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Aggressive blood pressure control in general practice (ABC-GP) study: can the new targets be reached?

Journal of Human Hypertension volume 17, pages 767–773 (2003)Cite this article

Abstract

Based on outcome trials, guidelines for hypertension management recommend lower blood pressure (BP) goals using an individualized treatment strategy (IND) and referral to a specialist of patients uncontrolled after 6 months of treatment. This study aimed to evaluate the performance of General Practitioners (GPs) in reaching the recommended BP goals using the IND, or a stepwise treatment strategy (STEP) as used in the outcome trials. Trained GPs were randomized to reach the BP goals within 6 months using the IND or a STEP strategy in untreated or treated uncontrolled hypertensives. In all, 24 GPs recruited 528 patients of whom 443 were analysed (mean age 65±9 years, 42% men, 70% treated, STEP/IND 12/12 GPs, 231/211 patients). After 6 months, 83% of the patients had reached the diastolic BP goal, whereas only 51% the systolic (P<0.0001 for difference). Factors associated with uncontrolled systolic BP were diabetes, age >60 years and triple antihypertensive therapy at baseline. A faster BP reduction was achieved during the first 3 months using the STEP strategy, but at the cost of using more drugs (combination therapy in 68/59% for STEP/IND, P=0.06). At 6 months similar rates of control were achieved with the two strategies. In conclusion, in primary care the diastolic BP goal can be reached within 6 months in the majority of patients, whereas systolic BP remains uncontrolled in 50% of the cases. The IND should be the recommended treatment strategy, but further investigation is required on the reasons for treatment failure and the optimal strategy for its improvement.

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Acknowledgements

We thank Dr Solon Solomon and Dr Irini Skeva for helping in setting the study database, Bristol Myers Squibb Greece for partial support of the study and G Leoussis SA, Athens, Greece for providing 35 Omron HEM-705CP devices and for technical support throughout the study.

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Authors and Affiliations

  1. Third University Department of Medicine, Hypertension Center, Sotiria Hospital, Athens, Greece

    G S Stergiou & V A Vassilopoulou

  2. Greek Association of General Practitioners (ELEGEIA), Greece

    A K Karotsis & A Symeonidis

Authors
  1. G S Stergiou
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  2. A K Karotsis
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  3. A Symeonidis
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  4. V A Vassilopoulou
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Corresponding author

Correspondence to G S Stergiou.

Appendix

Appendix

The ABC-GP Study Group

Christos Papathanakis (Health Center/National Health System [HC/NHS] of Orestiada, Evros); Dimitrios Petridis (HC/NHS of Echinos, Xanthi); Dimitrios Hellinas (HC/NHS of Prinos, Island of Thassos); Filitsa Piperkou (HC/NHS of Almiros, Magnessia); Ioannis Monedas (HC/NHS of Lefkimi, Island of Corfu); Alexandros Vassibossis (HC/NHS of Vlachioti, Laconia); Fani Sarigianni (HC/NHS of Velestino, Magnessia); Dimitrios Giannopoulos (HC/NHS of Agiassos, Island of Lesvos); Michael Flatsoussis (HC/NHS of Pirgi, Island of Chios); Dimitrios Kalabalikis (HC/NHS of Amphilochia, Aitoloakarnania); Theodoros Pavlidis (Social Insurance Fund, Policliniki, Stavroupolis, Kavala); Ioannis Abouzolof (General Practice of Velo, Corinthia); Antonios Batikas (HC/NHS of Perama, Rethymno, Island of Crete); Dimitra Karathanassi (HC/NHS of Varda, Achaia); Andreas Chatzialexandrou (HC/NHS of Kato Achaia, Achaia); Dimitrios Michalis (HC/NHS of Aliartos, Boeotia); Nikolaos Razis (HC/NHS of Calavrita, Achaia); Chariklia Androutsopoulou (HC/NHS of Iasmos, Rhodopi); Ioannis Dacoronias (HC/NHS of Karystos, Island of Euboea); Pavlos Nastas (HC/NHS of Thessprotiko, Thessprotia); Marios Chatziarsenis (HC/NHS of Neapolis, Island of Crete); Thomas Agelopoulos (HC/NHS of Prinos, Island of Thassos); Maria Panagopoulou (HC/NHS of Neapolis, Island of Crete); Panagiotis Raftopoulos (HC/NHS of Iasmos, Rhodopi).

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Stergiou, G., Karotsis, A., Symeonidis, A. et al. Aggressive blood pressure control in general practice (ABC-GP) study: can the new targets be reached?. J Hum Hypertens 17, 767–773 (2003). https://doi.org/10.1038/sj.jhh.1001610

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