title: Uncontrolled arterial hypertension in primary care--patient characteristics and associated factors.
abstract: BACKGROUND
  Most patients with arterial hypertension are treated in primary care. The objective is to assess characteristics of patients with uncontrolled arterial hypertension and its associated determinants in Swiss primary care.
  
  
  METHODS
  Data on 122 adult patients with uncontrolled hypertension (mm Hg >140 systolic and/or >90 diastolic) was collected from the baseline data of the on-going randomised controlled "CoCo" trial: Colour-coded Blood Pressure Control. Patient and general practitioner characteristics were analysed to investigate the relationship between BP and patient characteristics.
  
  
  RESULTS
  From October 2009 to March 2011 30 general practitioners recruited 122 patients; median age 64 years (IQR 54.8-72), 50% male, median BMI 28.3 kg/m2 (IQR 25.3-31.7), 21.5% smokers. 65.6% performed home blood pressure measurement, 88.5% received pharmacological treatment, 41.8% mono-therapy. Most frequent dual drug combinations: diuretics/angiotensin-receptor-blockers (33.3%), angiotensin-converting-enzyme-inhibitors/beta blockers (both 28.1%). BMI, smoking and age were independent predictors for elevated systolic blood pressure when controlled for gender, home blood pressure measurement, education, pulse rate and number of antihypertensive substances. We found a significant non-linear association between systolic blood pressure and number of antihypertensive substances. Age and any amount of antihypertensive substances were independently and inversely correlated with diastolic blood pressure. The findings did not change when additionally controlled for general practitioner clustering effect.
  
  
  CONCLUSIONS
  Smoking and high BMI are strong and independent factors associated with higher blood pressure levels in patients with uncontrolled arterial hypertension. A high rate of monotherapy and a decrease in the incremental gain on blood pressure control when more antihypertensive agents are used highlight the importance of adequate pharmacological treatment as well as risk factor control.
authors.affiliation: Division of Internal Medicine, University Hospital of Zurich and Institute of General Practice, University of Zurich, Switzerland. corinne.chmiel@usz.ch
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.forename: Mathyas
authors.initials: M
authors.lastname: Wang
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.forename: Valerio
authors.initials: V
authors.lastname: Del Prete
authors.forename: Marco
authors.initials: M
authors.lastname: Zoller
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Claudia
authors.initials: C
authors.lastname: Steurer-Stey
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
chemical_list: D000959:Antihypertensive Agents