Aggressive blood pressure control in general practice (ABC-GP) study: can the new targets be reached?
Based on outcome trials, guidelines for hypertension management recommend lower blood pressure (BP) goals using an individualized treatment strategy (IND) and referral to a specialist of patients uncontrolled after 6 months of treatment. This study aimed to evaluate the performance of General Practitioners (GPs) in reaching the recommended BP goals using the IND, or a stepwise treatment strategy (STEP) as used in the outcome trials. Trained GPs were randomized to reach the BP goals within 6 months using the IND or a STEP strategy in untreated or treated uncontrolled hypertensives. In all, 24 GPs recruited 528 patients of whom 443 were analysed (mean age 65+/-9 years, 42% men, 70% treated, STEP/IND 12/12 GPs, 231/211 patients). After 6 months, 83% of the patients had reached the diastolic BP goal, whereas only 51% the systolic (P<0.0001 for difference). Factors associated with uncontrolled systolic BP were diabetes, age >60 years and triple antihypertensive therapy at baseline. A faster BP reduction was achieved during the first 3 months using the STEP strategy, but at the cost of using more drugs (combination therapy in 68/59% for STEP/IND, P=0.06). At 6 months similar rates of control were achieved with the two strategies. In conclusion, in primary care the diastolic BP goal can be reached within 6 months in the majority of patients, whereas systolic BP remains uncontrolled in 50% of the cases. The IND should be the recommended treatment strategy, but further investigation is required on the reasons for treatment failure and the optimal strategy for its improvement.
Stergiou
G S
GS
Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece. gstergi@med.uoa.gr
Karotsis
A K
AK
Symeonidis
A
A
Vassilopoulou
V A
VA
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents