High Blood Pressure Despite Treatment: Results from a Cross-sectional Primary Healthcare-based Study in Southern Sweden

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 Skåne, 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% > or = 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 BP < 140/90 mmHg, 38% had a BP > or = 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 > or = 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.