Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006

Physician Perception of Blood Pressure Control and Treatment Behavior in High-Risk Hypertensive Patients: A Cross-Sectional Study

“…The difference between objective BP control and control as perceived by physicians has also been observed in other studies [14]–[16], [24]. Furthermore, the magnitude of treatment inaction in our study was almost 50%, similar to that reported in other studies in primary care [24], and lower than that observed in some other studies [7], [16], including those found in cardiovascular patients in specialty care [21].…”

“…These physicians consecutively recruited 1,812 patients (maximum of 6 patients per physician) aged 18 years or over, diagnosed with hypertension (BP ≥140/901mmHg) and on anti-hypertensive drug treatment for at least one year, who had suffered at least one of the following cardiovascular events, documented by hospital medical report: ischemic stroke (transient ischemic attack or acute stroke); cerebral hemorrhage; angina or myocardial infarction; coronary revascularization (by-pass, stent); congestive heart failure; or aortofemoral bypass graft surgery [2], [23]. The sample size was predetermined according to the expected frequency of treatment inaction in HT in Spain [16].…”

“…Other studies have found that one reason physicians say they theoretically would not intensify treatment [10], [11], or actually do not intensify it in their own practice [10], [12], [13], is satisfaction with BP values close to the therapeutic goal. In reality, physicians usually overestimate the degree of BP control in their patients [14]–[16]. Other studies have reported that BP levels at the office visit predict antihypertensive medication change [9], [17]–[19].…”

“…The high prevalence of treatment inaction in patients with poor BP control [7], [16], [21] suggests that physicians must sometimes have good reasons for not changing treatment, although few studies have addressed this question. It has been reported that “white coat” HT and treatment non-compliance are factors often cited by physicians as contributors to therapeutic inaction in hypothetical patients with elevated BP [22], which could be considered inaction that is clinically appropriate.…”

Evolución del control de la presión arterial en España en el período 2002–2006. Estudios PRESCAP

“…Las posibles causas del insuficiente control son múltiples y complejas; en unos casos dependen del propio paciente (incumplimiento) y en otras de un insuficiente tratamiento farmacológico (ineficacia) o de una conducta poco rigurosa del médico (inercia terapéu-tica), aspecto que recientemente adquiere especial protagonismo como motivo de mal control de la HTA y de otros FRCV 7 . De hecho, en nuestro país muchos médicos introducen pocos cambios terapéuticos farmacológicos en hipertensos no controlados, tanto en atención primaria (AP) 8,9 como en unidades de HTA 10 , a pesar de que los estudios de intervención nos han enseñado la dificultad de alcanzar objetivos prefijados de PA, especialmente de la PAS, sobre todo en los pacientes de elevado riesgo cardiovascular, como los diabéticos, y en aquellos que padecen nefropatía, en quienes suele ser necesario la mayoría de las veces utilizar terapia combinada de dos o más fármacos antihipertensivos para alcanzar los objetivos recomendados 5 .…”