Lack of treatment continuance: An obstacle for controlling blood pressure

Introduction: Blood pressure is one of the most prevalent risk factors for CVD. Despite the large arsenal of medications, the rate of BP control is not optimal. We studied the amount of attention family physicians pay to BP readings and treatment recommendations of hypertensive patients that were discharged from the hospital. Methods: We included 98 consecutive hypertensive patients (mean age 68.51.1, 44% males) admitted to the hospital. Excluded were patients referred to the hospital from a nursing home. BP measurements were obtained at ER, admission to the ward, 2nd day of admission and day of discharge. Recommended treatment was obtained from the discharge letter. A phone call was made to each patient, 4-8 weeks after discharge, and data was obtained regarding recent BP levels and the current treatment. Results: BP control was achieved in 48% of the patients at hospital discharge and 47% at follow-up. Among patients that received different treatment at follow-up because of the physician's advice or because they were considered to have a high BP (24 patients), BP control was reduced from 63% at discharge to 50% at follow-up. This reduction was attributed to decreased dosage of medications and to the replacement of medications with drugs from the same group, but given at non-equivalent doses. Ten patients that were controlled at discharge but not at follow-up were given fewer medications than recommended (2.7 vs. 3.2). Among the non-controlled patients with BP > 140/90 at follow-up, treatment was not changed for 48%. Conclusion: The blood pressure treatment guidelines are not implemented, and the data regarding BP control that appears in the discharge letter is not adequately used by the family physicians. A better relationship between hospitals and family practice should be obtained to aid in controlling BP.