Clinical management of patients with hypertension and high cardiovascular risk: main results of an Italian survey on blood pressure control

Abstract

Introduction: Hypertension management and control still represents a major clinical challenge for physicians, as well as for National Health Care Systems, since high blood pressure (BP) levels in treated uncontrolled outpatients are related to a persistently increased risk of cardiovascular (CV) events. The Italian Society of Hypertension (SIIA) has prompted several educational interventions for improving BP control in Italy.

Aim: To evaluate clinical attitudes and preferences of large community sample of both specialized physicians and general practitioners, included in an educational program, endorsed by SIIA and aimed at improving interventions for achieving better BP control in Italy.

Methods: A predefined questionnaire, which included a main body with 17 questions and 15 specific items (3-4 questions for each item), was anonymously administered to a large community sample of physicians who have practice in managing outpatients with hypertension and high CV risk profile. Both specialized physicians and general practitioners, distributed throughout the whole Italian territory, have been included in this educational program. Data were reported into a computerised spreadsheet and centrally analysed. Confidentiality of the data were guaranteed during each phase of the study.

Results: From a total of 64 questions, 557 physicians (478 male, mean age 54.2 ± 7.1 years, average age of medical activity 28.0 ± 8.1 years), among which 261 (46.9 %) specialised physicians and 296 (53.1 %) general practitioners, provided 60,713 answers to the survey questionnaire. Physicians devote time and effort for achieving the recommended BP targets (<140/90 and <130/80 mmHg in high risk subgroups), yet they reported a very high rate of BP control (about 70 %). Concomitant presence of diabetes, cardiac and renal organ damage (35-50 %), as well as comorbidities (20-35 %), is reported to be high and able to impact on antihypertensive treatment's efficacy. Appropriate BP assessment is also viewed as a key tool for verifying effectiveness of a given drug therapy. Beyond non-pharmacological options, ACE inhibitors and ARBs were considered to most useful, effective and well tolerated options to start and maintain antihypertensive treatment, thus adding diuretics or calcium-channel blockers if needed. Direct renin inhibitors was considered to be effective in difficult to treat hypertension and to provide sustained antihypertensive efficacy.

Conclusions: With the well-known limitations of an observational, cross-sectional survey, in which a predefined questionnaire was administered to physicians rather than collecting data from medical databases, this study provides useful and updated information on attitudes and preferences, as well as on difficulties and troubles for physicians when managing outpatients with hypertension and high CV risk profile in Italy.