How Many Hypertensive Patients Can Be Controlled in Reality
How Many Hypertensive Patients Can Be Controlled in Reality
The participating GPs cared for 24,918 subjects aged ≥ 15; 5 GPs worked in cities, 7 worked in towns, and 6 in small towns or semirural areas; 7 worked in Northern, 8 in Central, and 3 in Southern Italy. Their baseline performances differed widely (Figure 1), thus increasing the representativeness of the group.The number of patients with codified diagnosis of hypertension increased from 6,309 (age 58.5 +/- 12.4; M 45.5%; prevalence 25.3%) to 6,717 (age 59.6 +/- 12.9; M 45.7%; prevalence 27.0%); the main characteristics of this hypertensive population are reported in Table 1. The differences at baseline and at end of the observation period are probably due to the increased age of the population, and to the better recording of diseases for the hypertensive patients the GPs were focusing on. At baseline 4,305 patients (68.2%) had at least one recorded BP value in the previous year, and 3,203 were controlled (50.8% of all the diagnosed hypertensive patients – patients without BP records considered not controlled – and 74.4% of the subjects with at least one recorded BP value). At the end of the observation period 4,948 patients (78.4%) had at least one recorded BP value in the previous year, 4,043 were controlled (64.1% of all the diagnosed hypertensive patients – patients without BP records considered not controlled – and 81.7% of the subjects with at least one recorded BP value). The BP recording increased (+ 10.2%, ci 9.4%-10.9%; p < 0.001) as well as the BP control rate (+ 13.3%, ci 12.5%-14.2%; p < 0.001 in the whole hypertensive population – patients without BP records considered not controlled- and + 7.3%, ci 6.7%-8.0%; p < 0.001 in the patients with at least one recorded BP value). The hypertensive patients aged ≥ 80 were 1,095, and 791 (72.2%; 89.2% among the 887 patients with at least one recorded BP value) had BP < 150/90 mmHg, the target suggested by the NICE guidelines. If we had considered this different cut-off for very old people there would have been a further modest increase in the total rate of controlled patients.
(Enlarge Image)
Figure 1.
Baseline performances of the 18 participanting GPs (letters identify GPs).
The last available BP value (which determined the "controlled" or "non-controlled" status) was ambulatory or home-based in 135 (2.1%) and 735 (11.7%) subjects. Among the patients "non-controlled" with office measurement, none had at least one previous "controlled" value with home or ambulatory monitoring.
The mean number of anti-hypertensive drug increased from 1.17 (SD 0.81; range 0–7) at baseline to 1.18 (SD 0.82; range 0–7) at the end of the observation period: + 0.01 ± 0.66 (p < 0.001); further details on drug prescription are reported in Table 2 and in Table 3.
The mean number of days in therapy permitted by the recorded prescribed drugs increased from 229 to 236: + 7 ± 83 (p < 0.001); further details on adherence are reported in Table 4 and Table 5.
Results
The participating GPs cared for 24,918 subjects aged ≥ 15; 5 GPs worked in cities, 7 worked in towns, and 6 in small towns or semirural areas; 7 worked in Northern, 8 in Central, and 3 in Southern Italy. Their baseline performances differed widely (Figure 1), thus increasing the representativeness of the group.The number of patients with codified diagnosis of hypertension increased from 6,309 (age 58.5 +/- 12.4; M 45.5%; prevalence 25.3%) to 6,717 (age 59.6 +/- 12.9; M 45.7%; prevalence 27.0%); the main characteristics of this hypertensive population are reported in Table 1. The differences at baseline and at end of the observation period are probably due to the increased age of the population, and to the better recording of diseases for the hypertensive patients the GPs were focusing on. At baseline 4,305 patients (68.2%) had at least one recorded BP value in the previous year, and 3,203 were controlled (50.8% of all the diagnosed hypertensive patients – patients without BP records considered not controlled – and 74.4% of the subjects with at least one recorded BP value). At the end of the observation period 4,948 patients (78.4%) had at least one recorded BP value in the previous year, 4,043 were controlled (64.1% of all the diagnosed hypertensive patients – patients without BP records considered not controlled – and 81.7% of the subjects with at least one recorded BP value). The BP recording increased (+ 10.2%, ci 9.4%-10.9%; p < 0.001) as well as the BP control rate (+ 13.3%, ci 12.5%-14.2%; p < 0.001 in the whole hypertensive population – patients without BP records considered not controlled- and + 7.3%, ci 6.7%-8.0%; p < 0.001 in the patients with at least one recorded BP value). The hypertensive patients aged ≥ 80 were 1,095, and 791 (72.2%; 89.2% among the 887 patients with at least one recorded BP value) had BP < 150/90 mmHg, the target suggested by the NICE guidelines. If we had considered this different cut-off for very old people there would have been a further modest increase in the total rate of controlled patients.
(Enlarge Image)
Figure 1.
Baseline performances of the 18 participanting GPs (letters identify GPs).
The last available BP value (which determined the "controlled" or "non-controlled" status) was ambulatory or home-based in 135 (2.1%) and 735 (11.7%) subjects. Among the patients "non-controlled" with office measurement, none had at least one previous "controlled" value with home or ambulatory monitoring.
The mean number of anti-hypertensive drug increased from 1.17 (SD 0.81; range 0–7) at baseline to 1.18 (SD 0.82; range 0–7) at the end of the observation period: + 0.01 ± 0.66 (p < 0.001); further details on drug prescription are reported in Table 2 and in Table 3.
The mean number of days in therapy permitted by the recorded prescribed drugs increased from 229 to 236: + 7 ± 83 (p < 0.001); further details on adherence are reported in Table 4 and Table 5.
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