Results of antihypertensive treatment by primary and secondary care physicians as assessed by ambulatory blood pressure monitoring

Background We present data from a cross-sectional study on consecutive non-randomized drug-treated mild-to-moderate essential hypertensives, whose blood pressure was ambulatorily monitored for 24 h to evaluate the presence of adequate control. Design Primary and secondary care physicians were invited to send to our clinic drug-treated patients with essential hypertension (JNC VI stages 1 - 2) to undergo 24-h ambulatory blood pressure monitoring (ABPM) while continuing their prescribed medications. Methods The 436 enrolled patients (255 males, 181 females, age 61 +/- 11 years) were left on their therapeutic regime: monotherapy in 208 patients (47.7%) and combination therapy in 228 patients (52.3%). All the patients were divided into two care groups: primary care, 238 patients (54.6%) and secondary care, 198 patients (45.4%). A mean daytime blood pressure less than or equal to 135/85 mmHg was chosen as a definition of adequate blood pressure control. Results Adequate blood pressure control was found in 196/436 total patients (45%); 112/238 patients in primary care (47%) and 84/198 patients in secondary care (42.4%) (P = NS); 94/208 patients (45.2%) in monotherapy and 102/228 patients (44.7%) in combination therapy (P = NS); 125/255 male patients (49%) and 71/181 female patients (39.2%) (P = 0.0428). In the logistic regression model, female sex was associated with a higher risk of inadequate blood pressure control of about 50%. Conclusions Adequate blood pressure control, as assessed by ABPM, is not different in the two settings of family doctor's office and specialist's clinic and is predicted by male gender. The figures of adequate blood pressure control remind us of the rule of halves, regardless of treatment regimes and medications. (C) 2000 Lippincott Williams & Wilkins.