CARDIOVASCULAR MORBIDITY AND MORTALITY AMONG HYPERTENSIVE PATIENTS INGENERAL-PRACTICE - THE EVALUATION OF LONG-TERM SYSTEMATIC MANAGEMENT

Objective: To evaluate systematic management of hypertensive patients with regard to cardiovascular morbidity and mortality. Design: In a ma tched cohort study (1978-1993) the number of cardiovascular events amo ng hypertensive patients under continuous systematic management in fou r general practices was compared with those occurring among hypertensi ve patients from eight ''usual care'' general practices. Subjects: The source population consisted of employees of a major electronic compan y in Eindhoven with hypertension as determined at an occupational heal th examination. The index group (n = 120) consisted of employees who w ere participating in the systematic management program in four practic es. A reference group of 120 patients was selected from hypertensive e mployees who were registered in eight ''usual care'' practices by matc hing for age, gender, fasting blood glucose, and frequency of occupati onal health examinations. The total cohort consisted primarily of male s (78%), whose ages ranged from 50 to 65 years. Main outcome measures: Risk difference (RD) per 1000 patient years regarding left ventricula r hypertrophy, heart failure, angina pectoris, myocardial infarction, transient ischaemic attack, stroke, peripheral arterial disease, nephr opathy, retinopathy, cardiac death, death due to stroke, and non-cardi ovascular death was determined. In addition to morbidity and mortality , systematic hypertension management was evaluated with regard to card iovascular risk factors throughout a period of maxi mally 12 successiv e years (1978-1989). Morbidity and mortality data were derived from ge neral practice records and archives; data on risk factors were assesse d at hi-annual occupational health examinations. Results: The total fo llow up duration amounted to 2628 patient years. The mean follow-up du ration in the index group was 10.8, in the reference group 11.1 years. As compared to the ''usual care'' reference group, the index group sh owed less left ventricular hypertrophy (RD 8.2, 95% CI 1.4-15.0), less angina pectoris (RD 9.1, 95% CI 2.0-11.4) and less peripheral arteria l disease (RD 3.7, 95% CI 0.5-7.1). The difference in mean decrease in blood pressure during follow-up was 11.3 mmHg systolic and 5.9 mmHg d iastolic in favour of the index group. No significant differences betw een the index and the reference groups were found with regard to the c hanges in other risk factors. Conclusion: In our study systematic mana gement of hypertensive patients aged 50 to 65 in general practice was associated with a statistically significant, and clinically relevant d ecrease in cardiovascular morbidity and blood pressure. Although causa lity cannot be determined from this non randomized cohort study, the f indings do support the view that systematic management of hypertensive patients in general practice is valuable. (C) 1991 Elsevier Science I nc.