Archief Roodbont

Hypertension better controlled in USA than Europe

24 January 2007

Study findings published in the Archives of Internal Medicine suggest that hypertension is treated more effectively in the USA than in Europe.

The study showed that US patients were started on treatment at lower blood pressure (BP) levels, and were more likely to receive intensive treatment and have their BP under control than their European counterparts.

Speaking to MedWire News, study co-author Caleb Alexander (University of Chicago, Illinois, USA) said the findings do probably reflect differences between US and European guidelines, but also emphasized the potential role of “differences in healthcare financing, coverage, and delivery across the countries examined.”

To investigate why BP levels tend to be lower in US than in European populations, the researchers studied data from a clinic-based survey of 21,053 patients who visited 1284 primary care physicians and 291 cardiologists in the USA, Spain, Germany, France, Italy, and the UK.

The results indicated that US physicians initiate treatment at lower BP levels than their European peers, with patients’ average pre-treatment levels at 161/94 mmHg in the USA compared with 167-173/96-99 mmHg in European countries.

Systolic and diastolic BP levels were 5.3-10.2 mmHg and 1.9-5.3 mmHg lower, respectively, in US patients than in patients from European countries.

In addition, adequate BP control was seen more frequently in US than in European patients, with 63% of US patients at 140/90 mmHg or below compared with 31% in Italy, 36% in the UK, 40% in Spain and Germany, and 46% in France.

Furthermore, US patients with poorly controlled hypertension were more likely to have a change or increase in their medication than European patients, at 32% versus 14-26%.

With the exception of thiazides, which were prescribed consistently across groups, there were considerable cross-national variations in the classes of drug used, but these variations and resultant cost differences did not seem to affect BP control.

Interestingly, use of more than one antihypertensive agent – known to be more effective than simply escalating the dose of the first agent to improve control – was also most frequent in the USA, at 64% compared with 44-59% across European countries.

Alexander emphasized that the disparity found in the study is not the most important issue, and that there is an epidemic of untreated hypertension in all of these countries. Furthermore, he noted that diet and exercise remain the first important steps before pharmacologic therapy is initiated.

“Our study should be a call to action for all physicians to more aggressively identify and treat patients with high blood pressure who have failed non-pharmacologic therapy,” he said.

Arch Intern Med 2007: 167: 141-147