May Measurement Month 2017: an analysis of blood pressure screening results in Austria-Europe.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension (HTN), and statistical analysis followed the standard MMM protocol. In total, 2711 individuals (58.6% female) were screened during MMM17 in 56 centres. After multiple imputation, 1704 (62.9%) had HTN (≥140/90 mmHg). Of individuals not receiving antihypertensive medication, 764 (43.2%) were hypertensive. Of individuals receiving antihypertensive medication, 597 (63.5%) had uncontrolled BP. MMM17 was one of the largest BP screening campaigns undertaken in Austria. A large number of undiagnosed hypertensives was found and connected to a therapeutic strategy. An alarming number of uncontrolled but treated hypertensives should attract the attention of doctors and health care system in Austria.

Pharmacist interventions to improve blood pressure control in primary care: a cluster randomised trial.

BACKGROUND: High blood pressure (BP) is the single largest contributor to mortality world-wide. AIM: To investigate the effectiveness of a pharmacists-led intervention to improve BP control using automated office blood pressure (AOBP). METHOD: In this prospective parallel group, unblinded, cluster-randomised trial, 54 pharmacies enrolled pre-treated patients with uncontrolled AOBP above 135/85 mmHg. In the interventional group, pharmacists referred patients to the treating physician for therapy intensification in a structured fashion. In the control group, AOBP was recorded until the end of the trial. The primary endpoint was the proportion of patients achieving BP control at the threshold of 135/85 mmHg after 10 weeks. Key secondary endpoints were systolic AOBP reductions after 10 and 20 weeks. RESULTS: A total of 497 patients were included between 2017 and 2019. In the interventional and control group, 61.5% and 19.8% of patients underwent a therapy modification within 20 weeks. The primary endpoint was achieved in 38.8% in the interventional group and 31.2% in the control group (mean difference 7.6%, 95% CI -8.1; 23.3, p = 0.336). Mean systolic AOBP reductions were greater in the interventional vs. control group at 10 and 20 weeks (14.3 ± 7.4 vs. 6.9 ± 7.0 mmHg, mean difference 7.3 mmHg, 95% CI 3.2;11.5, p < 0.001, and 15.5 ± 9.0 vs. 9.8 ± 7.5 mmHg, mean difference 5.8 mmHg, 95% CI 0.8;10.7, p = 0.023). Atrial fibrillation was newly detected in 7.8% of patients. CONCLUSION: Through a pragmatic pharmacist-led disease management program, BP control was improved over time, without significant differences between groups. Greater systolic AOBP reductions were observed in the interventional vs. control group. (Pharmacists Intervention to Improve Hypertension Management in Primary Care:APOTHECARE; ClinicalTrials.gov registration NCT03274531).

Awareness, treatment, and control of hypertension in Austria: a multicentre cross-sectional study.

BACKGROUND: Hypertension (HTN) control is achieved in 30-50% of all diagnosed and treated patients in Europe today. There is no large, recent, and properly conducted Austrian study available, with the last representative data being obtained in the 1990s. We sought to close this gap of evidence in Europe by providing information on HTN control in predominantly adherent patients. METHODS AND RESULTS: In October 2015, we enrolled 4303 patients with HTN who approached one of 158 participating pharmacies with a prescription filled for antihypertensive medication. The recruitment was completed within 10 days. Patient's mean age was 68 ±â€Š12 years, 53% were women. The mean SBP/DBP was 144 ±â€Š20/84 ±â€Š12 mmHg. On average, patients received 2.2 ±â€Š1.1 different antihypertensive substances, 45% received a fixed-dose combination drug. A total of 93% were aware of their disease, 90% claimed to have taken their medication prior to the survey, and 41% had their blood pressure (BP) controlled at a threshold of 140/90 mmHg. Predictors of HTN control were lower age [per decade increase, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.85; 0.96, P < 0.01], female sex (OR 1.23, 95% CI 1.07;1.41), the intake of medication on the day of the conduct of the survey (OR 2.15, 95% CI 1.67;2.76), a university degree (OR 1.58, 95% CI 1.19; 2.08), and the consultation of a specialist for internal medicine/cardiology vs. a general practitioner (OR 1.20, 95% CI 1.04; 1.39). CONCLUSION: Despite a high degree of awareness and frequent use of fixed-dose combination drugs, only 41% of diagnosed, treated, and adherent HTN patients had their BP controlled. Immediate action is required to improve BP control in Austria. VIDEO ABSTRACT: : http://links.lww.com/HJH/A624.

Systematic screening for cardiovascular risk at pharmacies.

BACKGROUND: Early identification and treatment of cardiovascular risk factors (CVRFs) is essential to prevent excess morbidity, mortality and healthcare-related costs. We sought to investigate whether an active screening programme at pharmacies could identify a significant proportion of patients with previously undetected CVRFs. METHODS AND RESULTS: Between April and July 2013, 184 pharmacies in Lower Austria enrolled a total of 6800 participants, in whom body mass index (BMI), blood pressure (BP), total cholesterol and blood glucose were measured. Mean age was 58±17 years and 67.8% were women. 21% of men and 16% of women had a BMI≥30 kg/m2. The crude prevalence of diabetes mellitus (DM) was 7%, hypercholesterolaemia was identified in 57%, and 44% had elevated BP. Among fasting individuals (n=1814), DM was found in 18%. In total, 30% were confronted with a CVRF they were previously unaware of, and pharmacists recommended 45% of all participants to actively consult a physician. A first-time diagnosis of a CVRF was most frequent in the age groups between 25 and 64 (32% of participants). CONCLUSIONS: This pharmacy-based approach for cardiovascular risk screening found similar overall prevalences of CVRFs as reported by national surveys, but revealed underdiagnoses, particularly in lower age groups. A previously unknown CVRF was identified in every third individual, frequently prompting the pharmacists to recommend the consultation of a physician. An active screening approach at pharmacies might therefore serve as an effective alternative to the public preventive medical examination, particularly in younger age groups.