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 blo od 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 cl inic drug-treated patients with essential hypertension (JNC VI stages 1 - 2 ) to undergo 24-h ambulatory blood pressure monitoring (ABPM) while continu ing their prescribed medications. Methods The 436 enrolled patients (255 males, 181 females, age 61 +/- 11 ye ars) 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 secon dary 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 secon dary 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 reg ression model, female sex was associated with a higher risk of inadequate b lood pressure control of about 50%. Conclusions Adequate blood pressure control, as assessed by ABPM, is not di fferent in the two settings of family doctor's office and specialist's clin ic and is predicted by male gender. The figures of adequate blood pressure control remind us of the rule of halves, regardless of treatment regimes an d medications. (C) 2000 Lippincott Williams & Wilkins.