title: Blood pressure control and physician management of hypertension in hospital hypertension units in Spain.
abstract: Goal blood pressure (BP) was defined by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. However, there are few reports that address BP control among special subgroups of hypertensives by reference to targeted BP. We therefore conducted a study to evaluate BP control of 4049 hypertensives in 47 hospital-based hypertension units in Spain. Overall, 42% of patients achieved goal BP (<140 mm Hg systolic and <90 mm Hg diastolic). Only 13% of diabetic patients and 17% of those with renal disease achieved the BP goal (<130 mm Hg systolic and <85 mm Hg diastolic), and only 10% and 12%, respectively, achieved the even more rigorous goal (<130 mm Hg systolic and <80 mm Hg diastolic). Likewise, only 18% of patients in JNC-VI risk group C and 17% of WHO/ISH high-risk patients attained a goal BP <130 mm Hg systolic and <85 mm Hg diastolic. BP control (<125 mm Hg systolic and <75 mm Hg diastolic) was extremely low (2%) in patients with proteinuria >1 g/d. Poorer BP control was observed among patients at high risk, with diabetes, renal disease, or obesity, than in lower-risk groups. BP control was lower for systolic than for diastolic BP. In >50% of uncontrolled patients, no measures were taken by doctors to optimize pharmacologic treatment, and approximately one-third of patients were still using drug monotherapy. Control of BP, particularly of systolic BP, is still far from optimal in hospital-based hypertension units. Patients at high risk, with diabetes or proteinuria, warrant focused attention. Moreover, a more aggressive behavior of doctors treating uncontrolled hypertension is needed.
authors.affiliation: Department of Preventive Medicine and Public Health, of Medicine, Universidad Autónoma de Madrid, Spain.
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Julián
authors.initials: J
authors.lastname: Segura
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: Manuel
authors.initials: M
authors.lastname: Luque
authors.forename: Rafael
authors.initials: R
authors.lastname: García-Robles
authors.forename: Carlos
authors.initials: C
authors.lastname: Campo
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.forename: Juan
authors.initials: J
authors.lastname: Tamargo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D019090:Case Management / Q000706:statistics & numerical data*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology; D006040:Goals; D006306:Health Surveys; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013599:Systole
chemical_list: D000959:Antihypertensive Agents