Effectiveness of hypertension treatment assessed by blood pressure level achieved in primary care setting in Poland

Abstract

The effectiveness of hypertension treatment remains low in many developed countries. The aim of our study was to evaluate the treatment effectiveness in hypertensives treated by general practitioners (GPs) in Poland. Twenty thousand three hundred and five hypertensive patients (mean age 60.1 +/- 12.0 years, 9918 women, 10 387 men), pharmacologically treated by 677 GPs in Poland, were investigated. Blood pressure (BP) in every patient was measured twice, within approximately a 5-min interval, in a seated position, using a mercury sphygmomanometer, after a rest of at least 10 min. Mean blood pressure from both measurements was used for further analysis. Measurements were carried out by a GP in the office. Every physician investigated 30 consecutive hypertensive patients. Of the investigated hypertensive patients treated, 8.3% had systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (7.8% in women, 8.8% in men respectively; p > 0.05). Mean SBP in the investigated group was 161.9 +/- 20.4 mmHg, 162.7 +/- 20.8 mmHg in women and 161.1 +/- 20.1 mmHg in men, respectively; p < 0.05. Mean DBP was 95.4 +/- 11.0 mmHg. The difference between mean DBP in women (95.3 +/- 11.0 mmHg) and men (95.5 +/- 11.1 mmHg) was not significant, p > 0.05. Mean pulse pressure (PP) for the whole group was 66.5 +/- 16.3 mmHg. In this cohort, 26.7% of patients were treated with one, 37.6% with two, 26.7% with three, 8.2% with four and 0.8% with five antihypertensive drugs. Mean number of antihypertensive drugs prescribed for one hypertensive patient was 2.2 +/- 1.0. Effectiveness of hypertension treatment by GPs in Poland remained unsatisfactory despite frequent implementation of combined antihypertensive drug therapy.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

“…11 However, among the hypertensives receiving treatment in general practice in Poland, the blood pressure control rate is lower than 10% according to the control level of 140/90 mm Hg. 12 Although varying figures are presented for the blood pressure control rate among hypertensive patients receiving treatment in primary care services in USA, [13][14] overall they are higher than those reported for European countries. Maue et al 13 have reported BP control rate according to the level of 140/90 mm Hg to be 41% (36% according to the 130/85 level for diabetics) in USA primary care services, compared with the approximate 50% reported by Ornstein et al…”

“…Moreover, there are regional differences in both the percentage of taking medication and the blood pressure control rate. What is known on the topic K The blood pressure control rates are generally low and there are marked differences in the blood pressure control rates among hypertensives between different countries [2][3][4][5] K The blood pressure control rate among patients receiving antihypertensive treatment ranges from 10 to 40.3% in European countries 2,[9][10][11][12] What this study adds K The blood pressure control rate (24.3%) is consistently low among hypertensives receiving antihypertensive medication in primary care unit in Turkey, and is similar in general to that observed in primary care units in European countries K The blood pressure control was worse among diabetic patients and those with a high body mass index K The blood pressure control rate varies between the geographic regions of Turkey…”

Evaluation of arterial hypertension control and treatment in daily practice of family physicians

“…Epidemiological studies performed in America (United States, Canada) and Europe indicate that control of hypertension is insuffi cient despite pharmacotherapy: hypertension control (ABP <140/90 mm Hg) varies from 8.3% to 42% in different countries (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The data from other published trials indicate that the level of ABP control in treated patients is lower than in the mentioned trial.…”

Detection and treatment of hypertension in general health-care practice: a patient-based study

“…Our findings are, in general, in agreement with other studies regarding poor BP control. [11][12][13][14][15] The target BP levels are not achieved according to this study, for which there could be several explanations apart from the less aggressive treatment by the general practitioners (GPs). Patient concordance or adherence may play a major role.…”

“…11 Achieving BP goals is a challenge for patients and their physicians, and most patients fall short of the goal. [11][12][13][14][15] For example, Steinman et al 14 found in a survey among primary care patients at Veterans Affairs medical centres that only 43% had BP levels o140/90 mmHg. A Canadian study showed that 24% of hypertensive persons had systolic blood pressure (SBP) of 140-160 mmHg and diastolic blood pressure (DBP) o90 mmHg.…”