Outcomes/Effectiveness Research

More intensive treatment contributes to better hypertension control in the United States compared with western Europe

Hypertension is widely underdiagnosed and undertreated in Europe and the United States. However, U.S. hypertension guidelines tend to have more aggressive treatment recommendations than those in European countries. Based on the nationally representative CardioMonitor survey of hypertensive outpatient visits in 2004, latest blood pressure (BP) levels were lower and hypertension control was better in the United States than in five western European countries studied. Lower treatment thresholds (U.S. doctors tend to start medication at lower BP levels) and more intensive treatment contribute to better hypertension control in the United States.

The survey included 21,053 hypertensive patients visiting 291 cardiologists and 1,284 primary care physicians in 5 western European countries and the United States. The main outcome measures were latest systolic and diastolic blood pressure levels, hypertension control (latest BP level of less than 140/90 mm Hg), and medication intensification (dose escalation of a drug, addition of a second drug, or change of drug therapy) for inadequately controlled hypertension. At least 92 percent of patients in each country received antihypertensive drug treatment.

The initial pretreatment BP levels were lowest and use of combination drug therapy (two or more antihypertensive drug classes) was highest in the United States. After controlling for other factors, European patients had 5.3 to 10.2 mm Hg higher latest systolic BP levels and 1.9 to 5.3 mm Hg higher diastolic BP levels, 50 to 73 percent smaller likelihood of hypertension control, and a 35 to 71 percent smaller likelihood of medication increase for inadequately controlled hypertension. The study was supported in part by the Agency for Healthcare Research and Quality (HS11313).

See "Outpatient hypertension treatment, treatment intensification, and control in western Europe and the United States," by Y. Richard Wang, M.D., Ph.D., G. Caleb Alexander, M.D., M.S., and Randall S. Stafford, M.D., Ph.D., in the January 22, 2007, Archives of Internal Medicine 167, pp. 141-147.

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