[Uncontrolled arterial hypertension: pharmaco-economic interest of hospital diagnostic work-up].
The aim of this study was to assess both the clinical usefulness and the economical efficiency of an in-hospital workup for patients with uncontrolled arterial hypertension.


METHODS
Eligible patients were hospitalized in a specialized unit between 1st January 1998 and 30th June 2000 for management of an uncontrolled arterial hypertension, to general practitioners (GPs) request. A questionnaire was sent to each of these GPs in May 2001.


RESULTS
The cohort consisted of 214 patients (107 male, 107 female, mean age: 58 +/- 16 years). Pre-hospitalisation therapy was precisely identified in 178 patients. Forty-nine patients (28%) were given more than 3 antihypertensive drugs. The most frequently administered drugs were the following: diuretics (n = 93), beta-blockers (n = 85), and ACE-inhibitors (n = 78). Mean therapy cost was 1.71 +/- 1.05 [symbol: see text]. An etiology was found in 30 patients (14%). Plasma renin was measured in 140 out of the 184 patients with essential hypertension: it was found as low (< or = 7 ng/L) in 96 patients, with 50 of them (36%) having a very low plasma renin (< or = 3 ng/L). One hundred and fifty-four questionnaires were fulfilled by the GPs. Median follow-up was 23 months. Seventeen patients were lost of follow-up. Nine cardiovascular events were listed. Mean clinic BP was < 160/95 mmHg in 86 out of the 108 patients with both an essential hypertension and a fulfilled questionnaire, including 38 patients (35%) with a clinic BP < 140/90 mmHg. Eleven patients only, were given more than 3 antihypertensive drugs. The most frequently administered drugs were: calcium antagonists (73%), followed by diuretics (50%) and beta-blockers (34%). Mean therapy cost was 1.39 +/- 0.76 [symbol: see text] (p < 0.002 vs pre-hospitalization therapy cost); 84% of the GPs answered that the in-hospital workup resulted in an useful help in managing their patients.


CONCLUSIONS
The in-hospital workup of patients with uncontrolled hypertension turned out to be both clinically useful and economically efficient: an aetiology has been found in 14% of the cases; an appropriate therapy, based on the hormonal profile, allowed for a lowering of BP below 160/95 in 80% of the cases, and below 140/90 in one thirds of the patients; the mean therapy cost has been reduced by 19%.
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003363:Cost Control; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning
D000959:Antihypertensive Agents
HTA non contrôlées: intérêt pharmaco-économique d'un bilan hospitalier.