Suitability of antiplatelet therapy in hypertensive patients

• Published in: Journal of human hypertension Vol. 29; no. 1; pp. 40 - 45
• Main Authors: Martínez-Orozco, M J, Perseguer-Torregrosa, Z, Gil-Guillén, V F, Palazón-Bru, A, Orozco-Beltran, D, Carratalá-Munuera, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2015; Nature Publishing Group
• Subjects: 692/699/75/243; 692/700/459/1748; Aged; Aggregation; Antihypertensive Agents - therapeutic use; Blood platelets; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Chi-Square Distribution; Clopidogrel; Coronary artery disease; Diabetes mellitus; Drug Prescriptions; Drug therapy; Drug Utilization Review; Dyslipidemia; Epidemiology; Female; Guideline Adherence; Health Administration; Health risk assessment; Heart diseases; Humans; Hypertension; Hypertension - complications; Hypertension - diagnosis; Hypertension - drug therapy; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Odds Ratio; original-article; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Practice Patterns, Physicians; Primary Health Care; Prospective Studies; Public Health; Risk Assessment; Risk Factors; Spain; Time Factors; Treatment Outcome; Spain
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2014.25

Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007–2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6–58.5%). Associated profile: female (OR=0.460,
P
=0.091), no dyslipidemia (OR=0.393,
P
=0.048), no coronary heart disease (OR=0.215,
P
=0.001) and high diastolic blood pressure (OR=1.076,
P
=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0–14.2%). Associated profile: male (OR=1.610,
P
=0.089), smoking (OR=2.055,
P
=0.045), dyslipidemia (OR=3.227,
P
<0.001) and diabetes (OR=2.795,
P
<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt.