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Ambulatory hypertensive patients treated by cardiologists in France
Jacques Blacher1, Julie Peroz-Froz, Jean-Pierre Huberman
1Paris Descartes University, Faculté de Médecine, AP-HP, Diagnosis and Therapeutic Centre, Hôtel-Dieu, Paris, France. jacques.blacher@htd.aphp.fr
Insights
Hypertension control remains poor in France, with only 20.8% of patients treated by cardiologists achieving goal blood pressure (BP). Patient and physician factors significantly influence BP control, necessitating targeted strategies for improvement.
Area of Science:
- Cardiology
- Hypertension Management
- Epidemiology
Background:
- Hypertension is a leading cause of cardiovascular disease, with suboptimal control rates reported globally.
- While general practitioners manage most hypertensive patients in France, cardiologists treat a high-risk population, necessitating a deeper understanding of their specific challenges.
- Poor blood pressure (BP) control in hypertension persists, underscoring the need to identify influencing factors at both patient and physician levels.
Purpose of the Study:
- To characterize the population of hypertensive patients managed by independent cardiologists in France.
- To determine the prevalence of uncontrolled blood pressure (BP) in this population.
- To identify patient- and physician-level factors associated with BP control.
Main Methods:
- The COLHYGE study employed an observational, cross-sectional epidemiological design.
- Data were collected from 5,798 consecutive patients treated by 371 independent cardiologists across France.
- Patient and physician characteristics were assessed to analyze BP control determinants.
Main Results:
- The study population exhibited high cardiovascular risk, with 27.5% in secondary prevention and 22.8% having diabetes.
- Only 20.8% of patients achieved controlled BP.
- Factors negatively associated with BP control included older age, higher BMI, increased heart rate, recent hypertension diagnosis, left ventricular hypertrophy, and patient perception of polypharmacy. Positive associations were observed with atrial fibrillation and the use of renin-angiotensin system blockers and fixed-dose combinations. Cardiologists in large cities and those in exclusive independent practices showed better BP control.
Conclusions:
- The COLHYGE study confirms elevated cardiovascular risk and inadequate BP control in French patients managed by cardiologists.
- Both patient-specific factors (e.g., comorbidities, medication beliefs) and physician-related aspects (e.g., practice setting) are critical determinants of BP control.
- Future strategies to improve hypertension management should integrate considerations of both patient and physician characteristics.
Background:
While general practitioners treat most hypertensive patients in France, hypertension is the most frequent pathology treated by cardiologists, raising questions about the differing profiles of such patients. Poor control of hypertension is commonly reported, and yet has not improved over time. Better understanding of the determinants of control, at both patient and physician levels, is necessary to implement improvements in practice.
Aims:
To describe the hypertensive population treated by independent cardiologists in France and to assess the prevalence and determinants of not-at-goal blood pressure (BP), at patient and physician levels.
Methods:
The COLHYGE study was an observational cross-sectional epidemiological study. Consecutive patients (n=5798) were selected by 371 independent cardiologists in France. Data concerning patients and physicians were assessed.
Results:
Our study population had an elevated cardiovascular risk, high prevalence of patients in secondary cardiovascular prevention (27.5%) and a high proportion of diabetic patients (22.8%). Only 20.8% of the population presented controlled BP. At the patient level, the following variables were negatively and independently associated with BP control: age; body mass index; heart rate; recently diagnosed hypertension; left ventricular hypertrophy; patient belief that they are taking too many pills; prescription of calcium channel blockers, lipid-lowering agents and antiplatelet agents. Presence of atrial fibrillation and the prescription of renin-angiotensin system blockers and fixed combinations correlated positively with BP control. At the physician level, working in big cities and having an exclusive independent practice were associated with good BP control. There was high heterogeneity among physicians in terms of BP control, independent of the patient and physician characteristics assessed.
Conclusion:
The COLHYGE study has confirmed a high cardiovascular risk and poor BP control among hypertensive patients treated by cardiologists in France. Strategies aiming to control BP should focus on both patient and physician characteristics.
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