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Attitudes and preferences for the clinical management of hypertension and hypertension-related cardiac disease in general practice: results of the Italian Hypertension and Heart Survey

Journal of Human Hypertension volume 29, pages 409–416 (2015)Cite this article

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Abstract

The aim of this study was to evaluate attitudes and preferences for the clinical management of hypertensive patients with cardiac organ disease, including left ventricular hypertrophy (LVH) and coronary artery disease (CAD), in Italy. A predefined 15-item questionnaire was anonymously administered to a large community sample of general practitioners (GPs) and specialised physicians between November 2012 and June 2013. Estimated prevalence of hypertension-related clinical conditions was stratified into four groups (10–20%, 20–40%, 40–50%, >50%); preferences were reported as percentage among valid answers to the survey questionnaire. A total of 1319 physicians (672 males, age 55.0±7.1 years, age of medical activity 27.1±7.6 years), among whom 1264 GPs and 55 specialised physicians, was included. LVH was reported to be the most frequent marker of organ damage by the majority of physicians (73.5%). LV diastolic dysfunction was reported to be relatively frequent (>40%) by more than half of the specialised physicians (58.2%) and less frequent (10–20%) by GPs (49.8%); LV systolic dysfunction, atrial fibrillation and CAD were considered to be less frequent (10–20%) by the majority of physicians (61.3, 71.6 and 53.3%, respectively). Echocardiography was the preferred diagnostic tool used to estimate LVH (76.6%). Tight blood pressure control (130/80 mm Hg) was considered to be the most appropriate by the majority of physicians, both in hypertensive patients with LVH and in those with CAD. With the well-known limitations of a cross-sectional survey, this study provides information on attitudes and preferences for the clinical management of outpatients with hypertension and high CV risk profile in general practice in Italy.

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References

  1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360 (9349): 1903–1913.

    Article  PubMed  Google Scholar 

  2. Turnbull F . Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362 (9395): 1527–1535.

    Article  CAS  PubMed  Google Scholar 

  3. Andersson OK, Almgren T, Persson B, Samuelsson O, Hedner T, Wilhelmsen L . Survival in treated hypertension: follow up study after two decades. BMJ 1998; 317 (7152): 167–171.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Volpe M, Battistoni A, Tocci G, Rosei EA, Catapano AL, Coppo R et al. Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation: a role for organ damage markers. J Hypertens 2012; 30 (6): 1056–1064.

    Article  CAS  PubMed  Google Scholar 

  5. Masoudi FA, Ponirakis A, Yeh RW, Maddox TM, Beachy J, Casale PN et al. Cardiovascular care facts: a report from the National Cardiovascular Data Registry-2011. J Am Coll Cardiol 2013; 62 (21): 1931–1947.

    Article  PubMed  Google Scholar 

  6. de Simone G, Izzo R, Verdecchia P . Are observational studies more informative than randomized controlled trials in hypertension?: pro side of the argument. Hypertension 2013; 62 (3): 463–469.

    Article  CAS  PubMed  Google Scholar 

  7. Mancia G . Assessing antihypertensive treatment by real life data. J Hypertens 2012; 30 (1): 46–47.

    Article  CAS  PubMed  Google Scholar 

  8. Volpe M, Tocci G, Bianchini F, De Rosa M, Fedozzi E, Covezzoli A et al. Use of aliskiren in a 'real-life' model of hypertension management: analysis of national web-based drug-monitoring system in Italy. J Hypertens 2012; 30 (1): 194–203.

    CAS  PubMed  Google Scholar 

  9. Tocci G, Aimo G, Caputo D, De Matteis C, Di Napoli T, Granatelli A et al. An observational, prospective, open-label, multicentre evaluation of aliskiren in treated, uncontrolled patients: a real-life, long-term, follow-up, clinical practice in Italy. High Blood Press Cardiovasc Prev 2012; 19 (2): 73–83.

    Article  CAS  PubMed  Google Scholar 

  10. De Giusti M, Dito E, Pagliaro B, Burocchi S, Laurino FI, Tocci G et al. A survey on blood pressure levels and hypertension control in a sample of the italian general population. High Blood Press Cardiovasc Prev 2012; 19 (3): 129–135.

    PubMed  Google Scholar 

  11. Corrao G, Nicotra F, Parodi A, Zambon A, Heiman F, Merlino L et al. Cardiovascular protection by initial and subsequent combination of antihypertensive drugs in daily life practice. Hypertension 2011; 58 (4): 566–572.

    Article  CAS  PubMed  Google Scholar 

  12. Dallongeville J, Banegas JR, Tubach F, Guallar E, Borghi C, Backer GD et al. Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study. Eur J Prev Cardiol 2012; 19 (3): 541–550.

    Article  PubMed  Google Scholar 

  13. Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 2009; 120 (16): 1598–1605.

    Article  CAS  PubMed  Google Scholar 

  14. Tocci G, Giovannelli F, Sciarretta S, Ferrucci A, Zito GB, Volpe M . Management of hypertension and stroke prevention: results of the Italian cardiologist survey. Int J Clin Pract 2009; 63 (2): 207–216.

