Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.
To identify factors associated with poorer adherence to antihypertensive treatment.
The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records.
Of the patients, 2234/3799 (58.8%) stopped >or= 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective beta-blockers (59%), and the lowest with non-selective beta-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%).
Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence.
[Show abstract][Hide abstract] ABSTRACT: Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan.
Design: multicentric study quasi-experimental before - after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain). Sample: all patients with a diagnosis of hypertension (population based study). Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (alpha) will be set at < 0.05. Outcomes will be analysed on an intention-to-treat basis.
The implementation of a quality improvement plan might benefit the coordination of different professionals of PHCTs and may also improve blood pressure control.
This protocol has been registered at clinicaltrials.gov with the ID number MS: 1998275938244441.
BMC Public Health 04/2009; 9(1):89. DOI:10.1186/1471-2458-9-89 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hintergrund:
Ein therapierefraktärer Hypertonus stellt ein häufiges Problem
bei ambulanten Patienten dar und führt nicht selten im Rahmen hypertensiver
Entgleisungen zur Krankenhauseinweisung. Ursächlich spielen neben nicht
erkannten sekundären Hypertonieformen eine zusätzliche hypertensive renale
Schädigung sowie Complianceprobleme eine wesentliche Rolle.
Eine 75-jährige Frau wurde mit vermeintlich therapierefraktärem
Hypertonus und Cephalgien stationär eingewiesen. Zwei Monate
zuvor war eine Nierenarterienstenose ausgeschlossen und eine hypertensive
Herzerkankung diagnostiziert worden. Bei der aktuellen Aufnahme fanden
sich RR-Werte von 210/100 mmHg unter einer antihypertensiven Medikation
mit 16 Dosen neun verschiedener Medikamente. Für endokrinologische
Ursachen des Hypertonus gab es bei den Untersuchungen keinen Anhalt, in
der nephrologischen Diagnostik fanden sich Hinweise auf eine hypertensive
Nierenschädigung. Bei einer Tabletteneinnahme unter Aufsicht zeigten sich
im Tagesverlauf normale bis hypotensive Blutdruckwerte, sodass die antihypertensive
Medikation deutlich reduziert werden konnte. Eine 24h-Blutdruckmessung
zeigte schließlich ein weitgehend normotensives Blutdruckverhalten.
Nach intensiven Gesprächen zeigte sich schließlich, dass die Patientin
die zeitliche und quantitative Einnahme der Antihypertensiva zuvor
selbst sehr flexibel gestaltet hatte. Nach eingehender Aufklärung über die
Notwendigkeit einer regelmäßigen Medikamenteneinnahme konnte die Patientin
in die ambulante Betreuung entlassen werden.
Ein vermeintlich therapierefraktärer Hypertonus sollte
immer an ein Complianceproblem sowie an eine sekundäre hypertensive
Nierenschädigung denken lassen.
Treatment-resistant hypertension is a common problem in
an outpatient setting and often results in hospital admission. Non-identified
secondary hypertension, hypertensive nephrosclerosis and non-compliance
are major reasons for treatment resistance.
A 75-year old woman was admitted to the emergency room
because of a hypertensive crisis with alleged treatment-resistant hypertension
and progressive headache. Two months ago, renal artery stenosis had been
ruled out and a diagnosis of hypertensive cardiomyopathy was established. On
admission, the patient had a blood pressure of 210/100 mmHg despite an
antihypertensive treatment with nine different drugs. Further investigations
ruled out secondary hypertension due to an endocrine cause but were consistent
with hypertensive nephrosclerosis. With a supervised drug intake the
blood pressure was rather normal to hypotensive, resulting in the need for
significant reduction of the antihypertensive medication. The apparent discrepancies
were discussed in detail with the patient who finally admitted a
previous inconsistent intake of the antihypertensive drugs. Following thorough
training and education on the purpose of continued antihypertensive therapy,
the patient could be discharged with a normotensive blood pressure profile.
Therapy of treatment-resistant hypertension should always
consider non-compliance and secondary hypertension as possible reason.
Arterieller Hypertonus–Sekundärer Hypertonus–Non-
[Show abstract][Hide abstract] ABSTRACT: In order to determine the perception of general practitioners (GPs) and specialists regarding their clinical experience with the use of the low-dose fixed combination of perindopril 2 mg plus indapamide 0.625 mg in hypertensive patients with diabetes, a multicenter survey carried out across Spain was performed. A total of 894 physicians (597 GPs and 297 specialists) participated in the survey. A total of 5126 patients were included (3434 in the GPs' group and 1692 in the specialists' group). Associated risk factors and organ damage were more frequently documented in the specialists' group. At baseline, 1.7% of the GPs' patients and 1.3% of the specialists' patients had their blood pressure controlled and with the combined therapy the blood pressure control rate attained 30.7 and 29.8%, respectively (p < 0.001 vs baseline and not significant intergroups). Less than 85% of physicians considered the efficacy and tolerability of combined therapy as 'good' or 'very good' but 93% of the patients were 'satisfied' or 'very satisfied' with combined therapy.
Expert Review of Cardiovascular Therapy 10/2008; 6(8):1063-9. DOI:10.1586/14779072.6.8.1063
Yasemin Turker, Davut Baltaci, Yasin Turker, Serkan Ozturk, Cemil Isik Sonmez, Mehmet Harun Deler, Yunus Cem Sariguzel, Feyza Sariguzel, Handan Ankarali
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