General Practitioners’ vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension – a cross-sectional database study

Abstract

BackgroundPatients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension.MethodsWe cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥6 months. We compared patients with VKA for ≥3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity.ResultsWe identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9 %) were on Phenprocoumon (VKA) and 3,843 (87.1 %) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of −8.4 mm Hg (95 % CI −9.8 to −7.0 mm Hg) and −1.5 mm Hg (95 % CI −2.3 to −0.7 mm Hg), respectively (p < 0.001 for both).ConclusionsIn a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

“…Nevertheless, it must be acknowledged that periodical INR monitoring required under VKA treatment imposes not necessarily a burden for patients and primary physicians. A recent study suggested that it could also enhance patient-physician relation and therapy adherence and offer opportunities for the physician to provide additional care to patients, such as adjusting the dosage of antihypertensive drugs, giving smoking cessation advice or treating high cholesterol [93]. Our findings now show that concomitant comprehensive care for other conditions does not impair physicians' resources in controlling INR and ensuring high quality TTR control.…”

“…A recent study suggested that it could also enhance patient-physician relation and therapy adherence and offer opportunities for the physician to provide additional care to patients, such as adjusting the dosage of antihypertensive drugs, giving smoking cessation advice, or treating high cholesterol. 93 Our findings now show that concomitant comprehensive care for other conditions does not impair physicians' resources in controlling INR and ensuring high-quality TTR control. This is of particular relevance for daily practice in primary care worldwide, given the high prevalence of multimorbidity in primary care patients.…”

Factors influencing the development of primary care data collection projects from electronic health records: a systematic review of the literature

“… in-house IT and pharmaco-epidemiologist teams No private-sector company GRAPHC - Australian National University - A ustralian Primary Health Care Research Institute [ 182 ] Canning Division of General Practice Australian General Practice Network MEGPN Independent accredited not-for-profit organization [ 27 ] PCS Clinical Audit Tool© Practice Health Atlas© Intego a Flemish government, Department of Health Care [ 54 ] - Department of General Practice of the KU Leuven [ 54 ] - Other universities. - GPs’ participation in the ethics and scientific committee - Datasoft, Medidoc - Careconnect EHR - No private-sector company involved in data analysis NIHDI Public social security institution [ 23 ] Extraction module on EHR [ 23 ] Health Search Database / CSD© Cegedim © [ 77 ] Swedestar project - Department of Medical and Health Sciences, University of Linköping, Unit of Research and Development in Primary Care, Jönköping - Lindsdals Primary Health Centre [ 96 ] Swedestar software [ 96 ] FIRE - Institute of General Practice of Zurich University [ 97 ] - “SGAM informatics”, a study group of the Swiss Association of GPs [ 26 ] Grhanite extracting tool LPD network - Cegedim Doc’ware software - Cegedim © [ 8 ] a the contact person gave information on the project governance following our enquiry by email …”