{'fraction_non_alphanumeric': 0.03695976154992549, 'fraction_numerical': 0.030402384500745158, 'mean_word_length': 5.014336917562724, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Hypertension management in primary care in Iceland

High blood pressure is a well-established risk factor of cardiovascular (CV) and renal disease (1), and is among the most preventable causes of death (2). Despite the fact that today we have a broad selection of potent antihypertensive drugs to treat hypertension and several guidelines have been published to optimize blood pressure control (3 5), studies repeatedly show that many hypertensive patients are not receiving adequate treatment (6,7). The aim of this study was to assess how hypertensive patients are being managed in primary care in Iceland, to determine the proportion of patients reaching blood pressure targets and how different drugs were being utilized, and, in addition, to shed some light on the overall CV risk among these patients. Medical records of all hypertensive patients at the primary healthcare centre of Solvangur Hafnarfjordur, providing services for 23 066 inhabitants, were evaluated. A total of 982 patients had been diagnosed with hypertension. The mean systolic blood pressure was 145 (16 SD) mmHg, and the mean diastolic blood pressure was 86 (9 SD) mmHg. Only 27% of the hypertensive patients had documented blood pressure below the guideline target of 140/90 mmHg. More women than men had blood pressure controlled: 35% vs 28% for systolic blood pressure (p / 0.04) and 66% vs 50% for diastolic blood pressure (pB/0.001). More patients had systolic blood pressure uncontrolled than diastolic: 47% vs 20%. Blood tests had been obtained for 78% of the patients, of which 47% had a cholesterol value above 6.0 mm/l and 11% had blood glucose levels above 6.4 mmol/l. Electrocardiogram had been recorded for 628 (64%) patients. Smoking history had only sporadically been recorded, and information on body mass index (BMI, kg/m) was only recorded for 12% of these patients. During the years 2002 and 2003, 75% of the patients received drug treatment for hypertension, with 39% on monotherapy, 36% on two drugs, and 25% taking three or more drugs. The most commonly used agents were beta-blockers and diuretics, with 29% of patients on monotherapy taking beta-blockers and 27% diuretics. At least half of the patients have confirmed coronary heart disease (CHD), diabetes or hypercholesterolaemia. This study shows that, among hypertensive patients treated in general practice in Iceland, only 27% achieve the blood pressure targets set out by recently published clinical guidelines, i.e. below 140/ 90 mmHg (4,5). Relatively high proportions of these hypertensive patients have high blood glucose levels, at least 11% of them having diabetes by definition. Hypercholesterolaemia was also common, with nearly 50% of the hypertensives studied having serum cholesterol levels above 6.0 mmol/l. This group of hypertensive patients is a high-risk group, with over half with a documented CHD, diabetes or other risk factors. However, drug utilization, with beta-blockers and diuretics being the most commonly used drugs, is in accordance with most guidelines, although too many are on monotherapy given the inadequate blood pressure control and overall high cardiovascular risk. Numerous studies have demonstrated poor hypertensive control among patients with documented hypertension. In a survey carried out in England, the prevalence of hypertension was 37% among adults,