Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden

Journath, Gunilla; Hellénius, Mai-Lis; Petersson, Ulla; Theobald, Holger; Nilsson, Peter M.

doi:10.1097/hjr.0b013e3282f37a45

Cited by 28 publications

(24 citation statements)

References 31 publications

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“…Although we included all hypertensive patients within primary health care in a mixed urban region of more than 330 000 people, and the results are in agreement with findings by others in Sweden, 8,9,20 it cannot be taken for certain that our findings can be generalized to other populations. We used medical record data to analyse blood pressures in relation to prescribed drugs.…”

Section: Discussionsupporting

confidence: 78%

“…5,6 As only a minority of hypertensive patients reaches target blood pressure 2,7 it is important to study blood pressure levels and drug prescribing in clinical practice to identify areas for improvement. Some studies on prescribing patterns and blood pressure values have been conducted in primary health care, but most studies are based on small populations [8][9][10] or using selfreported data from questionnaires. 11,12 Recent studies have established that antihypertensive treatment is effective also in the very old patients.…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensive treatment and control in a large primary care population of 21 167 patients

et al. 2010

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The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure o140/90 mm Hg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary healthcare centres, with a combined registered population of 330 000 subjects. We included all patients X30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n ¼ 21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure o140/ 90 mm Hg. The number of prescribed drugs increased with age, except among the oldest (X90 years). Only 29% of patients given monotherapy had a blood pressure o140/90 mm Hg. Women more often received diuretics (52 vs 42%), and less often angiotensinconverting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. b-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Antihypertensive treatment and control in a large primary care population of 21 167 patients

et al. 2010

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“…What our findings contribute to the growing body of knowledge regarding the complex relationship between diabetes and hypertension, however, is that women with diabetes are more likely to have uncontrolled BP than men with diabetes, compared with women and men without diabetes, respectively. That is, women with diabetes are approximately 45% more likely to have uncontrolled SBP 35 but the disparity in reaching BP control is even more pronounced when comparing men and women with diabetes mellitus. Accordingly, women in general and women with diabetes mellitus in particular may require more vigilant evaluation, greater treatment intensity and arguably treatment under physicians who treat greater numbers of hypertensive patients and who practise in concordance with BPGs to achieve BP control.…”

Section: Warning Signs Of Poor Bp Controlmentioning

confidence: 99%

Gender-specific, multi-level determinants of outcomes of antihypertensive treatment: a sub-analysis of the Belgian PREVIEW study

et al. 2010

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Gender-specific determinants of blood pressure (BP) values and control have not been the focus of clinical hypertension research. The purpose of this analysis was to identify gender-specific and multi-level (physician and patient) determinants of BP values and predictors of uncontrolled BP. We completed a subgroup analysis comparing men and women who participated in the Belgian PREVIEW study of second-line treatment effectiveness of valsartan, applying two-level hierarchical modelling of 90-day BP values and guideline-defined BP control. In total, 1665 women and 1525 men were treated by 504 general practitioners. Fewer women than men reached systolic BP (SBP) (P ¼ 0.015) and combined BP targets at 90 days (P ¼ 0.007). More than 26% of the variance in 90-day SBP (intra-class correlation coefficient (ICC) ¼ 0.270) and diastolic BP (DBP) (ICC ¼ 0.262) was attributable to physicianlevel factors for men; the physician-level ICCs for SBP and DBP were 0.259 and 0.268, respectively, for women. Determinants of 90-day BP values and predictors of uncontrolled BP varied considerably by gender. Many of the multi-level determinants of BP by gender are amenable to intervention, and the remainder can serve as warning signs to clinicians that patients may remain vulnerable to poor outcomes associated with sub-optimal BP control.

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“…To the best of our knowledge, no previous studies have been published analysing sex of physicians in relation to risk factor control in treated hypertensive men and women. This study was primarily designed to describe risk factor control in treated hypertensive patients in general, on the basis of a national survey [13].…”

Section: Introductionmentioning

confidence: 99%

Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare

Journath

Hellénius

Manhem

et al. 2008

Journal of Hypertension

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Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden

Abstract: A need still exists for more intensified treatment of elevated blood pressure and hypercholesterolemia, especially in women. In hypertensives of both sexes, smoking and other risk factors also need to be addressed to reduce the risk of cardiovascular disease.

Cited by 28 publications

References 31 publications

Antihypertensive treatment and control in a large primary care population of 21 167 patients

Antihypertensive treatment and control in a large primary care population of 21 167 patients

Gender-specific, multi-level determinants of outcomes of antihypertensive treatment: a sub-analysis of the Belgian PREVIEW study

Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare

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