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Why is hypertension so frequently uncontrolled in secondary prevention?
Jacques Amar1, Bernard Chamontin, Nathalie Genes
1Médecine et Hypertension Artérielle, CHU Toulouse, France. amar.j@chu-toulouse.fr
Insights
Poor blood pressure control in secondary prevention is linked to multiple risk factors and underuse of combination therapy. Improving hypertension management requires emphasizing tight systolic blood pressure control below 140 mmHg.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Secondary prevention of cardiovascular disease aims to reduce recurrent events.
- Hypertension control is a critical component of secondary prevention.
- Associated risk factors can complicate blood pressure management.
Purpose of the Study:
- To analyze blood pressure control in patients undergoing secondary prevention.
- To assess the impact of associated risk factors on hypertension control.
- To evaluate the utilization of combination therapy in hypertension management.
Main Methods:
- Analysis of individual data from two cross-sectional studies (PRATIK and ESPOIR).
- Inclusion of patients with treated hypertension and coronary disease from general and specialized cardiology practices.
- Categorization of patients based on the number of associated risk factors (including diabetes).
Main Results:
- Hypertension control rates were 33.24% in general practice and 40.83% in cardiology practice.
- Associated risk factors significantly impaired blood pressure control, particularly in patients with three or more risk factors or diabetes.
- Underutilization of multi-drug regimens, including diuretics, was observed in patients with uncontrolled hypertension.
Conclusions:
- Associated risk factors and insufficient combination therapy contribute to suboptimal blood pressure control.
- A high prevalence of borderline isolated systolic hypertension was noted.
- Practitioners need to be convinced of the benefits of strict systolic blood pressure control (<140 mmHg) for secondary prevention.
Objective:
To analyze blood pressure (BP) control in secondary prevention.
Design:
Individual data of two cross-sectional studies on preventive cardiology (PRATIK and ESPOIR studies conducted, respectively, in general practice and with private cardiologists) were analyzed.
Setting:
Primary care.
Participants:
Patients both with treated hypertension and coronary disease.
Main Outcome Measures:
Risk factors, treatments, cardiovascular history and BP were recorded. Each population was divided in three groups: group I, no other risk factor; group II, one or two risk factors; group III, three or more risk factors or diabetes.
Results:
A total of 1423 and 2596 patients, respectively, recruited in general practice and by cardiologists were analyzed. Of these, 473 (33.24%) and 1060 (40.83%) patients, respectively, had controlled hypertension. Among uncontrolled hypertensives, more than 50% had borderline isolated systolic hypertension. Associated risk factors negatively affect hypertension control, which had been achieved in a lower percentage of patients in group III than in group I (general practice, 26.28 versus 42.20%; cardiological practice, 32.42 versus 56.13%). In general practice, the percentage of patients receiving beta-blockers was significantly lower in group III. Among individuals with uncontrolled hypertension, only 17.58 and 26.69% received at least three-drug treatment including diuretics in general and in cardiological practice, respectively.
Conclusion:
The negative influence of associated risk factors and the under-use of combination therapy contribute to poor BP control. In addition the high frequency of borderline isolated systolic hypertension suggests that the prerequisite to improve hypertension control should be to convince practitioners of the beneficial effect of tight systolic BP control (below 140 mmHg) in secondary prevention.