High blood pressure despite treatment: Results from a cross-sectional primary healthcare-based study in southern Sweden

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Abstract
Objective. To study degree of blood pressure (BP) control in primary healthcare (PHC) treated hypertensive patients in relation to sex, age, drug treatment, and concomitant diseases. Design. Random sample of patients with hypertension. Setting. Ten PHC centres in the Region of Skane, Sweden. Subjects. All the 30- to 95-year-old patients with hypertension who during the period 12 September to 24 September 2004 attended their PHC (146 men and 229 women). Main outcome measures. Achievement of BP control (< 140/90 mmHg) according to European guidelines. Results. Some 90% had been treated > 12 months, 40% had mono-therapy, 15% >= 3 drugs. Use of diuretics was more common in women while use of ACE inhibitors and calcium channel blockers was common in men. Inadequate BP control was related to age; only 22% had BPB < 140/90 mmHg, 38% had a BP >= 160/100 mmHg. BP decline was inversely related to BP measured 12 months or more prior to the present follow-up (r = -0.64, p < 0.001, for systolic and r = -0.67, p < 0.001, for diastolic BP). The systolic or diastolic BP had in every fifth patient during treatment increased by >= 10 mmHg. No association was found between average BP decline and prescribed number of drugs. Conclusion. A minority of the patients had BP below the level (< 140/90 mmHg) recommended by European guidelines. This study illustrates the need for continued follow-up of defined groups of patients in order to improve quality of care