Cor Vasa 2003, 44(4):187-191

Hypertension in chronic heart failure in the Czech and Slovak Republics. A causal factor not yet adequately addressed

Jiří Widimský^1,*, John G. F. Cleland², Martina Sachová³

¹ Klinika kardiologie, Subkatedra kardiologie IPVZ, Institut klinické a experimentální medicíny, Praha, Česká republika

² Department of Cardiology, University of Hull, Kingston-upon-Hull, Velká Británie

³ Servier, Praha, Česká republika

Aim of study:
To map the current situation in hypertension control in patients with chronic heart failure (CHF) in a group of patients from the Czech and Slovak Republics, participants in a program called IMPROVEMENT of Heart Failure were studied. The reason for our study was that hypertension belongs to the basic pathogenic factors for the development of heart failure; moreover, hypertension control markedly reduces the incidence of CHF.


Group of patients and methods:
A total of 96 general practitioners (GPs) from the Czech and Slovak Republics took part in IMPROVEMENT of Heart Failure, a European project. The medical records of each GP were used to prospectively select 9 consecutive patients (six with the diagnosis of heart failure, three after acute myocardial infarction). This gave rise to a group of 858 patients. Enrolled into the study were patients with heart failure classified as mild (defined as NYHA II), moderate (NYHA III), and severe (NYHA IV) by the GPs. In this way, a group of 477 patients was formed. This communication reports on patients shown to have an increased blood pressure (i. e., BP  140 and/or  90 mm Hg).

Results:
Hypertension was present in 64.1% of patients. Isolated systolic hypertension was diagnosed in 32.1% of patients. Normal BP was seen in only 35.9% of CHF patients. ACE inhibitors were used to treat adequate numbers of patients. Substantially fewer patients were treated by beta-blockers. Compared with younger-age patients (< 70 years), elderly patients ( 70 years) were treated by ACE inhibitors and beta-blockers almost twice and three times less often, respectively. The triple combination of diuretics + ACE inhibitors + beta-blockers was instituted in only 36.5% of patients below 70, and in as little as 14.9% of patients aged 70 and older.
The poor hypertension control was apparently also partly due to the frequent presence of overweight and obesity in patients with CHF.

Conclusion:
Frequent use of the triple combination of a diuretic, ACE inhibitors, and beta-blockers in the treatment of CHF should reduce the still alarming incidence of uncontrolled hypertension in patients with CHF. An alarming finding is the inadequate treatment of patients over 70. It is critical to increase beta-blocker use in therapy while reducing the excessive incidence of obesity and overweight.

Keywords: Chronic heart failure; Hypertension control; IMPROVEMENT of HF program

Published: April 1, 2003  Show citation