[Hypertension management in general practice in Iceland]

To evaluate the medical management and cardiovascular (CV) risk profile of patients with hypertension in general practice in Iceland.

All patients with the diagnosis of hypertension at the primary health care center Solvangur, providing services for 23.066 inhabitants, made up the study group. Medical records for these patients were evaluated and information about medical management and CV risk factors where gathered.

982 patients had been diagnosed with hypertension. Only 27% had documented blood pressure levels below the guideline target of 140/90 mmHg. More women than men had blood pressure below target levels, 35% v.s. 28% for systolic blood pressure (p=0.04) and 66% v.s. 50% for diastolic blood pressure (p<0.001). Systolic blood pressure was more frequently above target levels than the diastolic blood pressure, in 47% of patients v.s. 20%. Blood tests had been obtained for 78% of the patients of which 47% had cholesterol values above 6.0 mm/L and 11% had blood glucose levels above 6.4 mmol/L. During the years 2002 and 2003 75% of the patients received drug treatment for hypertension with 39% on monotherapy, 36% on two drugs and 25% taking three or more drugs. The most commonly used agents were beta blockers and diuretics, with 29% of patients on monotherapy taking beta blockers and 27% on diuretics. At least half of the patients have either confirmed coronary heart disease (CHD), diabetes or hypercholesterolemia. Information on smoking history and body mass index is incomplete in these medical records.

Overwhelming majority of hypertensives in this large primary health care center does not reach the treatment targets set out by clinical guidelines. However, drug utilization with beta blockers and diuretics being the most commonly used drugs, is in accordance with most guidelines. More use of combination therapy could possibly improve blood pressure control. This group of hypertensive patients is a high risk group with over half of them having either documented CHD, diabetes or other risk factors. Although the results are for most part in agreement with results from other studies they necessitate a comprehensive reassessment of the medical management of hypertensive patients in general practice in Iceland.