Hypertension is a chronic condition characterized by high blood pressure. It represents one of the main risk factors leading to cardiovascular diseases such as heart attack or cerebral stroke. In patients diagnosed with hypertension, guidelines recommend lifestyle changes and antihypertensive treatments to prevent these diseases. The objectives of these medications are to reduce blood pressure to recommended targets and to maintain it over time. Hypertension therapy usually begins with one drug, and it is recommended to increase the dose of the initial drug or to add another drug if blood pressure targets are not reached or maintained. Therefore, in clinical practice, blood pressure should be frequently monitored and several drugs can be prescribed over time to lower it. However, despite the availability of a broad range of treatments, a large proportion of adults with hypertension is not at the required level of blood pressure as shown in a study performed in England in 2017 in which 33% of adults aged 45 and over on treatment for hypertension were not at the recommended targets for blood pressure.
The overall objective of this study is to describe the course and management of blood pressure in treated hypertensive patients in the UK. Particularly for those patients with blood pressure not at the recommended target, the period during which they remain with high/uncontrolled blood pressure and changes in the antihypertensive treatment will be studied.
These findings will provide valuable information for understanding how high blood pressure is managed over time in treated hypertensive patients.
Hypertension is defined by a systolic blood pressure (SBP) of 140 mmHg or higher, or a diastolic blood pressure (DBP) of 90 mmHg or higher. It is the leading risk factor for cardiovascular diseases and patients diagnosed as hypertensive can be treated with antihypertensive medications to lower their blood pressure and prevent the onset of such diseases. Globally, guidelines for the management of hypertension such as the NICE (National Institute for Health and Clinical Excellence) guidelines of 2011 or the European Society of Cardiology (ESC) guidelines of 2013 recommend SBP and DBP targets below 140 mmHg and 90 mmHg in adults, as well as SBP and DBP targets below 150 mmHg and 90 mmHg in the elderly. Despite these recommendations and a large therapeutic armamentarium, 33% of the treated hypertensive population aged 45 and over remained uncontrolled in England in 2017 according to the Health Survey for England. Even though annual prevalence of hypertensive control are available, there is a lack of recent information regarding the management of high blood pressure, or the course of the BP values and treatment changes particularly when not restricted to new hypertensive patients.
The overall objective of this study is to describe the course and management of blood pressure over time in treated hypertensive patients in primary care. Uncontrolled BP in adult patients with a diagnosis of hypertension and at least one prescription of an antihypertensive drug between 2016 and 2017 will be quantified. The description of the management of uncontrolled BP will mainly be based on therapeutic inertia and the time needed to reach blood pressure control. Several subpopulations will be described according to the prior use (or not) of antihypertensive medications and/or their blood pressure control status at index date.
Uncontrolled blood pressure; Time to blood pressure control; Therapeutic inertia; BP values; GP consultations; BP records
CELINE DARRICARRERE - Chief Investigator - IRIS - Institut de Recherches Internationales Servier
CELINE DARRICARRERE - Corresponding Applicant - IRIS - Institut de Recherches Internationales Servier
Caroline Louis - Collaborator - IRIS - Institut de Recherches Internationales Servier
Emmanuelle Jacquot - Collaborator - IRIS - Institut de Recherches Internationales Servier
Marc Bénard - Collaborator - AIXIAL
Pauline Macouillard - Collaborator - IT&M Stats
Siham Eltaief - Collaborator - IT&M Stats
Stéphanie HENNEL - Collaborator - IRIS - Institut de Recherches Internationales Servier