Article

Prevalence of isolated uncontrolled systolic blood pressure among treated hypertensive patients in primary care in Belgium: results of the I-inSYST survey.

Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussels, Belgium.
Journal of Hypertension (impact factor: 4.02). 11/2008; 26(10):2057-63. DOI:10.1097/HJH.0b013e32830a9a49 pp.2057-63
Source: PubMed

ABSTRACT To evaluate the prevalence of isolated uncontrolled systolic blood pressure (on-treatment isolated systolic hypertension) in treated hypertensive patients and identify the characteristics and treatment strategy in these patients.
Prospective cross-sectional survey in primary care. Participating physicians enrolled more than 13 consecutive treated hypertensive patients. Patients were considered to have isolated systolic hypertension when systolic blood pressure was at least 140 mmHg and diastolic blood pressure was less than 90 mmHg.
On-treatment isolated systolic hypertension occurred in 28% of evaluable patients (n = 11562) and in 36% of uncontrolled patients (n = 9080). Among the isolated systolic hypertension and among other uncontrolled patients, 53% and 47%, respectively, used more than one antihypertensive drug class. beta-Blockers were the most frequently prescribed antihypertensive drugs. Patients with isolated uncontrolled systolic blood pressure were more frequently treated with diuretics (43 vs. 39%) and angiotensin II receptor antagonists (23 vs. 17%). Despite blood pressure being under control in only 21% of the patients, hypertension treatment was not changed in 46% of patients with isolated uncontrolled systolic blood presssure vs. 14% of patients with both uncontrolled systolic and diastolic blood pressure.
In Belgium, the prevalence of on-treatment isolated systolic hypertension in treated hypertensive patients, was 28%. The goal blood pressure was likely not reached in most patients due to inadequate treatment. The overall control rate was worse for systolic than for diastolic blood pressure. Furthermore, antihypertensive treatment was less frequently adapted in patients with isolated uncontrolled systolic blood pressure than in those patients with both uncontrolled systolic and diastolic blood pressure.

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    Article: "Later, lazier, and unluckier": a heuristic profile of high vulnerability is an independent predictor of uncontrolled blood pressure (the PREVIEW study).
    Ivo Abraham, Christopher Lee, Minkyoung Song, Stefaan Vancayzeele, Heidi Brié, Christine Hermans, Patricia Van der Niepen, Karen Macdonald
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    ABSTRACT: Vulnerability profiling, an alternative to deterministic risk assessment, offers clinicians a more intuitive but empirically-grounded assessment of patient risk. This study aimed to determine whether a heuristic profile of high vulnerability is an independent predictor of uncontrolled hypertension. Secondary analysis of prospective observational study data on 2999 hypertensive patients treated with valsartan. Predictive validity of vulnerability profiling for first-line, second-line, and first-or-second-line antihypertensive treatment was inferred from 1) logistic regression models with adequate statistical fit, 2) statistically significant odds ratios for uncontrolled BP for the high-vulnerability cluster exceeding 1.00, and 3) correct classification rates for patients' BP control status. All models of uncontrolled BP were significant (P < 0.001); all odds ratios for the high-vulnerability cluster were greater than 1.00 and significant (P < 0.001). Correct classification rates for the highly-vulnerability cluster on uncontrolled BP after first-line, second-line, or either treatment were 91.1%, 61.2%, and 93.5% for systolic BP; 74.5%, 65.8%, and 76.7% for diastolic BP; and 92.8%, 65.3%, and 94.6% for combined systolic and diastolic BP. The heuristic profile of "later, lazier, and unluckier" is an intuitive and valid tool to help identify patients at greater risk for poor BP control seen in general practice.
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Patricia Van der Niepen