Evolution of therapy inertia in primary care setting in Spain during 2002–2010

Escobar, Carlos; Barrios, Vivencio; Alonso-Moreno, Francisco J.; Prieto, M.; Valls, F.; Calderón, Alberto; Llisterri, J.L.; investigators, Prescap

doi:10.1097/hjh.0000000000000118

Cited by 30 publications

(15 citation statements)

References 46 publications

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“…This suggests that one of the main reasons for uncontrolled BP may not be true resistance but noncompliance with or underdosing of antihypertensives . The latter is related to the clinical inertia phenomenon among physicians, resulting in neither frequent titration nor changes in medications for uncontrolled hypertensive patients …”

Section: Discussionmentioning

confidence: 99%

Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008–2011

Sarganas

Neuhauser

2016

J of Clinical Hypertension

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The prevalence and associated factors of untreated, uncontrolled, and apparent‐resistant hypertension (RH) in Germany are unknown. Based on European Society of Hypertension criteria, apparent RH was defined as blood pressure (BP) ≥140/90 mm Hg (≥140/85 mm Hg in diabetics) under treatment with three different classes of antihypertensive agents including a diuretic. Data from the German Health Examination Survey (2008–2011; n=7115, age 18–79 years) including standardized BP measurements and Anatomical Therapeutic Chemical–coded taken medications were analyzed. Among patients aware of their hypertensive status (n=2205), 37.9% were uncontrolled and, among those, 33.4% were untreated. Being aware and having untreated and uncontrolled BP was associated with male sex, young age, not having cardiovascular disease, not performing BP self‐measurement, not being obese, and not smoking. Apparent RH occurred in 6.8% of treated aware hypertensive patients and was positively associated with having diabetes. The proportion of uncontrolled BP is still high. Not having “obvious risk factors” has become a risk itself for having untreated and uncontrolled hypertension.

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Section: Discussionmentioning

confidence: 99%

Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008–2011

Sarganas

Neuhauser

2016

J of Clinical Hypertension

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“…Por lo tanto, se puede decir que el control de la anticoagulació n en Españ a es malo, algo similar a lo que ocurre en otros países. A diferencia de lo que sucede con otras entidades cró nicas, como la hipertensió n, en las que uno de los motivos del mal control es una marcada percepció n incorrecta de este, el estudio PAULA muestra que el mal control de la anticoagulació n no parece deberse tanto a una percepció n incorrecta del mé dico como a la dificultad inherente a mantener al paciente dentro del rango terapé utico adecuado 32 . Distintos estudios han investigado qué factores se asocian con un peor control de la anticoagulació n. En el estudio ANFAGAL se observó que era má s frecuente el mal control de la INR en sujetos con valores de HAS-BLED elevados, diabetes mellitus, enfermedad renal e hipertensió n 12 .…”

Section: Discusió Nunclassified

Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA

Barrios

Escobar

Prieto

et al. 2015

Revista Española de Cardiología

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124

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“…This has improved from 2002 to 2010 but remains an issue. Treatment was modified in just 41.4% of those with uncontrolled BP in 2010, an improvement from 18.3% in 2002 …”

Section: Discussionmentioning

confidence: 99%

“…Treatment was modified in just 41.4% of those with uncontrolled BP in 2010, an improvement from 18.3% in 2002. 20 The prognostic importance of 24-hour ambulatory BP is well-known. 4,5 It is important to examine the day and night BP window as the nighttime BP is recognized to be of greater prognostic significance.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Prevalence, Awareness, Treatment, and Control: Should 24‐Hour Ambulatory Blood Pressure Monitoring be the Tool of Choice?

O’Flynn

Curtin

Perry

et al. 2015

J of Clinical Hypertension

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We aimed to examine hypertension prevalence, awareness, treatment and control in a community sample and investigate the impact of using 24 hour ABPM. Office blood pressure (BP) was taken from the electronic health record. Study BP was measured by standardised methods. Participants were invited to undergo ABPM. Hypertension was defined by accepted thresholds or anti-hypertensive use. Standardised questions assessed awareness and treatment. Control was defined as anti-hypertensive use with BP below normal threshold. There were 931 (45%) participants with office BP, study BP and ABPM. By study BP, hypertension prevalence was 60%, awareness 59%, 60% were treated and 46% controlled. By daytime ABPM threshold, prevalence was 61%, awareness 59%, 59% were treated and 54% controlled. ABPM reclassified 13.5% from normotensive to hypertensive and 14.5% from hypertensive to normotensive. ABPM may not hugely impact population hypertension prevalence but at an individual level it reduces misclassification and facilitates more appropriate management. J Clin Hypertens (Green-wich). 2016;18:697-702. ª 2015 Wiley Periodicals, Inc. Hypertension is a leading risk factor for cardiovascular mortality. In 2009 the World Health Organization estimated that raised blood pressure (BP) caused 51% of stroke deaths and 45% of coronary heart disease deaths worldwide. 1 However, many people with hypertension are undiagnosed 2 and of those who are diagnosed many have poorly controlled BP. 3 Accurate measurement of BP is essential for the diagnosis and management of hypertension. Traditionally , measurements are carried out in a clinical setting and a diagnosis of hypertension is made based on this office reading. Ambulatory BP monitoring (ABPM) provides information over a 24-or 48-hour period and in particular gives important information on night-time BP. Ambulatory BP has been shown to be superior for the prediction of clinical events. 4,5 A systematic review and meta-analysis on the relative effectiveness of clinic BP measurements and home BP monitoring (HBPM) compared with ABPM concluded that treatment decisions based on clinic BP or HBPM alone might result in overdiagnosis of hypertension. 6 A subsequent United Kingdom study on the cost-effectiveness of options for the diagnosis of hypertension in primary care reported that ABPM would reduce misdi-agnosis and save costs. It was suggested that in the United Kingdom the increased costs related to ABPM would be counterbalanced by cost savings from better targeted therapy. 7 The National Institute for Health and Care Excellence (NICE) in 2011 recommended that if office BP is 140/90 mm Hg or higher, ABPM should be offered to confirm the diagnosis of hypertension. 8 The 2013 European Society of Hypertension (ESH) guidelines state that office BP remains the "gold standard" for screening, diagnosis and management of hypertension. 9 They recommend HBPM or ABPM be carried out in certain clinically indicated situations including suspected white-coat hypertension, drug resistance, and hypotensive sympt...

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Evolution of therapy inertia in primary care setting in Spain during 2002–2010

Cited by 30 publications

References 46 publications

Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008–2011

Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008–2011

Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA

Hypertension Prevalence, Awareness, Treatment, and Control: Should 24‐Hour Ambulatory Blood Pressure Monitoring be the Tool of Choice?

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