Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project

Márquez-Contreras, Emilio; Coca, António; Wichmann, Mariano de la Figuera von; Divisón, J.A.; Llisterri, J.L.; Sobrino, Javier; Filozof, Claudia; Sánchez-Zamorano, Miguel A.; Shamagian, Lilian Grigorian

doi:10.1016/s0025-7753(07)72498-3

Cited by 60 publications

(14 citation statements)

References 22 publications

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“…A cross-sectional Spanish study assessing cardiovascular risk and comorbidities in hypertension patients attending primary care practices found the following prevalences of BP categories among 1413 subjects: controlled 3%, mild 50%, moderate 39%, severe 8%. 13 The mean age of their sample was similar to ours at 65.3 (11.4) years. Among high-risk patients (based on comorbidities and absolute BP levels) there was no medication change in 30%.…”

Section: Discussionsupporting

confidence: 79%

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The epidemiology and management of severe hypertension

2009

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Hypertension guidelines stress that patients with severe hypertension (systolic blood pressure (BP)⩾180 or diastolic BP⩾110 mm Hg) require multiple drugs to achieve control and should have close follow-up to prevent adverse outcomes. However, little is known about the epidemiology or actual management of these patients. We retrospectively studied 59 207 veterans with hypertension. Patients were categorized based on their highest average BP over an 18-month period (1 July 1999 to 31 December 2000) as controlled (<140/90 mm Hg), mild (140–159/90–99 mm Hg), moderate (160–179/100–109 mm Hg) and severe hypertension. We examined severe hypertension prevalence, pattern, duration, associated patient characteristics, time to subsequent visit, percentage of visits with a medication increase, and final BP control and antihypertensive medication adequacy. Twenty-three per cent had ⩾1 visit with severe hypertension, 42% of whom had at least two such visits; median day with severe hypertension was 80 (range 1–548). These subjects were significantly older, more likely black, and with more comorbidities than other hypertension subjects. Medication increases occurred at 20% of visits with mild hypertension compared to 40% with severe hypertension; P<0.05). At study end, 76% of patients with severe hypertension remained uncontrolled; severe hypertension subjects with uncontrolled BP were less likely to be on adequate therapy than those with controlled BP (43.7 vs 45.4%). Among hypertensive veterans, severe hypertension episodes are common. Many subjects had relatively prolonged elevations, with older, sicker subjects at highest risk. Although, follow-up times are shorter and antihypertensive medication use greater in severe hypertension subjects, they are still not being managed aggressively enough. Interventions to improve providers' management of these high-risk patients are needed.

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Section: Discussionsupporting

confidence: 79%

“…Limited cross-sectional data suggest a prevalence among those with hypertension in the 8–19% range. 10, 11, 12, 13 How long such patients are exposed to high BPs, or how they are being managed in actual practice is relatively unknown, with existing data based on small samples and select populations. 12, 13, 14 …”

Section: Introductionmentioning

confidence: 99%

The epidemiology and management of severe hypertension

2009

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“…A larger sample size could possibly have allowed the analysis of these relevant subgroups, considering the poor evaluation of cardiovascular risk and its frequent underestimation, especially in primary prevention. 26,27 The indication for AT in secondary prevention is clearer. 28 Emphasis should be given to the fact that, even assuming a minimum risk threshold, evidence now exists for the favorable effect of AT in primary prevention.…”

Section: Discussionmentioning

confidence: 99%

Suitability of antiplatelet therapy in hypertensive patients

et al. 2014

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Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.

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“…The need for prompt follow-up and/or referral to a specialist, and appropriate combinations of drugs to achieve BP control (BP < 140/90 mmHg) is emphasized in guidelines [4,19]. Yet previous studies of SHT management [20-22] have provided evidence that treatment is often inadequate in relation to the serious risks faced by these patients.…”

Section: Introductionmentioning

confidence: 99%

The management of severe hypertension in Australian general practice

Gallego

Runciman

Perez‐Concha

et al. 2013

BMC Health Serv Res

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BackgroundSevere hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices.MethodsReview of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008–2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range - sustained normotension).ResultsOf 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days – 2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.ConclusionsMost patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

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Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project

Cited by 60 publications

References 22 publications

The epidemiology and management of severe hypertension

The epidemiology and management of severe hypertension

Suitability of antiplatelet therapy in hypertensive patients

The management of severe hypertension in Australian general practice

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