The burden of blood-pressure-related cardiovascular mortality in Mexico

This study shows that in Mexico, a country at an advanced stage in the epidemiologic transition, with the national burden of disease dominated by noncommunicable diseases, elevated blood pressure is a major clinical and public health problem. 31.7% of the Mexican individuals aged 50 and over had systolic hypertension, and 47.3% were at systolic prehypertensive levels. Also, approximately half of all cardiovascular deaths that occurred annually in the population of Mexico aged ≥50 years are attributable to above optimal levels of systolic blood pressure. We think these estimates may help order health priorities in Mexico (and other middle-income countries) at a time when the costs of medical care take a considerable share of the gross national product in most countries

Physician Perception of Blood Pressure Control and Treatment Behavior in High-Risk Hypertensive Patients: A Cross-Sectional Study

Objective: We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines. Methods: A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis. Results: Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicianś judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors. Conclusions: Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP targetFunding for this study was obtained from RECORDATI ESPAÑA, S.L through an unrestricted grant. Krista Lundelin has a ‘‘Rio Hortega’’ research training contract (Expediente CM10/00327) from the Ministry of Science and Innovation (Instituto de Salud Carlos III), Spain Governmen

Physician treatment behavior in uncontrolled hypertensive patients, and its causes.

<p>Uncontrolled hypertension: current blood pressure ≥130/80 mmHg.</p><p>Adequate control: Physician deems control to be adequate (after examining patient's current blood pressure values).</p><p>Early appointment scheduled: Patient scheduled for appointment within 2–3 weeks.</p

Sociodemographic and clinical characteristics of the study sample.

<p>CVD indicates cardiovascular disease. See Methods section for definition of risk factors.</p

Patient factors associated with physician overestimation of blood pressure control in uncontrolled hypertensive patients, from multivariate logistic analysis.

<p>Patient factors associated with physician overestimation of blood pressure control in uncontrolled hypertensive patients, from multivariate logistic analysis.</p

Frequency of main reasons for lack of change in antihypertensive treatment, stratified by previous and current blood pressure values.

<p>Not changing treatment: Physician does not change drug treatment in patient with uncontrolled hypertension.</p><p>Previous HT: Hypertension grade at visit before the study visit.</p><p>Current BP: Blood pressure at the study visit.</p

Factors associated with lack of change in treatment in uncontrolled hypertensives patients, by the main reasons asserted by physicians, from multivariate logistic analysis.

<p>Adequate control indicates that patient does not require change in antihypertensive medication because physician deems control to be adequate (after examining patient's current blood pressure values);</p><p>Early appointment scheduled: Physician does not change treatment because patient scheduled for appointment within 2–3 weeks.</p

Blood pressure control based on measurement (objective) and according to physician opinion (subjective).

<p>Blood pressure control based on measurement (objective) and according to physician opinion (subjective).</p