gms | German Medical Science

The Hypertension and Diabetes Screening and Awareness (HYDRA) study is a cross-sectional point prevalence study involving 45,125 primary care attendees, who were recruited from a representative nationwide sample of 1,912 primary care practices in Germany.

Around 42 % of all patients presenting in these practices had hypertension (WHO-definition). In approx. 70 % of these patients hypertension (HT) was diagnosed, and 84 % of diagnosed patients were on antihypertensive medication, but in less than 30 % of treated patients blood pressure (BP) was controlled (<140/90 mmHg). The control rate in all patients presenting with HT (including those patients not diagnosed) was as low as 19 %. The present analysis aimed to find explanations for this unsatisfactory outcome of HT control. The main findings were:

a) The rate of diagnosis of HT is alarmingly low in young people: 80% of young men and 73% of young women aged 16 to 29 years were not diagnosed. In the age group ranging from 30 to 44 years, 60% of hypertensive patients were unrecognised. This poor outcome may be explained with an insufficient number of BP screenings in young people.

b) Doctors apparently still set their target of treatment according to outdated guidelines recommending a higher target BP (e.g.160/95 mmHg [JNC III]). In fact, 52% of treated patients presenting with uncontrolled HT were rated by their doctors as "well treated", and in 68% of these patients, doctors did not decide for an adjustment of treatment. Both phenomena were more frequently observed in older patients and in patients with only the systolic pressure being elevated, the latter speaking for the fact, that

c) apparently, doctors still orientate their treatment primarily with regard to the diastolic pressure.

These insights into the causes of unsatisfactory HT control may help to direct future educational programs designed to improve HT management specifically to these deficits and thereby to improve control rates.