[PP.32.02] IMPROVED TREATMENT AND CONTROL OF HYPERTENSION IN SWEDISH PRIMARY CARE: RESULTS FROM THE SWEDISH PRIMARY CARE CARDIOVASCULAR DATABASE (SPCCD)

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Abstract

Objective:

To study changes in hypertension control and antihypertensive treatment in patients treated in primary care from 2001–02 to 2007–08.

Design and method:

The SPCCD includes extractions from computerized medical records of 74,751 hypertensive patients treated in Swedish primary care 2001–08. The main outcome measures of this retrospective analysis were blood pressures in relation to clinical characteristics, comorbidity and pharmacotherapy.

Results:

The mean age of women and men in 2001–02 was 69 ± 12 and 66 ± 12 years respectively. This increased to 70 ± 13 and 67 ± 12 years. In 2001–02 72% of women and 64% of men had cardiovascular (stroke, IHD, CHF, AF) and/or diabetic comorbidity while in 2007–08 this proportion was 60% and 50% respectively. Mean blood pressure (BP) was 152 ± 19/82 ± 10 mmHg in women and 150 ± 18/84 ± 10 mmHg in men in 2001–02. In 2007–08 mean BP was 143 ± 18/79 ± 10 mmHg and 142 ± 17/81 ± 11 mmHg respectively. The proportion of all patients with BP <140/90 mmHg increased from 2001–02 to 2007–08 (22% vs 41%, p < 0.001) with the gretest improvement amongst patients with comorbidities. In patients with diabetes and cardiovascular comorbidity, BP in women decreased 151 ± 21/78 ± 11 mmHg to 141 ± 19/75 ± 11 mmHg and in men from 148 ± 19/80 ± 10 mmHg to 139 ± 18/76 ± 11 mmHg and the proportion with BP <140/90 mmHg increased from 22% to 43% and from 25% to 49% respectively (all p < 0.001). Main drug classes used in 2001–02 and 2007–08 were ACEI (17% and 28%), ARB (9% and 16%), beta-blockers (48% and 41%), calcium antagonists (23% and 22%), and diuretics (34% and 42%), respectively. The mean number of drugs used to treat was 1.5 in both genders in 2001–02 and 1.7 in women and 1.8 in men in 2007–08 (p < 0.001). The mean number of drugs used to treat patients who reached BP <140/<90 mmHg was 1.5 in women and 1.6 in men in 2001–02 and 1.7 and 1.8 respectively in 2007–08 (p < 0.001).

Conclusions:

Blood pressure control in Swedish primary care has improved as did the use of ACEI and ARBS. However, the combination of several drug classes in patients with insufficient blood pressure control remains underused. There is room for further improvement.

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