BP control rates have improved in Spain from 2002 to 2010. This may be related, at least in part, with the higher use of antihypertensive treatment, particularly combined therapy.

ObjectiveA good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence.MethodsAn observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals.ResultsA total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively) and “adverse events” (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of “cost and co-payment” for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that “to adjust medication to activities of daily living” was the best strategy to reduce therapeutic complexity, whereas physicians believed that “reducing the frequency of administration” (47.9%) followed by “reducing the number of tablets” (28.5%) was the most effective strategy to improve patients’ adherence.ConclusionOur results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients’ daily lives.

Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (Euro 940 vs Euro 238). Reaching the gold standard (ABPM) involved an after-cost of Euro 115 per patient. The results for a 5% discount rate showed a saving of Euro 68,883 if ABPM was performed in all the patients included in the study (n = 241, Euro 285 per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost-effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.

Although therapeutic inertia has decreased in the last years in primary care setting in Spain, nowadays in nearly 60% of patients with uncontrolled BP, no therapeutic action is actually taken. Therefore, despite a significant improvement, therapeutic inertia still remains a relevant clinical problem in hypertension general practice.

This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients 80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90 mm Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians.

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More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

This study sought to assess blood pressure (BP) control rates by determining the factors associated with poor BP control, therapeutic management and physicians' therapeutic behavior among elderly Spanish hypertensive patients in a primary care setting. This cross-sectional multicenter study included hypertensive patients at least 80 years of age in primary care settings throughout Spain who were on pharmacologic treatment. BP was considered well controlled at o140/90 mm Hg (o130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). A total of 923 patients were included (83.3±3.5 years; 62.9% women). Almost two-thirds (64.0%) of the patients were taking a combined therapy (68.7%; 2 drugs) and approximately one-third (35.6%; 95% CI 32.6-38.7) of the patients attained BP goals. Physicians modified the antihypertensive treatment in 26.1% (95% CI 22.3-29.9) of patients with uncontrolled BP, which most frequently involved the addition of another drug (47.6%). Predictive factors for no BP control and no therapeutic modification in patients with uncontrolled BP included diabetes (OR 2.8 (95% CI 2.0-3.9); Po0.0001) and mistaken physician perceptions about BP control (OR 108.1 (95% CI 40.5-288.6); Po0.0001), respectively. Only three out of 10 hypertensive patients 80 years or older in Spain achieved the BP goals. Physicians only modified the treatment in one out of four patients with uncontrolled BP. Diabetes was associated with a threefold increase in the likelihood of uncontrolled BP, and the mistaken physician perceptions about BP control were associated with a 100-fold rise in the probability of not modifying antihypertensive therapy.