Hypertension in high-risk patients: beware of the underuse of effective combination therapy (results of the PRATIK study)

Objective To determine whether blood pressure control in a general practice setting is influenced by the presence of additional risk factors, and to analyse the role of antihypertensive therapy in this relationship. Design A cross-sectional study was conducted with a sample of 3153 general practitioners. Setting Primary care. Participants The first five hypertensive patients presenting at the practitioner's office were included. Main outcome measures Cardiovascular risk factors, antihypertensive drugs and cardiovascular history were reported. Blood pressure was measured. The analysis was conducted in treated patients who were divided in three groups: no other risk factors (group I); 1–2 risk factors (group II); 3 or more risk factors or target-organ damage or diabetes or associated cardiovascular disease (group III). Results Data were available for all variables in the 14 066 treated hypertensive individuals who form the basis of this report. Blood pressure control had been achieved in a lower percentage of individuals in group III (27%) than in group I (42.9%). To control hypertension, combination therapies were more frequently required in group III (55.8%) than in group II (43.5%) or group I (34.2%). Among individuals with uncontrolled hypertension, about 39% of patients in group III were receiving monotherapy and the percentage receiving two-drug treatments identified as effective in the 1999 WHO guidelines was significantly lower in group III. Conclusion The study shows that, in general practice, control of blood pressure decreases as the number of risk factors present increases. An underuse of combination therapy, especially effective two-drug treatment in patients with several risk factors, may account for this finding.