that hypertension is still inadequately controlled in the majority of patients. Recent ESH/ESC guidelines (2007) emphasize that blood pressure should be lowered below 140/90 mm Hg in all hypertensive patients and below 130/80 mm Hg in hypertensive subjects with diabetes or associated cardiovascular disease. The aim of present study was to analyze clinical characteristics of hypertensive subjects in primary care settings in a large sample of patients in Poland.
Material and methods The study included hypertensive subjects aged 18 years or more. Based on medical history and physical examination family practitioners filled questionnaires. Selected laboratory investigations were also included. The risk of diabetes was established based on Finnish diabetes risk score (FINDRISC).
Results 74 745 hypertensive subjects were included in the study (mean age 59.7±11.5 years, females 58.5%). Mean body mass index was 28.8 kg/m². Abdominal obesity was found in almost half of the patients. In 23.1% i 6.5% patients diabetes risk based on FINDRISC score was high and very high. Mean number of antihypertensive drugs was 1.9 ± 1.0, median 2 drugs. In the studied population, 60.1% of patients received 2 or more antihypertensive drugs. 3 or more antihypertensive drugs were used in 28.5% of patients. In patients without diabetes or established cardiovascular disease target blood pressure levels were achieved in 1 of 3 patients. LDL cholesterol serum concentration of 115 mg/dl or lower was found in 35.1% of patients. In patient with diabetes or established cardiovascular disease target blood pressure levels (< 130/80 mm Hg) were achieved in 7.0% of patient. LDL cholesterol serum concentration of 100 mg/dl or lower was found in 21.7% of patients.
Conclusions In the large sample of hypertensive subjects in the primary care settings, target blood pressure levels were achieved in the minority of patients. Lower target blood pressure levels recommended by recent guidelines were achieved in less than 10% of patients with diabetes or established cardiovascular disease. The implementation of current recommendation is insufficient in primary care settings.