Managing hypertension in general practice: can we do better?

Two surveys of hypertension treatment in Europe have revealed major differences between doctor perception, patient belief and the reality of BP control. The first survey (part of the Cardiomonitor Study) investigated 23,339 cardiovascular patients treated by 1471 doctors in Italy, Spain, France, the UK and Germany. The second survey researched attitudes to treatment among 301 general practitioners and 300 patients in Italy, France and the UK. Cardiomonitor revealed that hypertension was poorly controlled, with only 37% of patients achieving target BP. In contrast, the second survey revealed that doctors believed that target BP was reached in the majority (76%) of their treated patients with hypertension, while an even higher percentage of patients (95%) believed their BP to be well controlled. There were significant discrepancies in the perceived reasons for treatment failure between doctors and patients. Most doctors considered poor compliance with therapy to be the main reason for failure to achieve target BP. In contrast, most patients reported good compliance, blaming poor efficacy or side-effects for treatment failure. Objective studies suggest that compliance is lower than patients report and can be reduced by factors that affect quality of life, such as side-effects of treatment, complex dosing regimens, changes in therapy and concern about poorly controlled disease. This argues for effective, well-tolerated antihypertensive drugs that can be taken once daily, enabling quality of life to be maintained throughout treatment.