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. 2022 Apr 1:352:137-143.
doi: 10.1016/j.ijcard.2022.02.014. Epub 2022 Feb 14.

Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

Victor J M Zeijen  1 , Melvin Lafeber  2 , Jorie Versmissen  2 , Abraham A Kroon  3 , Eric Boersma  1 , Joost Daemen  4
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Free article

Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

Victor J M Zeijen et al. Int J Cardiol. .
Free article

Abstract

Introduction: Hypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events. New invasive treatment options are becoming available that might be particularly appealing for high-risk patients. Therefore, the aim of this study was to determine the prevalence of high-risk patients on routine therapy that do not meet guideline recommended ambulatory blood pressure (ABP) targets.

Methods: This single-center, cross-sectional study was conducted at the Erasmus University Medical Center (Rotterdam, The Netherlands). Inclusion criteria were: (1) age 18-80 years, (2) drugs prescribed for hypertension or history of hypertension and (3) high cardiovascular risk as defined according to the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Patients underwent standardized office blood pressure (OBP) and same-day 24-h ABP measurements. Blood pressure (BP) control was defined according to the 2018 ESC/ESH and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines.

Results: A total of 100 patients were enrolled (median age 71 years, 35% female). Mean OBP was 142.2/81.9 ± 18.6/12.6 mmHg and mean 24-h ABP was 126.1/70.1 ± 14.3/9.2 mmHg. Patients were on 2.0 [25th-75th percentile: 1.0-3.3] Defined Daily Doses of antihypertensive drugs. ESC/ESH guideline 24-h ABP and OBP targets were not met in 41.8% (95%CI: 31.5-52.6%) and 52.7% (95%CI: 42.0-63.3%), respectively. ACC/AHA guideline 24-h ABP and OBP targets were not met in 59.3% (95%CI: 48.5-69.5%) and 79.1% (95%CI: 69.3-86.9%), respectively.

Conclusions: BP remains uncontrolled in 40-60% of high-risk hypertensive patients despite routine use of guideline-recommended therapy. Our findings support the search towards novel invasive BP lowering treatment options.

Keywords: Ambulatory; Antihypertensive agents; Blood pressure monitoring; Cardiovascular diseases; Guideline; Hypertension; Prevalence.

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