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Outpatient Hypertension Treatment, Treatment Intensification, and Control in Western Europe and the United States
Y. Richard Wang, MD, PhD;
G. Caleb Alexander, MD, MS;
Randall S. Stafford, MD, PhD
Arch Intern Med. 2007;167(2):141-147.
Background Hypertension guidelines in the United States tend to have more aggressive treatment recommendations than those in European countries.
Methods To explore international differences in hypertension treatment, treatment intensification, and hypertension control in western Europe and the United States, we conducted cross-sectional analyses of the nationally representative CardioMonitor 2004 survey, which included 21 053 hypertensive patients visiting 291 cardiologists and 1284 primary care physicians in 5 western European countries and the United States. The main outcome measures were latest systolic and diastolic blood pressure (BP) levels, hypertension control (latest BP level, <140/90 mm Hg), and medication increase (dose escalation or an addition to or switch of drug therapy) for inadequately controlled hypertension.
Results At least 92% of patients in each country received antihypertensive drug treatment. The initial pretreatment BP levels were lowest and the use of combination drug therapy ( 2 antihypertensive drug classes) was highest in the United States. Multivariate analyses controlling for age, sex, current smoking, and physician specialty indicated that, compared with US patients, European patients had higher latest systolic BP levels (by 5.3-10.2 mm Hg across countries examined) and diastolic BP levels (by 1.9-5.3 mm Hg), a smaller likelihood of hypertension control (odds ratios, 0.27-0.50), and a smaller likelihood of medication increase for inadequately controlled hypertension (odds ratios, 0.29-0.65) (all P<.001). In addition, controlling for initial pretreatment BP level attenuated the differences in latest systolic and diastolic BP levels and the likelihood of hypertension control.
Conclusion Lower treatment thresholds and more intensive treatment contribute to better hypertension control in the United States compared with the western European countries studied.
Author Affiliations: Department of Medicine, Temple University Hospital (Dr Wang), and Leonard David Institute of Health Economics, University of Pennsylvania (Dr Wang), Philadelphia; Robert Wood Johnson Clinical Scholars Program, and MacLean Center for Clinical Medical Ethics, The University of Chicago, Department of Internal Medicine, The University of Chicago Hospitals, and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago (Dr Alexander); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Stanford, Calif (Dr Stafford).
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