title: How many hypertensive patients can be controlled in "real life": an improvement strategy in primary care.
abstract: BACKGROUND
  It is well known that hypertension control is non-satisfactory, but it is not clear how many hypertensive patients can be controlled in real life. We addressed this question implementing a simple, multifaceted improvement strategy in family practice.
  
  
  METHODS
  Eighteen General Practitioner (GPs) agreed upon a simple improvement strategy including: 1) the use of occasional direct/indirect contacts (prescription refilling) to decrease missing blood pressure (BP) recording, and to increase therapeutic adherence, 2) the use of home BP measurements in non-controlled patients, 3) the addition of a new drug in non-controlled, but adequately adherent patients. Results were assessed after one year by automatic data extraction from the clinical records of all hypertensive subjects.
  
  
  RESULTS
  The patients with a diagnosis of hypertension increased from 6.309 (age 58.5 +/- 12.4; M 45.5%) to 6.717 (age 58.6 +/- 12.9; M 45.7%): prevalence 25.3% to 27.0%. The BP recording increased: 4,305 patients (68.2%) vs 4,948 patients (78.4%) (+ 10.2%, ci 9.4%-10.9%; p < 0.001), as well as the BP control: 3,203 (50.8% of all the diagnosed hypertensive patients and 74.4% of the subjects with recorded BP value) vs 4,043 (64.1% of all the diagnosed hypertensive patients and 81.7% of the subjects with recorded BP value) (+ 13.3%, ci 12.5%-14.2%; p < 0.001 and + 7.3%, ci 6.7%-8.0%; p < 0.001).
  
  
  CONCLUSIONS
  Almost 82% of hypertensive subjects who contact their doctors can be easily controlled. Most non-controlled patients simply don't see their GPs; in almost all the remaining non-controlled patients GPs fail to increase drug therapy. A further improvement is therefore possible.
authors: Italian College of General Practitioners, Florence, Italy. filippi.alessandro@simg.it.
authors: Alessandro
authors: A
authors: Filippi
authors: Diego
authors: D
authors: Sangiorgi
authors: Stefano
authors: S
authors: Buda
authors: Luca
authors: L
authors: Degli Esposti
authors: Giulio
authors: G
authors: Nati
authors: Italo
authors: I
authors: Paolini
authors: Antonino
authors: A
authors: Di Guardo
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007558:Italy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement
chemical_list: D000959:Antihypertensive Agents