The Swedish Primary Care Cardiovascular Database (SPCCD): 74 751 hypertensive primary care patients.

OBJECTIVE: To describe the Swedish Primary Care Cardiovascular Database, SPCCD. Design. Longitudinal data from electronic medical records, linked to national registers. Setting. 48 primary healthcare centres in urban (south-western Stockholm) and rural (Skaraborg) regions in Sweden. Subjects. Patients diagnosed with hypertension 2001-2008. MAIN OUTCOME MEASURES: Blood pressure (BP) and impact of retrieval of data on BP levels, clinical characteristics, co-morbidity and pharmacological treatment. RESULTS: The SPCCD contains 74 751 individuals, 56% women. Completeness of data ranged from > 99% for drug prescriptions to 34% for smoking habits. BP was recorded in 98% of patients during 2001-2008 and in 63% in 2008. Mean BP based on the last recorded value in 2008 was 142 ± 17/80 ± 13 mmHg. Digit preference in BP measurements differed between the two regions, p < 0.001. Antihypertensive drugs were prescribed in primary healthcare to 88% of the patients in 2008; however, when all prescribers were included 96% purchased their drugs. Cardiovascular co-morbidity and diabetes mellitus were present in 28% and 22%, respectively. CONCLUSION: This large and representative database shows that there is room for improvement of BP control in Sweden. The SPCCD will provide a rich source for further research of hypertension and its complications.

Improved treatment and control of hypertension in Swedish primary care: results from the Swedish primary care cardiovascular database.

OBJECTIVE: To study temporal trends in hypertension treatment and control in Swedish primary care, in relation to clinical characteristics, comorbidity, and drug treatment. MATERIALS AND METHODS: Repeated cross-sectional analysis of 43 239 hypertensive patients attending primary care in 2001-2002 and of 62 407 patients in 2007-2008. RESULTS: Mean blood pressure (BP) 2007-2008 was 143/79 mmHg in women and 142/81 mmHg in men. Cardiovascular comorbidity and diabetes were present in 13 and 15% of women, and in 18 and 20% of men. Overall BP reductions from 2001-2002 to 2007-2008 were 9.0/3.1 mmHg; greater in women than men, with advancing age, and in patients with comorbidity (all P < 0.001). Attainment of target BP (<140/90 mmHg) increased from 24 and 26% in women and men (2001-2002) to 37 and 37% (2007-2008; all P < 0.001). Most common drug classes in 2001-2002 were, in descending frequency, ß blockers, diuretics, and calcium channel blockers (both sexes), and in 2007-2008 ß blockers, diuretics, and angiotensin-converting enzyme inhibitors in women, and ß blockers, angiotensin-converting enzyme inhibitors, and diuretics in men. The number of drug classes/patient increased from 1.5 (2001-2002) to 1.8 (2007-2008; P < 0.001) but remained low (1.7) in those above target BP. CONCLUSION: BP control in hypertensive patients attending Swedish primary care has improved over 5-7 years, and more so in high-risk groups. There is, however, room for improvement. In uncontrolled hypertension the combination of several drug classes remain low.