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Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia
BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic s...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330736/ https://www.ncbi.nlm.nih.gov/pubmed/30642264 http://dx.doi.org/10.1186/s12875-019-0902-2 |
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author | Jurić, Diana Pavličević, Ivančica Marušić, Ana Malički, Mario Buljan, Ivan Šarotić, Velen Mrduljaš-Đujić, Nataša Komparak, Ante Vujević, Miona De Micheli-Vitturi, Danijela Šušnjar, Pjera Puljiz, Tina Jerčić, Minka Leskur, Dario Marušić, Matko |
author_facet | Jurić, Diana Pavličević, Ivančica Marušić, Ana Malički, Mario Buljan, Ivan Šarotić, Velen Mrduljaš-Đujić, Nataša Komparak, Ante Vujević, Miona De Micheli-Vitturi, Danijela Šušnjar, Pjera Puljiz, Tina Jerčić, Minka Leskur, Dario Marušić, Matko |
author_sort | Jurić, Diana |
collection | PubMed |
description | BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95–0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5–201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-019-0902-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6330736 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63307362019-01-16 Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia Jurić, Diana Pavličević, Ivančica Marušić, Ana Malički, Mario Buljan, Ivan Šarotić, Velen Mrduljaš-Đujić, Nataša Komparak, Ante Vujević, Miona De Micheli-Vitturi, Danijela Šušnjar, Pjera Puljiz, Tina Jerčić, Minka Leskur, Dario Marušić, Matko BMC Fam Pract Research Article BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95–0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5–201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-019-0902-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-14 /pmc/articles/PMC6330736/ /pubmed/30642264 http://dx.doi.org/10.1186/s12875-019-0902-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Jurić, Diana Pavličević, Ivančica Marušić, Ana Malički, Mario Buljan, Ivan Šarotić, Velen Mrduljaš-Đujić, Nataša Komparak, Ante Vujević, Miona De Micheli-Vitturi, Danijela Šušnjar, Pjera Puljiz, Tina Jerčić, Minka Leskur, Dario Marušić, Matko Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title | Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title_full | Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title_fullStr | Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title_full_unstemmed | Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title_short | Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia |
title_sort | effectiveness of treatment of newly diagnosed hypertension in family medicine practices in south croatia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330736/ https://www.ncbi.nlm.nih.gov/pubmed/30642264 http://dx.doi.org/10.1186/s12875-019-0902-2 |
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