title: Why is my hypertensive patient still not controlled?
abstract: Despite the well-known obstacles to blood pressure (BP) control, significant improvement can be obtained. Unfortunately more than a third of hypertensive patients remain non-controlled even after improving initiatives. We asked a group of General Practitioners (GPs) why their patients failed to reach the target despite their efforts.
  
  
  METHODS
  After an audit the control rate increased from 50.8 % to 64.1 %. The 18 participating GPs analyzed the 2,674 patients who remained non controlled (no available BP recording in the last year or last available recorded value ≥140/90 mmHg -office BP-, ≥135/85 mmHg -home BP-, ≥130/80 mmHg -ambulatory BP-) and filled a questionnaire about the reasons for patients' non-attendance and for lack of BP control.
  
  
  RESULTS
  BP values were missing in 1,769 (66.1 %) patients; reasons: contact impossible (19 %), contacted, but did not attend (29 %), forgot to check BP (19 %), BP checked at home, but not recorded (10 %), patients cared for by specialists (12 %), the patient is a doctor or a doctor's relative (4 %), other (12 %). Among the other 905 (33.9 %) non-controlled subjects (with recorded BP) 23 % were prescribed with ≥3, and 10 % with ≥4 drugs. Reasons not to increase therapy were: patient choice (29 %), wait and see strategy/patient not stable yet (26 %), increase inappropriate (20 %), others caring for hypertension (9 %), secondary hypertension (5 %), reached maximum possible therapy (4 %), "resistant hypertension" (4 %), forgot to increase therapy (3 %), other (5 %).
  
  
  CONCLUSIONS
  The priorities for further improvement are the patients who do not see their doctors (regularly), followed by those unwilling to increase their therapy.
authors.affiliation: Italian College of General Practitioners, Firenze, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Luca
authors.initials: L
authors.lastname: Degli Esposti
authors.forename: Stefano
authors.initials: S
authors.lastname: Buda
authors.forename: Antonino
authors.initials: A
authors.lastname: Diguardo
authors.forename: Italo
authors.initials: I
authors.lastname: Paolini
authors.forename: Giulio
authors.initials: G
authors.lastname: Nati
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002983:Clinical Competence; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008485:Medical Audit; D009819:Office Visits; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents