Longitudinal study on hypertension control in primary care: the Insubria study.
BACKGROUND
Hypertension control is still unsatisfactory. The study was aimed to evaluate blood pressure (BP) control rate and the impact of training general practitioners (GPs) about hypertension 1999 World Health Organization/International Society of Hypertension guidelines.


METHODS
After a training session on the hypertension guidelines, 588 GPs consecutively enrolled 5524 known hypertensive patients. During the first and follow-up visits (after 3, 6, and 9 months) GPs recorded BP, lifestyle habits, and drug therapy.


RESULTS
The BP was controlled in 33.4%, with systolic BP less controlled than diastolic BP. The BP control rate decreased (P < .001) from low to very high cardiovascular risk group and from lean to overweight and obese subjects. At the first visit 97.3% of the patients were already on drug treatment: 40.3% with 1 drug, 38.9% with 2 drugs, 17.2% with 3 drugs and 3.6% with 4 or 5 drugs. The adherence to correct dietary and lifestyle habits was low. The drugs most often used were the angiotensin-converting enzyme inhibitors (3009 patients, 56%). During follow-up body weight and BP decreased; 1 or more drugs were added in 17.8% and the adherence to healthier lifestyle habits significantly increased. At the end of the survey BP control rate was significantly improved (52.7%).


CONCLUSIONS
In primary care the hypertension control rate was still unsatisfactory, and our data suggest that it may be due to a not aggressive enough drug treatment and a low adherence to recommended lifestyle and dietary habits. Increasing the knowledge of GPs about guidelines was associated with an improvement of hypertension control rate.
Grandi
Anna Maria
AM
Department of Clinical Medicine, University of Insubria, Varese, Italy. amgrandi@libero.it
Maresca
Andrea Maria
AM
Sessa
Aurelio
A
Stella
Roberto
R
Ponti
Daniele
D
Barlocco
Elena
E
Banfi
Fabio
F
Venco
Achille
A
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D004032:Diet / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents