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Why is My Hypertensive Patient Still Not Controlled?

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Abstract

Despite the well-known obstacles to blood pressure (BP) control, significant improvement can be obtained. Unfortunately more than a third of hypertensive patients remain non-controlled even after improving initiatives. We asked a group of General Practitioners (GPs) why their patients failed to reach the target despite their efforts.

Methods

After an audit the control rate increased from 50.8 % to 64.1 %. The 18 participating GPs analyzed the 2,674 patients who remained non controlled (no available BP recording in the last year or last available recorded value ≥140/90 mmHg -office BP-, ≥135/85 mmHg -home BP-, ≥130/80 mmHg -ambulatory BP-) and filled a questionnaire about the reasons for patients’ non-attendance and for lack of BP control.

Results

BP values were missing in 1,769 (66.1 %) patients; reasons: contact impossible (19 %), contacted, but did not attend (29 %), forgot to check BP (19 %), BP checked at home, but not recorded (10 %), patients cared for by specialists (12 %), the patient is a doctor or a doctor’s relative (4 %), other (12 %). Among the other 905 (33.9 %) non-controlled subjects (with recorded BP) 23 % were prescribed with ≥3, and 10 % with ≥4 drugs. Reasons not to increase therapy were: patient choice (29 %), wait and see strategy/patient not stable yet (26 %), increase inappropriate (20 %), others caring for hypertension (9 %), secondary hypertension (5 %), reached maximum possible therapy (4 %), “resistant hypertension” (4 %), forgot to increase therapy (3 %), other (5 %).

Conclusions

The priorities for further improvement are the patients who do not see their doctors (regularly), followed by those unwilling to increase their therapy.

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Alessandro Filippi deceased on 23 October 2014.

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Filippi, A., Degli Esposti, L., Buda, S. et al. Why is My Hypertensive Patient Still Not Controlled?. High Blood Press Cardiovasc Prev 22, 69–72 (2015). https://doi.org/10.1007/s40292-014-0075-y

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  • DOI: https://doi.org/10.1007/s40292-014-0075-y

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