Blood Pressure Control in Italian Essential Hypertensives Treated by General Practitioners

Giannattasio, Cristina; Cairo, Matteo; Cesana, Francesca; Alloni, M.; Scocco, Paola; Colombo, Giulia; Mancia, Giuseppe

doi:10.1038/ajh.2012.108

Cited by 17 publications

(10 citation statements)

References 48 publications

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“…Our study suggests that before considering more aggressive treatment and lower BP targets, it might be more effective to focus on achieving, and maintaining BP control using existing blood pressure targets—a goal that is not achieved in US, Europe, or in low and middle income countries. [7–9,39–41] Countries with different antihypertension treatment strategies or medication prescription patterns may have a different TITRE profile in patients. We report an estimated 1823 cases of any cardiovascular disease and deaths that might be prevented per 100,000 newly diagnosed hypertensive patients over 5 years by increasing patients’ TITREs a level higher.…”

Section: Discussionmentioning

confidence: 99%

Time spent at blood pressure target and the risk of death and cardiovascular diseases

et al. 2018

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BackgroundThe time a patient spends with blood pressure at target level is an intuitive measure of successful BP management, but population studies on its effectiveness are as yet unavailable.MethodWe identified a population-based cohort of 169,082 individuals with newly identified high blood pressure who were free of cardiovascular disease from January 1997 to March 2010. We used 1.64 million clinical blood pressure readings to calculate the TIme at TaRgEt (TITRE) based on current target blood pressure levels.ResultThe median (Inter-quartile range) TITRE among all patients was 2.8 (0.3, 5.6) months per year, only 1077 (0.6%) patients had a TITRE ≥11 months. Compared to people with a 0% TITRE, patients with a TITRE of 3–5.9 months, and 6–8.9 months had 75% and 78% lower odds of the composite of cardiovascular death, myocardial infarction and stroke (adjusted odds ratios, 0.25 (95% confidence interval: 0.21, 0.31) and 0.22 (0.17, 0.27), respectively). These associations were consistent for heart failure and any cardiovascular disease and death (comparing a 3–5.9 month to 0% TITRE, 63% and 60% lower in odds, respectively), among people who did or did not have blood pressure ‘controlled’ on a single occasion during the first year of follow-up, and across groups defined by number of follow-up BP measure categories.ConclusionBased on the current frequency of measurement of blood pressure this study suggests that few newly hypertensive patients sustained a complete, year-round on target blood pressure over time. The inverse associations between a higher TITRE and lower risk of incident cardiovascular diseases were independent of widely-used blood pressure ‘control’ indicators. Randomized trials are required to evaluate interventions to increase a person’s time spent at blood pressure target.

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Section: Discussionmentioning

confidence: 99%

Time spent at blood pressure target and the risk of death and cardiovascular diseases

et al. 2018

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“…BP control rates, as defined by the European Society of Hypertension and European Society of Cardiology guidelines, 19 were 22.3% in the group receiving ≥3 medications. 14 Those uncontrolled on ≥3 medications in this treated hypertensive population would be estimated at 17.4%.…”

Section: Prevalence Of Resistant Hypertensionmentioning

confidence: 98%

“…12 Control rates across Europe have since improved with recent reports indicating 19% control in 2001 (Germany), 28% in 2006 (England) and 37% in 2009 (Italy). 4,13,14 …”

Section: Introductionmentioning

confidence: 99%

Apparent and true resistant hypertension: definition, prevalence and outcomes

2014

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Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of ≥3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires ≥4 agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension. This classically defined resistant group consists of patients with true resistant hypertension, controlled resistant hypertension and pseudo-resistant hypertension. In studies where pseudo-resistant hypertension cannot be excluded (for example, 24-h ambulatory BP not obtained), the term apparent resistant hypertension has been used to identify ‘apparent’ lack of control on ≥3 medications. Large, well-designed studies have recently reported the prevalence of resistant hypertension. Pooling prevalence data from these studies and others within North America and Europe with a combined sample size of >600 000 hypertensive participants, the prevalence of resistant hypertension is 14.8% of treated hypertensive patients and 12.5% of all hypertensives. However, the prevalence of true resistant hypertension, defined as uncontrolled both by office and 24-h ambulatory BP monitoring with confirmed medication adherence, may be more meaningful in terms of identifying risk and estimating benefit from newer therapies like renal denervation. Rates of cardiovascular events and mortality follow mean 24-h ambulatory BPs in patients with resistant hypertension, and true resistant hypertension represents the highest risk. The prevalence of true resistant hypertension has not been directly measured in large trials; however, combined data from smaller studies suggest that true resistant hypertension is present in half of the patients with resistant hypertension who are uncontrolled in the office. Our pooled analysis shows prevalence rates of 10.1% and 7.9% for uncontrolled resistant hypertension among individuals treated for hypertension and all hypertensive individuals, respectively.

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“…General practitioners (GPs) form an essential first line of defense in the diagnosis and management of hypertension in the Italian health care system (Giannattasio et al, 2012). According to the Cardio Monitor 2004 Survey (n = 3516), hypertension was diagnosed by GPs in 81% of cases (Wang et al, 2007).…”

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confidence: 99%

Type D Personality and Essential Hypertension in Primary Care

Oliva

Versino

Gammino

et al. 2016

Journal of Nervous &Amp; Mental Disease

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To estimate the relationship between type D personality and essential hypertension among patients visiting their GPs for any health problem, 101 hypertensive and 138 nonhypertensive patients were consecutively recruited and assessed using the Type D Personality Scale (DS14). The predictive value of type D personality was determined using a logistic regression model, taking into account the differences in recognized confounders between groups. Type D personality in the hypertension group was twice as frequent as in the no hypertension group and hypertension was more frequent among type D than non-type D patients. Logistic regression showed a significant predictive value of type D personality for hypertension, adjusting for sex, age, body mass index, family history of hypertension, living condition, education, and employment. Therefore, type D personality was strongly related to hypertension and it was a noteworthy predictor of hypertension in a real-world cohort of primary care patients.

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Blood Pressure Control in Italian Essential Hypertensives Treated by General Practitioners

Cited by 17 publications

References 48 publications

Time spent at blood pressure target and the risk of death and cardiovascular diseases

Time spent at blood pressure target and the risk of death and cardiovascular diseases

Apparent and true resistant hypertension: definition, prevalence and outcomes

Type D Personality and Essential Hypertension in Primary Care

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