[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)

Effect of pharmaceutical intervention on medication adherence and blood pressure control in treated hypertensive patients: Rationale, design and methods of the AFenPA pilot study

Objective: To assess the effect of a protocol-based pharmacist intervention on blood pressure control and medication adherence among treated hypertensive patients who are users of community pharmacies.Methods: A quasi experimental study design with control group has been designed to compare the effect of pharmaceutical intervention (intervention group) versus the standard healthcare procedure (control group) on blood pressure and medication adherence among hypertensive patients receiving drug therapy in community pharmacies. The patients will be allocated evenly between the two groups (ncontrol = nintervention), with a 6-month follow-up. The pharmaceutical intervention program will comprise three main parts: 1) patient education / information on issues relating to hypertension and medication adherence; 2) self-monitoring of blood pressure; and 3) interaction with the physician through personalized reports when the mean blood pressure values recorded at home exceed the treatment goal according to the clinical condition of the patient. In order to evaluate the effect of the pharmaceutical intervention upon medication adherence and blood pressure, blood pressure recordings will be made in the pharmacy, while percent medication adherence will be established based on pill count in both groups at the start and end of the study.Discussion: To our knowledge, this is the first study in the community pharmacy setting in Spain to evaluate the effectiveness of pharmaceutical intervention in combination with home blood pressure monitoring on blood pressure control. In addition, the pharmaceutical intervention has been designed for inclusion as standard practice in the context of Pharmaceutical Care(AU)

Objetivo: Evaluar el efecto de una intervención farmacéutica protocolizada sobre el control de la presión arterial y la adherencia al tratamiento farmacológico en pacientes usuarios de farmacias comunitarias.Material y métodos: Estudio cuasi-experimental con grupo control en el que se comparará el efecto de una intervención farmacéutica (grupo intervención) con el proceso de atención habitual (grupo control), sobre la presión arterial y la adherencia al tratamiento de pacientes hipertensos tratados farmacológicamente en farmacias comunitarias. Los pacientes serán distribuidos de forma equitativa en ambos grupos (n control = n intervención) y serán seguido durante 6 meses. El programa de la intervención farmacéutica constará de tres partes fundamentales: 1) educación/información al paciente sobre aspectos relacionados con la hipertensión y adherencia al tratamiento farmacológico, 2) automonitorización de la presión arterial y, 3) interacción con el médico mediante informes personalizados cuando la media de las cifras de presión arterial realizadas en el domicilio superen el objetivo terapéutico acorde con la situación clínica del paciente. Para evaluar el efecto de la intervención farmacéutica sobre la adherencia terapéutica y la presión arterial se obtendrán medidas de presión arterial en la farmacia y porcentaje de cumplimiento terapéutico mediante recuento de comprimidos en ambos grupos al principio y al final del estudio.Discusión: Según nuestros conocimientos, éste es el primer estudio que se realiza en farmacia comunitaria en España para probar la efectividad de una intervención farmacéutica conjuntamente con la automedida de la presión arterial sobre el control de la presión arterial. Además, la intervención farmacéutica se ha diseñado de forma que pueda integrase como práctica habitual enmarcada dentro de la Atención Farmacéutica(AU)

Evolución del control de la presión arterial en España en el período 2002–2006. Estudios PRESCAP / Evolution of the control of blood pressure in Spain in the period 2002–2006. PRESCAP Studies

ObjetivosDiscutir la evolución del grado de control de la presión arterial (PA) en una amplia muestra de pacientes hipertensos españoles durante el período 2002–2006.Material y métodosLos PRESCAP fueron estudios transversales y multicéntricos diseñados para la estimación de prevalencias, que se realizaron en los años 2002 y 2006 con la misma metodología en poblaciones similares asistidas en atención primaria (AP). Éstos incluyeron a pacientes ≥18 años diagnosticados de hipertensión arterial (HTA) que recibían tratamiento farmacológico antihipertensivo. Se consideró buen control de la HTA cuando la PA fue <140 y<90mmHg en general (<130 y<80mmHg en pacientes con diabetes, nefropatía o enfermedad cardiovascular). Se realizó estadística descriptiva y comparación de medias y porcentajes con el paquete SPSS versión 15.0.ResultadosSe incluyó a 12.754 pacientes (el 57,2% eran mujeres) con una edad media de 63,3±10,8 años en PRESCAP 2002 y a 10.520 pacientes (el 53,7% eran mujeres) con una edad media de 64,6±11,3 años en el PRESCAP 2006. En el año 2002 se observó un control de la PA sistólica (PAS) y de la PA diastólica (PAD) del 36,1% (intervalo de confianza del 95% [IC 95%]: 35,2–36,9) y en 2006 del 41,4% (IC 95%: 40,5–42,4). El porcentaje de pacientes diabéticos con PA controlada resultó del 9,1% (IC 95%: 8,0–10,2) en 2002 y del 15,1% (IC 95%: 13,8–16,5) en 2006.ResultadosEn el PRESCAP 2002 el 56,0% recibía monoterapia antihipertensiva, el 35,6% recibía combinaciones de dos fármacos y el 8,4% recibía tres o más fármacos, y en el PRESCAP 2006 estos porcentajes fueron del 44,4; el 41,1 y el 14,5%, respectivamente.Conclusiones(..) (AU)

ObjectivesDiscuss the evolution of blood pressure (BP) control grade in a large sample of Spanish hypertensive patients in the period of 2002–2006.Material and methodsThe PRESCAP were cross-sectional and multicenter studies designed to calculate prevalences that were conducted in 2002 and 2006 using the same methodology in similar populations attending in primary care (PC). They included patients ≥18 years diagnosed of high blood pressure (HBP) who received anti-hypertensive drug treatment. Good control of HBP was considered as BP<140 and<90mmHg in general (<130 and<80mmHg in patients with diabetes, nephropathy or cardiovascular disease). A descriptive statistical study and comparison of means and percentages with the SPSS version 15.0 were made.ResultsA total of 12,754 patients (57.2% women) with mean age of 63.3±10.8 years were included in PRESCAP 2002 and 10,520 (53.7% women) with a mean age of 64.6±11.3 years in PRESCAP 2006. In the year 2002, control of systolic BP (SBP) and diastolic BP (DB) of 36.1% (95% CI, 35.2–36.9) was observed and, in 2006, of 41.4% (95% CI, 40.5–42.4). The percentage of diabetic patients with controlled BP was 9.1% (95% CI, 8.0–10.2) in 2002 and 15.1% (95% CI, 13.8–16.5) in 2006.ResultsIn the PRESCAP 2002, 56.0% received antihypertensive monotherapy, 35.6% combinations of two drugs and 8.4% three or more drugs, and in the PRESCAP 2006 these percentages were 44.4%, 41.1% and 14.5%, respectively.ConclusionsThe control grade of HBP in Spain improved in the period of 2002–2006. The factors that may have had an influence in these results are the extensive amount of bibliography generated during this period on the need to achieve adequate control of BP and the change in the prescription profile of the PC physician, which indicates a greater percentage of combinations of 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.