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Journal of Evaluation in Clinical Practice ISSN 1365-2753

Blood pressure control in patients with hypertension: a retrospective cohort study Umit Aydogan MD,1 Yusuf C. Doganer MD,2,3 Aslı Atik MD,4 James E. Rohrer PhD,5 Deniz Engin Gok MD,6 Ebru Cirpan MD,7 Mahmut I. Yilmaz MD8 and Kenan Saglam MD9 1

Associate Professor, Department of Family Medicine, Gulhane Military Medical Faculty, Ankara, Turkey Research Fellow, Department of Family Medicine, Mayo Clinic, Rochester, MN, USA 3 Family Physician, Department of Family Medicine, Primary Care Examination Center, Turkish Military Academy, Ankara, Turkey 4 Family Physician, Oran Outpatient Clinic, Primary Care & Family Health Center, Beytepe Military Hospital, Ankara, Turkey 5 Professor, Department of Family Medicine, Mayo Clinic, Rochester, MN, USA 6 Internal Medicine Specialist, Department of Internal Medicine, Gulhane Military Medical Faculty, Ankara, Turkey 7 Family Physician, Foca Naval Base Outpatient Clinic, Primary Care & Family Health Center, I˙zmir Military Hospital, I˙zmir, Turkey 8 Associate Professor, Department of Nephrology, Gulhane Military Medical Faculty, Ankara, Turkey 9 Professor, Department of Internal Medicine, Gulhane Military Medical Faculty, Ankara, Turkey 2

Keywords blood pressure targets, guidelines, hypertension, improvement Correspondence Dr Yusuf C. Doganer Department of Family Medicine Mayo Clinic 200 First St. Southwest Rochester, MN 55905 USA E-mail: [email protected] Accepted for publication: 2 December 2014 doi:10.1111/jep.12318

Abstract Rationale, aims and objectives: Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals. Methods: We conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model. Results: Follow-up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow-up visit achieved the overall SBP/DBP targets specified by the JNC-8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P < 0.001, P < 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P < 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = −7.968, P = 0.005; β = −5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P < 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = −5.682, P = 0.002; β = −0.098, P = 0.005; respectively). Conclusions: Although the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

Introduction Hypertension (HT) is the most common chronic health issue determined in primary care centers affecting almost one in three adults and still remains one of the most essential preventable contributors to morbidity and mortality rates of which secondary from myocardial infarction, stroke, renal failure, congestive heart failure and peripheral vascular disease [1,2]. It is reported as 49% of developmental risk of coronary heart disease and 62% of stroke risk [3]. Based on global data, it was predicted that 26.4% of the adult

population in 2000 of whom had HT, is going to have an increase to 29.2% by the year 2025 [2]. More than nine million deaths that means 16.5% of all annual deaths are attributed to adverse effects of HT among the global population in comparative risk assessment [4]. Early diagnosis and appropriate treatment is crucial stages in the management of high blood pressure (BP) and its adverse outcomes worldwide [1]. Regarding the potential risk jeopardizing the cardiovascular health, the Institute of Medicine in the United States described HT as a ‘neglected disease’, and remarked that this hazard could derive from poor adherence to treatment reports [5].

Journal of Evaluation in Clinical Practice 21 (2015) 313–319 © 2015 John Wiley & Sons, Ltd.

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Blood pressure control

Despite the improvements to identify new pathophysiologic pathways and advances in HT treatment adjusted based on latest effect mechanisms, the detection and control of high BP is a major public health problem in Turkey, as well as in other countries at all economic development stages [6]. According to the findings of Turkish Statistics Institute, cardiovascular diseases (CVDs) are the highest reason of deaths in Turkey [7]. Although national public health campaigns were designed to enhance dietary habits and physical outdoor activities, they have not contributed to well enough to the management of cardiovascular risk factors including HT. In regards to close causal link between HT and CVDs, further concerns should be devoted to the management of this silent approaching hazard [6]. Various qualified research committees worldwide prepared and issued several guidelines on HT management including diagnosis, treatment and follow-up stages (‘Hypertension without compelling indications: 2013 CHEP recommendations’ [8–10] ). The latest guideline on HT management designed upon rigorous, evidencebased methods was presented to provide the needs of health care professionals, particularly for primary care clinicians [1]. Regardless, from the slight difference of benchmarks about HT goals, all reports emphasize upon the dietary, lifestyle and pharmacological interventions to reduce the high BP, cardiovascular risk factors as well [11]. On the other side, which level of BP requires to be lowered or through which precise BP level should be targeted by BP-lowering drugs are developed perpetually in clinical trials [12]. The purpose of this study was to assess the effectiveness of HT treatment during the high BP control to attain the BP goals. In addition, we hypothesized that some of the demographics and co-morbidities would impact on the achievement of BP goals.

Methods Study sample The systolic (SBP)/diastolic blood pressure (DBP) values of a random sample of all enrolled patients for whom BPs were reviewed between 1990 and 2010 were extracted from patients’ files (n = 437). After the initial evaluation of inclusion criteria, total of 276 (63.1%) patients admitted to the hypertensive outpatient clinic were enrolled in the study of whom had been applied for two follow-up visits and BPs were recorded at baseline and first visit. Personal characteristics include patient age group (

Blood pressure control in patients with hypertension: a retrospective cohort study.

Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed ...
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