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Long-term follow-up study of hypertensive patients by practicing internists after a controlled drug trial
Insights
Achieving optimal blood pressure control in essential hypertension is challenging for private practice physicians. Even with multiple medications, many patients did not reach target diastolic pressures below 90 mmHg.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Pharmacy
Background:
- Essential hypertension management requires long-term strategies.
- Physicians in private practice face unique challenges in patient care.
- Previous drug trials inform current treatment approaches.
Purpose of the Study:
- To evaluate the effectiveness of antihypertensive therapy in private practice.
- To assess blood pressure control in patients with essential hypertension over a long-term follow-up.
- To identify factors influencing treatment outcomes in community-based settings.
Main Methods:
- A cohort of 30 patients with uncomplicated essential hypertension was followed for an average of 44 months.
- Treatment decisions were based on the best judgment of 14 internists in private practice.
- Commonly prescribed medications included diuretics and beta-blocking agents.
Main Results:
- Approximately 60% of patients achieved diastolic pressures below 96 mmHg.
- Only a small fraction of patients reached diastolic pressures below 90 mmHg.
- 80% of patients received at least two different antihypertensive agents.
Conclusions:
- Optimal blood pressure reduction in essential hypertension remains difficult in private practice settings.
- Despite available antihypertensive drugs, achieving target blood pressure goals is not always successful.
- Practitioner tendencies to round blood pressure readings may contribute to suboptimal outcomes.
Abstract:
Thirty patients with uncomplicated essential hypertension were treated for an average of 44 months by 14 internists in private practice. All patients had previously participated in a controlled comparative trial of antihypertensive drugs carried out by the same physicians in their offices. During the long-term follow-up period, ie, after completion of the initial trial, the physicians administered antihypertensive therapy based on their best judgment; the drugs they most commonly prescribed were diuretics (80% of patients) and beta-blocking agents (60% of patients). Although 80% of the patients received at least two different antihypertensive agents, diastolic pressures fell below 96 mmHg in approximately 60% of the patients and below 90 mmHg in only a small fraction. Thus it appears that it is not easy for physicians in private practice to optimally reduce blood pressure levels in hypertensive patients despite the availability of numerous antihypertensive drugs. The tendency of practitioners to approximate blood pressure levels to multiples of 5 or even 10 mmHg may be partially responsible for the unsatisfactory results.