title: General Practitioners' vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension--a cross-sectional database study.
abstract: BACKGROUND
  Patients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension.
  
  
  METHODS
  We cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥ 6 months. We compared patients with VKA for ≥ 3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity.
  
  
  RESULTS
  We identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9%) were on Phenprocoumon (VKA) and 3,843 (87.1%) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of -8.4 mm Hg (95% CI -9.8 to -7.0 mm Hg) and -1.5 mm Hg (95% CI -2.3 to -0.7 mm Hg), respectively (p < 0.001 for both).
  
  
  CONCLUSIONS
  In a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.
authors.affiliation: Institute of Primary Health Care BIHAM, University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. sven.streit@biham.unibe.ch.
authors.forename: Sven
authors.initials: S
authors.lastname: Streit
authors.affiliation: District Hospital Freiamt Muri, Muri, Switzerland. vladimir.kaplan@spital-muri.ch.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kaplan
authors.affiliation: Institute of General Practice, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Busato
authors.affiliation: Institute of General Practice, University of Zurich, University Hospital Zurich, Zurich, Switzerland. sima.djalali@usz.ch.
authors.forename: Sima
authors.initials: S
authors.lastname: Djalali
authors.affiliation: Institute of General Practice, University of Zurich, University Hospital Zurich, Zurich, Switzerland. oliver.senn@usz.ch.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.affiliation: Institute of Primary Health Care BIHAM, University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. damian.meli@biham.unibe.ch.
authors.forename: Damian N
authors.initials: DN
authors.lastname: Meli
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D019934:International Normalized Ratio; D008297:Male; D055118:Medication Adherence; D008991:Monitoring, Physiologic; D011320:Primary Health Care; D012307:Risk Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D014812:Vitamin K