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Control of primary hypertension by pharmacologic monotherapy in primary care
G J Díaz Grávalos1, G Palmeiro Fernández, I Casado Górriz
1Centro de Salud Cea, Ourense.
Insights
Hypertension monotherapy shows poor arterial pressure control, especially systolic BP, in under 30% of patients. Diuretic use significantly differs between sexes without clear rationale.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Context:
- Essential hypertension (HBP) management often involves monotherapy.
- Assessing the effectiveness of single-drug treatments is crucial for optimizing patient outcomes.
- Understanding demographic and pharmacologic patterns in HBP treatment is vital.
Purpose:
- To analyze the control degree and characteristics of arterial pressure (AP) in hypertensive patients receiving monotherapy.
- To identify factors influencing AP control and medication choices.
Summary:
- A study of 277 HBP patients on monotherapy found less than 30% achieved adequate AP control (< 140/90 mmHg), primarily due to uncontrolled systolic BP.
- Angiotensin-converting enzyme inhibitors (ACEI) and calcium channel blockers (CAB) were common, with enalapril and chlorthalidone frequently prescribed.
- Diuretic use was higher in women, and varied with age, unlike ACEI and beta-blockers.
Impact:
- Highlights suboptimal HBP control with monotherapy, particularly for systolic pressure.
- Reveals significant, theoretically unfounded, sex-based differences in diuretic prescription.
- Suggests a need for re-evaluation of monotherapy strategies and prescription patterns in hypertension management.
Objective:
To analyze the control degree and characteristics of arterial pressure (AP) obtained with monotherapy.
Subjects And Methods:
A sample was obtained of 277 hypertensive patients (83 men and 194 women) on monotherapy from cluster sampling. All included patients were older than 18 years and had essential hypertension (HBP). Both systolic and diastolic pressure values (mean of two measurements), prescribed drug, age and sex were recorded.
Results:
Less than 30% of subjects had adequate control (< 140/90), mainly because of poor control of systolic BP. The drug group most commonly was ACEI, followed by calcium blockers (CAB); enalapril and chlortalidone were the most commonly prescribed drugs. Diuretics were used most frequently by women (OR 4.2). The use of diuretics, calcium channel antagonists and alphaadrenergic blockers increased with age. The opposite was true for ACEI and beta blockers.
Conclusions:
A poor control of HBP in patients on monotherapy was observed, particularly for the systolic component. There is a higher use of ACEI and HBP. There is a highly significant difference regarding the use of diuretics between men and women which has no theoretical basis.