paper of Kleijer, et al. J Psychopharmacol. 2010;24:1131-2.
general practice. J Hum Hypertens. 2009;23:758-63.
ledge of BP management in clinical practice is needed to develop more effective improving
strategies. Using a large Italian primary care database, we selected the subjects diagnosed
with hypertension, and extracted the diagnosis of myocardial infarction, angina pectoris/
coronary disease, stroke/transitory ischemic attack (TIA), heart failure, atrial fibrillation,
peripheral arterial disease, diabetes mellitus, the serum total cholesterol, HDL choleste-
rol, triglycerides, creatinine, BP, electrocardiogram, weight, height and the prescription of
cardiovascular (CV) drugs. Hypertension was recorded in 119.065 individuals (prevalence
19.3%), 19.134 (16%) had no ambulatory visit and 33.183 (27.8%) had no BP value
recorded. Overall, 14.594 (21.9%) had at least one recorded diagnosis showing high CV
risk. BP was controlled (mean of BP values <140/90 mm Hg) in 28.918 patients (16.690
women, 12 189 men and 40 gender not recorded), that is, 43.23% of the subjects with
recorded BP. Among the non-controlled patients, 21.866 (57.8%) were non-high risk
grade 1 (mean BP 142.5/84.5 mm Hg; s.d. 13.1/8.2) and 7.123 (18.8%) high-risk gra-
de 1 hypertensives (mean BP 150/83 mm Hg; s.d. 6.2/7.2). Less than three drugs were
prescribed in 29.919 (79.1%) of non-controlled patients. Low attendance rate, BP under-
recording and suboptimal use of politherapy are major obstacles to hypertension control.
Most uncontrolled individuals are low-CV risk, grade 1 hypertensive patients, for whom
the personal benefit of adding another drug is modest. Aiming at the recommended BP
target in uncontrolled grade 2-3 hypertensive/high-CV risk patients would probably requi-
re two additional drugs.
diabetics: a primary care perspective. Nephrol Dial Transplant. 2009;24:1528-33.
and cardiovascular (CV) outcome, and early identification largely depends on the general
practitioners' (GPs) awareness of it. Only a few studies have evaluated the prevalence of
CKD in type 2 diabetes in primary care, and no studies are available on hypertensive dia-
betics. Thus, the aim of this study was to assess the prevalence of CKD and its association
with CV morbidity in such a population. METHODS: On the basis of an Italian national
project involving GPs and nephrologists, we retrieved demographic, laboratory and clini-
cal data regarding 7582 hypertensive type 2 diabetics (3564 men; age 25-89 years) who
were selected using the diagnostic code Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM) for diabetes and hypertension. Blood pressure (BP) values, se-
rum creatinine, ECG-diagnosed left ventricular hypertrophy (LVH) and the occurrence of
previous major CV events were obtained for each patient from the GPs' Health Search
Database. Estimated glomerular filtration rate (GFR) was calculated according to the four-
variable MDRD equation. CKD was defined as an estimated GFR < 60 mL/min/ 1.73 m2.
RESULTS: CKD prevalence was 26%, although renal disease was diagnosed by GPs in
only 5.4% of cases. The prevalence of both LVH and major CV events was 8%. Adequate
BP control was only achieved in 10.4% of patients. Patients whose GFR was <60 mL/
min/1.73 m2 were older, prevalently female, had increased pulse pressure and higher
prevalence of dyslipidaemia. Moreover, the prevalence of both LVH and major CV events