Blood pressure control according to new guidelines targets in low- to high-risk hypertensives managed in specialist practice.
OBJECTIVE
It is well established that adequate blood pressure (BP) control characterizes only a fraction of treated hypertensive patients. Few reports are available on BP control in relation to the cardiovascular risk profile in patients followed by specialist physicians.


METHODS
We evaluated the cardiovascular risk profile (according to recent ESH/ESC Guidelines), antihypertensive drug treatment and systolic and diastolic blood pressure values (SBP/DBP) by semi-automatic BP monitoring in 2775 hypertensive patients, aged 60.6 +/- 16.1 years (mean +/- SD), followed by 131 specialist centres in northern (34.5%), central (28.1%) and southern (37.4%) Italy. Of these patients, 94.6% received antihypertensive treatment with one (36.9%) or more (57.7%) drugs.


RESULTS
Optimal SBP and DBP control (< 140/90 mmHg) was shown by 37.5% of the patients, the rate of controlled values being much greater for DBP (64.4%) than for SBP (40.2%). About one-third of patients displayed BP values in the higher range (>/= 160/95 mmHg). No difference in BP control was found in relation to different geographic areas, patient's gender, occupational activity and attitude to the use of home blood pressure monitoring. BP control was inversely related to patient's age and directly related to educational level. It was more manifest in low- or medium-risk categories than in higher-risk patients (43.2 versus 34.9%). Follow-up visits performed after 6 and 12 months after patient enrollment have shown an improvement in blood pressure control (from 40.7 to 51.8%), related to therapeutic modifications and better compliance.


CONCLUSIONS
These data provide evidence that BP control in different Italian geographic areas remains largely inadequate, particularly for SBP and high-risk patients. They also suggest that an improvement in treatment compliance may produce favourable therapeutic effects.
Mancia
Giuseppe
G
Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Monza, Italy. giuseppe.mancia@unimib.it
Pessina
Achille C
AC
Trimarco
Bruno
B
Grassi
Guido
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000209:etiology; D003710:Demography; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D007558:Italy; D008511:Medicine; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013038:Specialization
D000959:Antihypertensive Agents