Journal Article

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

Djalali, Sima, Senn, Oliver, Streit, Sven, Meli, Damian N., Kaplan, Vladimir, Busato, André

2015

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd
• Subject: Aged / Analysis / Angiology / Anticoagulants - therapeutic use / Antihypertensive Agents - therapeutic use / Blood pressure / Blood Transfusion Medicine / Cardiac Surgery / Cardiology / Cross-Sectional Studies / Databases, Factual / Diet therapy / Electronic Health Records / Female / Health aspects / Humans / Hypertension / Hypertension - drug therapy / Hypertension and Cardiovascular Risk / Internal Medicine / International Normalized Ratio / Male / Medication Adherence / Medicine / Medicine & Public Health / Monitoring, Physiologic / Physicians (General practice) / Primary Health Care / Research Article / Risk Factors / Vitamin K - antagonists & inhibitors