In France, antihypertensive triple therapies most frequently combine renin-angiotensin system inhibitors, diuretics and beta-blockers (BB) which is inconsistent with current recommendations. This could be explained by the high proportion of patients in secondary prevention among those receiving triple therapy. The objective of the Trianon survey was to describe the prevalence and the predictors of BB within triple therapies in France.Design and method:
Prospective, cross-sectional survey conducted by 258 cardiologists in 2014 and involving adult hypertensive patients receiving 3 antihypertensive drugs at stable dose for at least 8 weeks.Results:
The analysis involved 1055 patients (mean age 69 ± 11 years, males 59.2%, diabetics 32.3%). Treatment was prescribed for secondary prevention (SP) in 378 patients (35.8%) and in primary prevention (PP) in 677. Current use of tobacco, diabetes, dyslipidemia, sleep apnea, history of atrial fibrillation, history of supraventricular or ventricular extrasystoles, left ventricular hypertrophy, and renal failure were more frequent in SP than in PP patients. Blood pressure was 144 ± 81 mmHg and was controlled in 41.8% of patients without difference between SP and PP patients. Current treatment regimen included a BB in 253 SP patients (66.9%) and 293 (43.3%) PP patients (p < 0.0001). In those PP patients prescribed with BB, physicians declared BB prescription to be related to cardiac rhythm disorders (139/293). Therefore 154 patients (52.6% of PP patients with BB, 22.7% of all PP patients) were treated with a BB out of context of secondary prevention or cardiac rhythm disorders. In multivariate analysis and for the overall population, angina (OR 3.37 [2.15;5.26]), history of myocardial infarction (OR 4.63 [2.47;8.69]), asthma (OR 0.21 [0.09;0.46]), COPD (OR 0.52 [0.33;0.81]) and cardiac rhythm disorders (OR 2.01 [1.50;2.69]) were related to BB prescription. In PP patients, cardiac rhythm disorders (OR 2.07 [1.44;2.98]), asthma (OR 0.18 [0.05;0.62]) and COPD (OR = 0.32 [0.16;0.65]) were related to BB prescription.Conclusions:
Beta-blockers prescription is not fully explained by secondary prevention purpose nor by cardiac rhythm disorders in hypertensive patients treated with triple therapies. This overprescription could be involved in the explanatory factors of the rate of patients at goal, which is largely perfectible.