[Medical conduct in primary care as regards blood pressure control. PRESCAP 2010 study]. / Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010.

INTRODUCTION: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg. RESULTS: A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. CONCLUSIONS: The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.

Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010 / Medical conduct in Primary Care as regards blood pressure control. PRESCAP 2010 Study

Introducción. Es necesario tener mayor información sobre la inercia terapéutica en la hipertensión arterial (HTA). El objetivo de este estudio fue conocer la conducta del médico de atención primaria (AP) en pacientes hipertensos que presentan mal control de presión arterial (PA) y determinar los factores asociados. Pacientes y métodos. Estudio transversal y multicéntrico realizado en hipertensos asistidos en el ámbito de la AP española. Se registraron datos de los pacientes (sociodemográficos, clínicos y tratamiento) y médicos (asistenciales, formativos y conducta ante el mal control de PA). Se consideró mal control cuando el promedio de PA era >= 140/90mmHg. Resultados. Se incluyeron 12.961 hipertensos (52,0% mujeres), con una edad media de 66,3 (11,4) años y antigüedad media de la HTA de 9,1 (6,7) años. El 62,4% recibía terapia combinada (44,2%, 2 fármacos, y 18,2%, 3 o más). El 38,9% (IC 95%: 38,1-39,7) presentó mal control de PA. El médico modificó el tratamiento en el 41,8% (IC 95%: 40,4-43,2) de los 5.036 pacientes mal controlados. La conducta terapéutica más frecuente fue la asociación farmacológica (55,6%). La percepción por parte del médico de buen control de PA en el hipertenso mal controlado y la presencia de terapia combinada fueron las variables que mostraron mayor probabilidad de no modificar el tratamiento farmacológico. Conclusiones. El médico de AP modifica el tratamiento antihipertensivo en tan solo 4 de cada 10 hipertensos mal controlados. La percepción por parte del médico de buen control de PA es la variable que más incrementa la probabilidad de no modificar el tratamiento farmacológico (AU)

Introduction. There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. Patients and methods. Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where >=140/90mmHg. Results. A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. Conclusions. The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia (AU)

Conducta del médico ante el mal control de la hipertensión arterial. Aportaciones de los estudios PRESCAP 2002 y PRESCAP 2006 al conocimiento de la inercia terapéutica en España / Attitude of the physician towards poorly controlled arterial hypertension. Contributions of the PRESCAP 2002 and PRESCAP 2006 studies to knowledge on the therapeutic inertia in Spain

En España tan solo 4 de cada 10 hipertensos tratados con fármacos antihipertensivos que reciben asistencia sanitaria en Atención Primaria tienen bien controlada la PA. La inercia terapéutica está reconocida como una de las principales causas de mal control de la HTA y de otras enfermedades crónicas. Los PRESCAP fueron estudios tranversales y multicéntricos diseñados para estimación de prevalencias, que se realizaron en los años 2002 y 2006 con la misma metodolología en poblaciones similares asistidas en AP. Uno de los objetivos de ambos estudios fue analizar la conducta terapéutica del médico ante pacientes mal controlados (PA sistólica o diastólica ≥140 o ≥90mmHg, respectivamente, en población hipertensa en general, o PA≥130 o ≥80mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). El estudio PRESCAP 2002 mostró que el porcentaje de pacientes con inadecuado control de la PA en los que el médico modificó la pauta terapéutica fue del 18,3% (IC 95%: 17,5–19,1), siendo el cambio de fármaco la opción más elegida (47%), seguida de la combinación (34,7%) y del aumento de dosis (18,3%). En el estudio PRESCAP 2006 el médico modificó el tratamiento en el 30,4% (IC 95%: 29,2–31,6) de los sujetos mal controlados, resultando las acciones más frecuentemente llevadas a cabo la combinación con otro fármaco (46,3%), el incremento de dosis (26,1%) y la sustitución del antihipertensivo (22,8%). La percepción de buen control de la PA por parte del médico fue la variable que más se relacionó con la no modificación del tratamiento farmacológico. Aunque la conducta terapéutica del médico dista de ser idónea, nuestros resultados parecen indicar que se ha producido una mejora importante en la inercia terapéutica de los médicos de Atención Primaria ante los hipertensos mal controlados que siguen tratamiento farmacológico antihipertensivo (AU)

In Spain, only 4 out of 10 hypertensive patients treated with antihypertensive drugs who are attended in Primary Care (PC) have well-controlled blood pressure (BP). Therapeutic inertia (TI) is recognized as one of the main causes for poorly controlled arterial hypertension and other chronic diseases. The PRESCAPs were cross-sectional and multicenter studies designed to calculate prevalence. These studies were conducted in the years 2002 and 2006 using the same methodology in similar populations attended in PC. One of the purposes of both studies was to analyze the therapeutic attitude of the physician in regards to poorly-controlled patients (systolic or diastolic BP≥140 or ≥90mmHg, respectively, in hypertensive population in general, or BP PA≥130 or ≥80mmHg in patients with diabetes, nephropathy or cardiovascular disease). The PRESCAP 2002 study showed that the percentage of patients with inadequate control of PB in whom the physician changed the therapeutic regime was 18.3% (95% CI: 17.5–19.1), the change in the drug of choice being the action chosen the most (47%), followed by combination (34.7%) and dose increase (18.3%). In the PRESCAP 2006 study, the physician modified the treatment in 30.4% (95% CI: 29.2–31.6) of the poorly controlled subjects. The most frequently performed actions were combination with another drug (46.3%), dose increase (26.1%) and substitution of the antihypertensive drug (22.8%). Perception of good control of BP by the physician was the variable that was most related with the non-modification of the drug treatment. Although the therapeutic attitude of the physician is far from being the best, our results seem to indicate that there has been an important improvement in the therapeutic inertia of the primary care physicians in regards to poorly controlled hypertensive patients who follow a treatment with antihypertensive drugs (AU)

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study]. / Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006.

INTRODUCTION: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. RESULTS: A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. CONCLUSIONS: Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.