Changes in the prevalence, treatment and control of hypertension in Germany? A clinical-epidemiological study of 50.000 primary care patients

Abstract

Introduction: Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001.

Methods: Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician's diagnosis of hypertension (HTN(doc)) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician's diagnosis or the patient's self-reported diagnosis of hypertension (HTN(doc,pat)), physician's or patient's self-reported diagnosis or a BP measurement with a systolic BP ≥ 140 mmHg and/or a diastolic BP ≥ 90 (HTN(doc,pat,bp)) and diagnosis according to the National Health and Nutrition Examination Survey (HTN(NHANES)). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined.

Results: The overall prevalence rate for hypertension was 35.5% according to HTN(doc) and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity.

Conclusions: Rates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement.

Figure 1. Diagnosis, treatment and control rates among NHANES hypertension cases in DETECT and HYDRA study.

Comparison between DETECT study (N = 30189) and HYDRA study (N = 22744) for diagnosis, treatment and control rates. Diagnosed = diagnosed by physician among NHANES cases; diagnosed+treated = diagnosed by physician and treated by antihypertensive drugs among NHANES cases; diagnosed+treated+controlled = diagnosed by physician, treated by antihypertensive drugs and blood pressure <140/90 mmHg among NHANES cases. A comparison between both studies reveals that the proportion of diagnosed patients among NHANES hypertension cases was lower in the first study for all age groups above age 30 for men and women (p<0.05). Small (significant) improvements in rates of diagnosed and treated hypertension were found in females 30–44 years of age and in males 30–44 and 45–59 years of age (p<0.05). Small (significant) improvements in rates of diagnosed, treated and controlled hypertension were found in females 60–64 years of age and in males 30–44 and 45–59 years of age (p<0.05).