The impact of an individualized risk-adjusted approach on hypertension treatment in primary care

Abstract

Previous studies suggest that up to 60% of all patients with hypertension receive inappropriate treatment. Current 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines recommend taking cardiovascular risk factors into account when assessing treatment for patients with hypertension. The authors hypothesize that this approach will reduce the proportion of patients receiving inappropriate treatment. In this cross-sectional study using electronic medical records of Swiss primary care patients, the authors estimate the proportion of patients receiving inappropriate treatment using two approaches: (1) based on a blood pressure threshold of 140/90 mm Hg; and (2) based on cardiovascular risk factors. A total of 22 434 patients with hypertension were identified. Based on these approaches, 72.7% and 44.6% of patients, respectively, qualified for drug treatment. In addition, 23.0% and 10.8% of patients, respectively, received inappropriate treatment. Application of the 2013 ESH/ESC guidelines reduced the proportion of patients receiving inappropriate treatment by 50%. This shows the major impact of risk adjustment and highlights the need for a patient-centered approach in hypertension treatment.

Keywords: antihypertensive therapy; clinical management of high blood pressure; primary care issues; risk assessment; treatment and diagnosis/guidelines.

Figure 1

Stratification of patients. BP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure; HT, hypertension; CKD, chronic kidney disease; CVD, cardiovascular disease; OD, organ damage; RFs, risk factors

Figure 2

Inclusion flowchart. ATC, Anatomical Therapeutic Chemical Classification System; BP, blood pressure; FIRE, Family Medicine ICPC‐Research Using Electronic Medical Records; ICPC‐2, second version of the International Classification of Primary Care

Figure 3

Patients with hypertension. BP, blood pressure; CI, confidence interval

Figure 4

Age stratification of patients.