We have analysed the database of 1,595 consecutive patients
visiting our department of cardiology and internal medicine clinic in
2005-2014. The analysis included 13,990 visit records and the average number of
visits per patient was 8.5 ± 7.0. Our goals were to evaluate the effectivity of
hypertension treatment as for drug choice, decrease of sBP and dBP associated
with certain drug, drug combination and therapeutic inertia in patients with
metabolic syndrome and/or diabetes mellitus. The final number of patients for
analysis who fulfilled the inclusion criteria for interpenetration of both
diagnostic circles was 570. Results: 15% of patients were treated using
hypertension monotherapy, 70% of patients were treated using 2- to 4-drug
combination therapy, and 15% of patients were treated using 5- to 6-drug
combination. The drugs usedmost frequently were perindopril (perin),
nitrendipine (nitre), amlodipine (amlo), telmisartan (telmi),
hydrochlorothiazide (hydro), rilmenidine and nebivolol (used >100 patients).
The most significant decrease of sBP was associated with treatment by nitre,
hydro, telmi and urapidil (>19 mmHg).The most significant decrease of dBP
was associated with treatment by nitre, hydro, telmi and verapamil (>10
mmHg). The most significant decrease of both sBP and dBP was associated with
treatment using 3-drug combination of telmi+hydro+spironolactone (41 and
16mmHg, respectively), telmi+hydro+nitre (34 and 15 mmHg, respectively) and
telmi+hydro+urapidil (34 and15 mmHg, respectively). At the last visit, 281 out
of 413 patients at the first visit had sBP >140 mmHg (68%) i.e. sBP control
was 32%. At the last visit 76 patients out of 217 at the first visit had dBP
>90 mmHg (35%) i.e. dBP control was 65%. Therapeutic inertia was calculated
by evaluating the proportion of visits at which sBP was above the target for eligible visits
minus the proportion of visits where the change was made in antihypertensive
treatment (AHT), either medication type or dose, over the number of eligible
visits, with the resultant value multiplied by the mean of difference between
actual sBP and target value at clinic visits: TIQ= ((%>TARGET - %Δ
AHT/visits)/visits)* mean sBP- target sBP.
TIQ was counted at first 200 consecutive patients and the average value
was 57.30 ± 147.20. Conclusion: The study presents the real-life data
concerning the difficulties in hypertension treatment in patients with
concomitant metabolic syndrome and/or 2 type diabetes mellitus. SBP was
controlled at 32% patients only. The study results allow evaluating effectivity
of hypertension treatment as for drug choice, decrease of sBP and dBP
associated with a certain drug, a drug combination, and therapeutic inertia in
patients with metabolic syndrome and/or diabetes mellitus. The score of
therapeutic inertia evaluation should contribute to the improvement of
hypertension control and should be a part of the quality assessment in
hypertension management.
Author(s) Details
Author(s) Details
Štefan Farský,
Andrea Strišková,
House of the Heart (Dom Srdca), Slovak League against Hypertension, Martin, Slovakia.
View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/178
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