General Practitioners’ vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension – a cross-sectional database study

BMC Cardiovascular Disorders

Damian N. Meli²  Oliver Senn¹  Sima Djalali¹  André Busato¹  Vladimir Kaplan³  Sven Streit² 

[1] Institute of General Practice, University of Zurich, University Hospital Zurich, Zurich, Switzerland;Institute of Primary Health Care BIHAM, University of Bern, Gesellschaftsstrasse 49, Bern, 3012, Switzerland;District Hospital Freiamt Muri, Muri, Switzerland

关键词: Primary care;    Blood pressure control;    Anticoagulant agents;   

Others  :  1211951
DOI  :  10.1186/s12872-015-0053-x

 received in 2015-02-09, accepted in 2015-06-01,  发布年份 2015

【 摘 要 】

Background

Patients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension.

Methods

We cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥6 months. We compared patients with VKA for ≥3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity.

Results

We identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9 %) were on Phenprocoumon (VKA) and 3,843 (87.1 %) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of −8.4 mm Hg (95 % CI −9.8 to −7.0 mm Hg) and −1.5 mm Hg (95 % CI −2.3 to −0.7 mm Hg), respectively (p < 0.001 for both).

Conclusions

In a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.

【 授权许可】

   
2015 Streit et al.

【 图 表 】

Fig. 1.

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