An observational study of the medical events associated with clinician-initiated changes in treatment for essential hypertension

We report a retrospective longitudinal observational study of co-morbidities and medical events associated with initiations and changes in antihypertensive therapy in 475 hypertensive patients of a large general practice. The median follow-up time was 7.0 years for males and 7.2 years for females. The data showed a low frequency of appropriate lifestyle recommendations (<30%), a gender-bias in lifestyle recommendations against women and that more than half of all patients' blood pressure (BP) was uncontrolled when last seen. Nearly half of all patients had co-morbidities relevant to essential hypertension (EHT) at first treatment for EHT and more than 11% of patients had more than one such co-morbidity. Whilst there was an increase in usage of ACE inhibitors and calcium channel blockers (CCB) as first treatment for EHT, there was also evidence that the existence of relevant co-morbidities rationally accounted for the majority of that increase. There were 5176 medical events relevant to EHT associated with change of drug or dosage treatment of EHT and the study provided evidence that the occurrence of such relevant medical events can rationally account for the majority of changes to EHT treatment. The study suggests that whilst general practitioners may fail to promote lifestyle changes to their patients with EHT, there is evidence that, when examined in sufficient detail, general practitioners' decisions to initiate changes in antihypertensive therapy are in keeping with the evidence base

Prevalence of peripheral arterial disease: persistence of excess risk in former smokers

Objective: To determine the age-standardised prevalence of peripheral arterial disease (PAD) and associated risk factors, particularly smoking. Method: Design: Cross-sectional survey of a randomly selected population. Setting: Metropolitan area of Perth, Western Australia. Participants: Men aged between 65-83 years. Results: The adjusted response fraction was 77.2%. Of 4,470 men assessed, 744 were identified as having PAD by the Edinburgh Claudication Questionnaire and/or the ankle-brachial index of systolic blood pressure, yielding an age-standardised prevalence of PAD of 15.6% (95% confidence intervals (CI): 14.5%, 16.6%). The main risk factors identified in univariate analyses were increasing age, smoking current (OR=3.9, 95% CI 2.9-5.1) or former (OR=2.0, 95% CI 1.6-2.4), physical inactivity (OR=1.4, 95% CI 1.2-1.7), a history of angina (OR=2.2, 95% CI 1.8-2.7) and diabetes mellitus (OR=2.1, 95% CI 1.7-2.6). The multivariate analysis showed that the highest relative risk associated with PAD was current smoking of 25 or more cigarettes daily (OR=7.3, 95% CI 4.2-12.8). In this population, 32% of PAD was attributable to current smoking and a further 40% was attributable to past smoking by men who did not smoke currently. Conclusions: This large observational study shows that PAD is relatively common in older, urban Australian men. In contrast with its relationship to coronary disease and stroke, previous smoking appears to have a long legacy of increased risk of PAD. Implications: This research emphasises the importance of smoking as a preventable cause of PAD