Impact of hypertension in cardiac diseases in Spain. The CARDIOTENS Study 1999

INTRODUCTION AND OBJECTIVES: To analyze the prevalence and control of hypertensive patients with associated cardiac diseases in Spain. METHODS: All the 32,051 outpatients seen the same day by 1,159 primary physicians (79%) and cardiologists (21%) were prospectively included in a database including history of cardiac disease (heart failure, coronary disease or atrial fibrillation), casual blood pressure and ongoing treatments. RESULTS: Hypertension was present in 33% of the whole group and 19% had both hypertension and a cardiac disease. Hypertension was present in 77% of the patients with heart failure, in 66% of those with coronary diseases and in 66% with atrial fibrillation. Less than 60% of the hypertensive patients with heart failure were treated with an angiotensin or a converting enzyme inhibitor. Thirty-two percent of the hypertensive patients with coronary disease received a betablocker and 25% of the hypertensive patients with atrial fibrillation were on oral anticoagulation. Less than 20% of the patients with hypertension and cardiac disease had blood pressure levels under 130/85 mmHg as recommended by international guidelines. Patients seen by primary care physicians were found to be slightly better treated than those under cardiologists' care. CONCLUSIONS: High blood pressure is associated with heart failure, coronary disease and atrial fibrillation in a high percentage of patients. The blood pressure levels recommended by current guidelines for cardiac hypertensives were attained in less than 20% of the cases. The control of blood pressure in these high risk hypertensive patients was low and the use of appropriate pharmacological treatment was poor.