Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Journal of Human Hypertension volume 23, pages 758–763 (2009)Cite this article

Abstract

Blood pressure (BP) control remains unsatisfactory worldwide. Better knowledge of BP management in clinical practice is needed to develop more effective improving strategies. Using a large Italian primary care database, we selected the subjects diagnosed with hypertension, and extracted the diagnosis of myocardial infarction, angina pectoris/coronary disease, stroke/transitory ischemic attack (TIA), heart failure, atrial fibrillation, peripheral arterial disease, diabetes mellitus, the serum total cholesterol, HDL cholesterol, triglycerides, creatinine, BP, electrocardiogram, weight, height and the prescription of cardiovascular (CV) drugs. Hypertension was recorded in 119.065 individuals (prevalence 19.3%), 19.134 (16%) had no ambulatory visit and 33.183 (27.8%) had no BP value recorded. Overall, 14.594 (21.9%) had at least one recorded diagnosis showing high CV risk. BP was controlled (mean of BP values <140/90 mm Hg) in 28.918 patients (16.690 women, 12 189 men and 40 gender not recorded), that is, 43.23% of the subjects with recorded BP. Among the non-controlled patients, 21.866 (57.8%) were non-high risk grade 1 (mean BP 142.5/84.5 mm Hg; s.d. 13.1/8.2) and 7.123 (18.8%) high-risk grade 1 hypertensives (mean BP 150/83 mm Hg; s.d. 6.2/7.2). Less than three drugs were prescribed in 29.919 (79.1%) of non-controlled patients. Low attendance rate, BP under-recording and suboptimal use of politherapy are major obstacles to hypertension control. Most uncontrolled individuals are low-CV risk, grade 1 hypertensive patients, for whom the personal benefit of adding another drug is modest. Aiming at the recommended BP target in uncontrolled grade 2–3 hypertensive/high-CV risk patients would probably require two additional drugs.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Canto JG, Iskandrian AE . Major risk factors for cardiovascular disease: debunking the ‘only 50%’ myth. JAMA 2003; 290: 947–949.

    Article  Google Scholar 

  2. Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289: 2363–2369.

    Article  Google Scholar 

  3. Mancia G, de Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the Management of Arterial Hypertension The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the EuropeanSociety of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

    Article  CAS  Google Scholar 

  4. Düsing R . Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin 2006; 22: 1545–1553.

    Article  Google Scholar 

  5. Coca A, Aranda P, Bertomeu V, Bonet A, Esmatjes E, Guillén F et al. [Strategies for effective control of arterial hypertension in Spain. Consensus document]. Rev Clin Esp 2006; 206: 510–514.

    Article  CAS  Google Scholar 

  6. Filippi A, Bignamini AA, Sessa E, Samani F, Mazzaglia G . Secondary prevention of stroke in Italy: a cross-sectional survey in family practice. Stroke 2003; 34: 1010–10149.

    Article  Google Scholar 

  7. Cricelli C, Mazzaglia G, Samani F, Marchi M, Sabatini A, Nardi R et al. Prevalence estimates of chronic diseases in Italy: exploring the differences between selfreport and primary care databases. J Public Health Med 2003; 25: 254–257.

    Article  Google Scholar 

  8. World Health Organisation. International Classification of Diseases. Manual of the international statistical classification of diseases: injuries and causes of deaths, 9th revision. World Health Organisation: Geneva, 1977.

  9. World Health Organisation Collaborating Centre for Drug Statistics Methodology. ATC Index with DDDs. World Health Organisation: Oslo, 2001.

  10. Sessa E, Samani F, Niccolai C, Pecchioli S, Ventriglia G, Mazzaglia G . The creation of a validated sample of doctors in general medicine for database Health Search. J Italian Soc Gen Pract (SIMG) 2004; 3: 10–14.

    Google Scholar 

  11. Lawrenson R, Williams T, Farmer R . Clinical information for research: the use of general practice databases. J Pub Health Med 1999; 21: 299–304.

    Article  CAS  Google Scholar 

  12. Brosius FC, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease. A Science Advisory From the American Heart Association Kidney and Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation 2006; 114: 1083–1087.

    Article  Google Scholar 

  13. Roland M . Linking physician pay to quality of care: a major experiment in the UK. N Engl J Med 2004; 351: 1488–1454.

    Article  Google Scholar 

  14. Doran T, Fullwood C, Gravelle H, Reeves D, Kontopantelis E, Hiroeh U et al. Pay-for-performance programs in family practices in the United Kingdom. NEJM 2006; 355: 375–384.

    Article  CAS  Google Scholar 

  15. Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD . Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2006; 19: CD000259.

  16. Wong ND, Lopez VA, L’Italien G, Chen R, Kline SEJ, Franklin SS . Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med 2007; 167: 2431–2436.

    Article  Google Scholar 

  17. Phillips LS, Branch WT, Cook CB, Doyle JP, El Kebbi IM, Gallina DL et al. Clinical inertia. Ann Intern Med 2001; 135: 825–834.

    Article  CAS  Google Scholar 

  18. Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S et al. Therapy modifications in response to poorly controlled hypertension, dyslipidaemia and diabetes mellitus. Ann Intern Med 2006; 144: 475–484.

    Article  Google Scholar 

  19. Inkster ME, Montgomery A, Donnan P, MacDonald TM, Sullivan F, Fahey T . Organisational factors in relation to control of blood pressure: an observational study. Br J Gen Pract 2006; 55: 931–937.

    Google Scholar 

  20. Marshall T . Coronary heart disease prevention: insights from modelling incremental cost effectiveness. BMJ 2003; 327: 1264–1267.

    Article  Google Scholar 

  21. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J . Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA 2005; 293: 1223–1238.

    Article  CAS  Google Scholar 

  22. Filippi A, Sabatini A, Badioli L, Samani F, Mazzaglia G, Catapano A et al. Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behavior among Italian general practitioners in diabetic patients: an intervention trial. Diabetes Care 2003; 26: 1497–1500.

    Article  Google Scholar 

  23. Fahey T, Schroeder K, Ebrahim S . Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev 2006; 18: CD005182.

  24. Ho PM, Magid DJ, Shetterly SM, Olson KL, Peterson PN, Masoudi FA et al. Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease. Arch Intern Med 2008; 168: 271–276.

    Article  Google Scholar 

  25. Mazzaglia G, Mantovanic LG, Sturkenboome MC, Filippi A, Trifiró G, Cricelli C et al. Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care. J Hypertens 2005, 2093–2100.

  26. Poluzzi E, Strahinja P, Vaccheri A, Vargiu A, Silvani MC, Motola D et al. Adherence to chronic cardiovascular therapies: persistence over the years and dose coverage. Br J Clin Pharmacol 2007; 63: 346–355.

    Article  CAS  Google Scholar 

  27. Mancia G, Grassi G . Systolic and diastolic blood pressure control in antihypertensive drug trials. J Hypertens 2002; 20: 1461–1464.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Italian College of General Practitioners, Via del Pignoncino, Florence, Italy

    A Filippi, I Paolini, A Battaggia & O Brignoli

  2. The Health Search Database, Largo Cesare Cantu 4, Florence, Italy

    F Innocenti & G Mazzaglia

Authors
  1. A Filippi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I Paolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Innocenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Mazzaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Battaggia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. O Brignoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Filippi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Filippi, A., Paolini, I., Innocenti, F. et al. Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice. J Hum Hypertens 23, 758–763 (2009). https://doi.org/10.1038/jhh.2009.14

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2009.14

This article is cited by

Search

Advanced search

Quick links