Blood Pressure Control in Real Clinical Practice: Essential and Renoparenchymal Arterial Hypertension

We compared blood pressure (BP) control in Ukrainian population with renoparenchymal(RAH) and essential arterial hypertension(AH) and defined the factors associated with failed BP control.

9259 hypertensive patients were included in 3-month multicentre open trial. All patients were divided in 2 groups: 1^st–2197(23.7%) with RAH; 2^nd –7062(76.3%) with essential AH. Patients were treated by primary care physicians. On 4 visits were done: office BP measurements, ECG, patient’s compliance and cardiovascular risk evaluations, inquiring by author’s questionnaire. Multifactor regression analysis was used for evaluation of antihypertensive treatment failure predictors.

Patients with RAH had more complications, concomitant diseases, risk factors and target organ damage. The target BP was achieved in 53.9% patients of 1^st group and in 60.7%(p<0.001) of 2^nd. The mean quantity of drugs and combination therapy rate were more in 1^st group–2.2±0.02vs2.04±0.01(p<0.001) and 64vs57.1%(p<0.001). Baseline only 20.1% and 23.5% in 1^st and 2^nd groups(p<0.001) had high compliance. We noted improvement in patient`s compliance in both groups on treatment, but more rate of low complained patients was in 1^st group, than in 2^nd at the end. In both groups poor BP control was associated with baseline SBP and DBP. Higher patient compliance at the end(but not baseline) and fruit/vegetable consumption decreased the chance of failed BP control in both groups. In patients with RAH age and quantity of antihypertensive drugs were associated with poor BP control, while additional physical activity- with success in treatment. History of HF and MI increased and high education level of patients/“working” status decreased the chance of poor BP control only in 2^nd group.

Patients with RAH had more complications and needed more aggressive BP management with other risk factor corrections. We need to use defined common and different factors associated with poor BP control for more effective antihypertensive treatment of patients with different etiology of hypertension.