1. Primary care of hypertensive patients and the risk of acute events Irina Stirbu-Wagner Markus MJ Nielen Maaike Langelaan Robert A. Verheij Joke C. Korevaar Netherlands Institute for Health Services Research

2. Why this study Hypertension is one of the most important risk factors for developing acute events Studies focused mostly on treatment options to reduce risk of acute events Treated hypertension patients have various outcomes

3. Objective To establish which factors play a role in determining the risk of an acute cardiovascular event in hypertensive patients. We compared two groups of hypertensive patients: those who were hospitalised with an acute cardiovascular event (stroke or myocardial infarction) and those who did not experience any acute cardiovascular event and assessed the difference in: use of GP care medication [quality of care] clinical parameters demographic parameters

4. Methods GP database (EMR) About 400,000 people Dutch Hospital database (national) Population Register 80% probability linkage on DbGP 34328 patients with Hypertension 448 patients hospitalized with AMI/Stroke

5. Methods Age Gender Comorbidities Utilization of care Medication BP 448 hospitalized with AMI/Stroke 33880 patients no acute events 365 day follow up period Event

6. Results: demographic parameters

7. Results: comorbidity Mean number of patients having: HospitalizedNot hospitalized Chronic diseases (28)1.49 (1.33-1.65)0.83 (0.78-0.89) Diabetes0.19 (0.14-0.25)0.18 (0.17-0.19) CV complaints/diseases (K01-K99) 2.14 (1.97-2.31)1.50 (1.49-1.51) CV diseases (K70-K99)1.93 (1.79-2.08)1.38 (1.34-1.41)

8. Results: comorbidity

9. Results: health care use HospitalizedNot hospitalized All types of contacts 9.69 (8.37-11.00)7.85 (7.09-8.60) Office consultations 5.52 (4.83-6.21)4.78 (4.42-5.15) Home visits0.93 (0.58-1.27)0.49 (0.42-0.56) Telephone consultations 2.10 (1.54-2.66)1.42 (1.24-1.60) Procedures1.14 (0.76-1.51)1.15 (0.79-1.52) Mean number of contacts with GP

10. Results: health care use Odds Ratio Hospitalization +Corrected for CV diseases +Corrected for systolic BP All types (0-2)111 3-71.460.960.84 8-122.60*1.421.58 13+4.00*1.74*1.92 Consultations (0-1)1 11 2-41.240.990.90 5-81.371.131.24 9+2.47*1.381.76 Home visits (0)111 1+4.61*1.89*2.00* Tel. consult (0)111 1-21.42*1.181.12 3+2.38*1.58*1.77*

11. Results: health care use Event

12. Results: medication Number ofHospitalizedNot hospitalized Drugs prescribed7.60*5.61 Drugs related to CV system 2.72*2.08 Ca channel blockers 0.250.18 Diuretics0.57*0.42 ACE inhibitors0.66*0.55 Beta blockers0.63*0.45 Lipid modifying agents 0.410.37

13. Results: BP measurements Blood pressure measurements HospitalizedNot hospitalized BP was registered % 71.068.5 Mean number of occasions measured 2.592.24 Mean systolic BP 158.2*145.9 Mean diastolic BP 88.24*83.81

14. Conclusions The risk of an acute cardiovascular event (AMI stroke) in hypertensive patients o Demographic parameters: older men o Clinical parameters: more comorbidities, less controlled BP o Use of GP care: more contacts with GP long before event o Medication: more drugs prescribed Possibility to link different registries on patient’s level