Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care

Abstract

Cross-sectional surveys on prevalence, treatment and control of hypertension could not satisfactorily distinguish between diastolic hypertension and isolated systolic hypertension because the definition of hypertension included patients under pharmacological treatment. We assessed the situation in the two types of hypertension in general practice in Belgium, based on current blood pressure (BP) measurements and on BP prior to the initiation of drug therapy. Participating physicians enrolled the first 15 at least 55-year-old men visiting the surgery, measured their BP and recorded data on medical history including pretreatment BP, drug utilization, cardiovascular risk factors and target organ damage. Diastolic hypertension was defined as diastolic BPX90 mmHg, irrespective of systolic BP, and isolated systolic hypertension as systolic BPX140 mmHg and diastolic BPo90 mmHg. Among 3761 evaluable patients, 74% were hypertensive. Among the 1533 hypertensive patients in whom blood pressure was known prior to treatment (n ¼ 965) or who were untreated at the study visit (n ¼ 568), 1164 had diastolic hypertension and 369 isolated systolic hypertension. The prevalence of antihypertensive treatment was, respectively, 75 and 25% (Po0.001) in these two types of hypertension. The odds of being treated were independently determined by type of hypertension, severity of hypertension and level of risk (Po0.001). BP was controlled in 25% of all patients with diastolic hypertension and in 13% of all patients with isolated systolic hypertension (Po0.001). About half of the treated patients with systolic hypertension were on a diuretic and/or a calcium-channel blocker. In conclusion, isolated systolic hypertension is less frequently treated than diastolic hypertension, overall BP control is poor and actual drug therapy diverges from recommendations based on placebo-controlled intervention trials.

Blood Pressure Reduction and Cardiovascular Prevention: An Update Including the 2003-2004 Secondary Prevention Trials

“…The relevance of achieved blood pressure for cardiovascular prognosis must be gauged in terms of the poor control rates of SBP in the population at large (154) as well as in primary care (155). If blood pressure is the major determinant of prognosis, the inescapable inference is that antihypertensive therapy should be individualized and initiated with the drug class that is most likely to be effective in each individual patient, taking into account his overall risk profile and comorbid conditions (3).…”

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

“…In the United States, data from the National Health and Nutrition Examination Survey (NHANES) showed that 70% of hypertensive patients were aware of having the disease, 59% were under treatment, but only 34% had their hypertension under control 9. Studies carried out in other countries revealed a similar low rate of blood pressure control: 25% in Belgium,10 21% in the Czech Republic,11 13.6% in India,12 15% in Hungary,13 10% in Áustria,13 38% in England,14 8% in Egypt,13 5% in Slovakia,14 less than 5% in China,15 and 2.2% in Northern Greece 16. Brazil is no exception, as multiple studies have demonstrated that approximately 30% of Brazilian hypertensive patients have adequate blood pressure control 17,18.…”

Structure and Function of CLCA Proteins

“…This usually results from the diastolic pressure greater than 90 mmHg and the systolic pressure greater than 140 mmHg (32,55,198). Sustained increases in vascular tone can be very detrimental.…”