Análisis de las áreas de mejora del control de la hipertensión arterial en Atención Primaria

Epidemiological analysis of the improving areas for blood pressure control at Primary Care practice

P. García-Pavíaa, J. González Mirelisa, R. Pastorínb, M. Brunab, J. Raezb, A I. Tabuencab, L. Alonso-Pulpónc, J R. Banegasb

a Servicio de Cardiología. Hospital Univesitario Puerta de Hierro. Madrid. Departamento de Medicina Preventiva y Salud Pública. Facultad de Medicina. Universidad Autónoma de Madrid.

b Departamento de Medicina Preventiva y Salud Pública. Facultad de Medicina. Universidad Autónoma de Madrid.

c Servicio de Cardiología. Hospital Univesitario Puerta de Hierro. Madrid.

Background and objectives. Most hypertensive patients do not have their blood pressure (BP) under control. This study aims to evaluate Primary Care physicians' management of hypertension by analyzing the four main areas proposed by experts to improve BP control. Material and methods. From February to May 2003 a questionnaire was completed by 195 Primary Care physicians from 33 Primary Care centers of Madrid, Spain. Four aspects of clinical practice were examined: a) knowledge of hypertension guidelines and objectives; b) diagnosis and follow-up of patients; c) hypertension treatment, and d) drug compliance. Results. Guidelines were followed by 90.6% of the physicians. Twenty six percent of the physicians perceived that guideline objectives are too strict and only 32% identified systolic BP as the component that provides more risk. Only 14% used automatic devices to measure BP while 89% still use the mercury sphygmomanometer. Diuretics were included among the 3 most used antihypertensive drugs by 94% of the physicians, ACEI by 91%, beta blockers by 62% and combinations only by 24%. Eighty eight percent believed that more than 40% of their patients have their BP under control and 53% felt that less than 20% of their patients were non-compliant with antihypertensive treatment. Conclusions. Hypertension management among Primary Care physicians showed some deficiencies in the 4 analyzed areas. Thus, perception of excessively rigorous guideline objectives, underrating of systolic BP, underuse of automatic devices and drug associations, and the overestimation of BP control and therapeutic compliance are specific areas that should be modified to improve BP control.

Keywords:

hypertension, control, Primary Care, guidelines