Characteristics of uncontrolled and resistant hypertensive patients treated by general practitioners and cardiologists in Poland - Polfokus study

Purpose: The aim of the Pol-Fokus study was to evaluate factors related to uncontrolled and resistant hypertension (HT) in a large sample of treated hypertensive subjects. Methods: In the cross-sectional questionnaire-based observational study we included 12436 patients (mean age 64,0±12,3 years; range 18-98 years; 59% F, 41% M, diabetes 22,3%, coronary artery disease 44,2%) attending to general practitioner (GP) or cardiologist. To be included patients had to be ≥ 18 years old and treated for at least 12 months with antihypertensive drugs. Blood pressure (BP) was measured twice in a seated position and mean value was calculated. We defined HT control as BP both 102 cm in M and > 88 cm in F), eGFR (acc. to MDRD formula) and LDL cholesterol (well controlled: LDL < 2,5 mmol/L in patients with DM or known cardiovascular disease and <3,0 mmol/L in the remaining patients). Results: Among studied patients 5857 had controlled HT (47,3%), 3458 uncontrolled (27,9%) and 3060 RHT (24,7%). There were no differences in gender distribution across the groups. The frequency of uncontrolled HT and RHT differed across the age groups: 65 years (25,4%; 28,1%; p<0,001) and among patients attending cardiologist (23,4%; 29,8%) or GPs (29,6%; 22,8%; p<0,001). Patients with RHT were characterized by higher frequency of abdominal obesity as compared with the controlled and uncontrolled HT patients. Patients with eGFR <60 ml/min/1,73m2 were characterized by higher frequency of RHT (31,9%) as compared with patients with eGFR 60-89 and ≥90 (25,1% and 20,8%) respectively. Among patients treated with statin the frequency of LDL cholesterol control was lower in patients with RHT and uncontrolled HT as compared with controlled ones (36,3% and 35,4% vs. 49,2%; p<0,001). Patients with diabetes, coronary artery disease and cerebrovascular disease were characterized by higher frequency of RHT as compared to patients without these disease (32,5% vs. 22,6%; p<0,001, 31,5% vs. 19,7%; p<0,001; 33,3% vs. 23,6%; p<0,001). Conclusion: Our results showed that 28% and 25% of HT patients treated for at least one year had uncontrolled HT and RHT, respectively. Both groups were characterized by higher cardiovascular risk, which was most pronounced in RHT.