title: Assessment of primary healthcare professionals' management of hypertensive patients with riser pattern.
abstract: BACKGROUND
  Ambulatory blood pressure monitoring (ABPM) was implemented in our primary care setting four years ago. Since then, 450 ABPMs have been performed and 69 riser subjects identified. The riser pattern is an independent risk factor for both incidence of cardiovascular events and their associated mortality.
  
  
  OBJECTIVE
  The purpose of this study was to assess the amount of control of essential hypertension (EH) among riser patients and to evaluate how our health professionals manage therapeutic changes in riser individuals.
  
  
  METHODS
  This retrospective study involved 34,289 inhabitants served in a centre in the Barcelona metropolitan area. EH individuals (450) were recruited and ABPM was performed following guidelines of the MAPAPRES (www.cardiorisc.com/MP/index_MP.asp).
  
  
  RESULTS
  Good control of blood pressure was observed in 46% of dipper and non-dipper subjects but only 35% of riser subjects had blood pressures within good control ranges. The measured cardiovascular risk was either high or very high in 35% of riser individuals. Changes in medication were introduced in riser patients with both good and poor blood pressure control. A second follow-up ABPM was done in only 27% of the riser individuals. In these subjects, therapeutic changes successfully modified ABPM patterns in 87% of cases.
  
  
  CONCLUSIONS
  Therapeutic changes in riser patients were introduced when these subjects were poorly controlled and these changes were highly effective. Additional ABPM to confirm the effectiveness of therapeutic changes was only performed in some individuals. Thus, for management of riser patients, more specific training of health professionals is needed.
authors.affiliation: ABS Canaletes, Institut Català de la Salut, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sagarra-Tió
authors.affiliation: ABS Canaletes, Institut Català de la Salut, Spain ABS Guinardó, Institut Català de la Salut, Spain efelezcarrobe@gmail.com.
authors.forename: Estel
authors.initials: E
authors.lastname: Félez-Carrobé
authors.affiliation: Genetics Department, Hospital Sant Pau, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Baiget
authors.affiliation: ABS Canaletes, Institut Català de la Salut, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Félez
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards* / Q000639:trends; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D019468:Disease Management; D000075222:Essential Hypertension; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension management; ambulatory; blood pressure; educational program; primary care; riser pattern of hypertension