    Article  CAS  PubMed  Google Scholar 

  15. Tocci G, Borghi C, Volpe M . Clinical management of patients with hypertension and high cardiovascular risk: main results of an italian survey on blood pressure control. High Blood Press Cardiovasc Prev 2013; 21 (2): 107–117.

    Article  PubMed  Google Scholar 

  16. Bohm M, Thoenes M, Danchin N, Bramlage P, La Puerta P, Volpe M . Association of cardiovascular risk factors with microalbuminuria in hypertensive individuals: the i-SEARCH global study. J Hypertens 2007; 25 (11): 2317–2324.

    Article  PubMed  Google Scholar 

  17. Leoncini G, Viazzi F, Rosei EA, Ambrosioni E, Costa FV, Leonetti G et al. Chronic kidney disease in hypertension under specialist care: the I-DEMAND study. J Hypertens 2010; 28 (1): 156–162.

    Article  CAS  PubMed  Google Scholar 

  18. Cuspidi C, Mancia G, Ambrosioni E, Pessina A, Trimarco B, Zanchetti A . Left ventricular and carotid structure in untreated, uncomplicated essential hypertension: results from the Assessment Prognostic Risk Observational Survey (APROS). J Hum Hypertens 2004; 18 (12): 891–896.

    Article  CAS  PubMed  Google Scholar 

  19. Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001; 19 (11): 1981–1989.

    Article  CAS  PubMed  Google Scholar 

  20. Muiesan ML, Salvetti M, Paini A, Monteduro C, Rosei CA, Aggiusti C et al. Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J Hypertens 2010; 28 (9): 1935–1943.

    Article  CAS  PubMed  Google Scholar 

  21. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH/ESC 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 European Society of Cardiology (ESC). Eur Heart J 2013; 34 (28): 2159–2219.

    Article  PubMed  Google Scholar 

  22. 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 European Society of Cardiology (ESC). Eur Heart J 2007; 28 (12): 1462–1536.

    PubMed  Google Scholar 

  23. Cifkova R, Erdine S, Fagard R, Farsang C, Heagerty AM, Kiowski W et al. Practice guidelines for primary care physicians: 2003 ESH/ESC hypertension guidelines. J Hypertens 2003; 21 (10): 1779–1786.

    Article  CAS  PubMed  Google Scholar 

  24. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L et al. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999; 21 (5–6): 1009–1060.

    CAS  PubMed  Google Scholar 

  25. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS et al. Regression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study. Circulation 2003; 108 (6): 684–690.

    Article  CAS  PubMed  Google Scholar 

  26. Devereux RB, Dahlof B, Gerdts E, Boman K, Nieminen MS, Papademetriou V et al. Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) trial. Circulation 2004; 110 (11): 1456–1462.

    Article  CAS  PubMed  Google Scholar 

  27. Haller H, Ito S, Izzo JL Jr, Januszewicz A, Katayama S, Menne J et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med 2011; 364 (10): 907–917.

    Article  CAS  PubMed  Google Scholar 

  28. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358 (15): 1547–1559.

    Article  CAS  PubMed  Google Scholar 

  29. Parving HH, Brenner BM, McMurray JJ, de Zeeuw D, Haffner SM, Solomon SD et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367 (23): 2204–2213.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Mrs Giusy Mazza from Springer Healthcare Italy for her help and assistance in data collection, and Mrs Maria Antonietta Savina for project coordinator activities.

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Authors and Affiliations

  1. Division of Cardiology, Department of Clinical and Molecular Medicine, Hypertension Unit, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Sant'Andrea Hospital, Rome, Italy

    G Tocci, P Francia, A Ferrucci & M Volpe

  2. IRCCS Neuromed, Pozzilli, Italy

    G Tocci & M Volpe

  3. Division of Internal Medicine, University of Bologna, Bologna, Italy

    A F Cicero & C Borghi

  4. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    M Salvetti

Authors
  1. G Tocci
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  2. A F Cicero
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  3. M Salvetti
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  4. P Francia
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  5. A Ferrucci
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  6. C Borghi
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  7. M Volpe
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Corresponding author

Correspondence to G Tocci.

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Competing interests

MV and CB have served in International Advisory Boards of Daiichi Sankyo, Menarini, Malesci and Guidotti, and have lectured in symposia supported by several drug companies producing ACE Inhibitors and ARBs; GT, AFC, AF and MS have lectured in symposia supported by Menarini, Malesci and Guidotti; PF declares no conflict of interest.

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Tocci, G., Cicero, A., Salvetti, M. et al. Attitudes and preferences for the clinical management of hypertension and hypertension-related cardiac disease in general practice: results of the Italian Hypertension and Heart Survey. J Hum Hypertens 29, 409–416 (2015). https://doi.org/10.1038/jhh.2014.115

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  • DOI: https://doi.org/10.1038/jhh.2014.115

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