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(Hypertension. 2004;43:1338.)
© 2004 American Heart Association, Inc.

Scientific Contributions

Blood Pressure Control and Physician Management of Hypertension in Hospital Hypertension Units in Spain

José R. Banegas; Julián Segura; Luis M. Ruilope; Manuel Luque; Rafael García-Robles; Carlos Campo; Fernando Rodríguez-Artalejo; Juan Tamargo on behalf of the CLUE Study Group Investigators

From the Department of Preventive Medicine and Public Health (J.R.B., F.R.-A.), School of Medicine, Universidad Autónoma de Madrid, Spain; Hypertension Unit (J.S., L.M.R., C.C.), Hospital Doce de Octubre, Madrid, Spain; Hypertension Unit (M.L.), Hospital San Carlos, Madrid, Spain; Hipertensión Unit (R.G.-R.), Hospital Ramón y Cajal, Madrid, Spain; Pharmacology Department (J.T.), School of Medicine, Universidad Complutense, Madrid, Spain.

Correspondence to Dr Luis M. Ruilope, Unidad de Hipertensión, Hospital 12 de Octubre, Ctra Andalucía km 5400 Madrid, Spain. E-mail ruilope{at}ad-hocbox.com

Goal blood pressure (BP) was defined by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) and the World Health Organization–International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. However, there are few reports that address BP control among special subgroups of hypertensives by reference to targeted BP. We therefore conducted a study to evaluate BP control of 4049 hypertensives in 47 hospital-based hypertension units in Spain. Overall, 42% of patients achieved goal BP (<140 mm Hg systolic and <90 mm Hg diastolic). Only 13% of diabetic patients and 17% of those with renal disease achieved the BP goal (<130 mm Hg systolic and <85 mm Hg diastolic), and only 10% and 12%, respectively, achieved the even more rigorous goal (<130 mm Hg systolic and <80 mm Hg diastolic). Likewise, only 18% of patients in JNC-VI risk group C and 17% of WHO/ISH high-risk patients attained a goal BP <130 mm Hg systolic and <85 mm Hg diastolic. BP control (<125 mm Hg systolic and <75 mm Hg diastolic) was extremely low (2%) in patients with proteinuria >1 g/d. Poorer BP control was observed among patients at high risk, with diabetes, renal disease, or obesity, than in lower-risk groups. BP control was lower for systolic than for diastolic BP. In >50% of uncontrolled patients, no measures were taken by doctors to optimize pharmacologic treatment, and approximately one-third of patients were still using drug monotherapy. Control of BP, particularly of systolic BP, is still far from optimal in hospital-based hypertension units. Patients at high risk, with diabetes or proteinuria, warrant focused attention. Moreover, a more aggressive behavior of doctors treating uncontrolled hypertension is needed.

Key Words: blood pressure • arterial hypertension • cardiovascular diseases • arterial pressure

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