Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)

Abstract Background Hypertension poses a significant public health challenge in Bulgaria, requiring comprehensive strategies for prevention and management. Purpose The aim was to assess the evolution of blood pressure (BP) control and antihypertensive therapy compared to one year earlier in patients with hypertension. Methods SNAPSHOT was a cross-sectional, observational, multicentre, epidemiological study conducted in Bulgaria. It involved 129 investigators and included 3366 patients with hypertension. Patients’ data were collected from both a single visit and medical records dating back one year. Results A total of 3363 patients were analysed, with a mean (standard deviation SD) age of 67.2 (10.8) years. Most patients were female (60.9%), educated at secondary school level (63.4%), overweight or obese (77.9%), and non-smokers (76.5%). The mean (SD) systolic and diastolic BP were 143.1 (18.4) mmHg and 84.3 (11.8) mmHg, respectively, during the study visit, compared with values of 135.9 (14.9) mmHg and 82.3 (8.2) mmHg obtained from medical records on average 11.1 (5.5) months earlier. Systolic/diastolic BP was assessed as 140/90 mmHg in 39.1% of patients at the study visit, compared to 55.1% one year earlier. At the study visit, BP was considered as controlled according to stricter age and diseases specific targets in the guidelines in 22.8% of patients, compared to 16.0% one year earlier (Figure 1). For most patients (73.8%), BP control status, as per guidelines, remained consistent between the study visit and one year earlier. Most patients (67.5%) did not achieve controlled blood pressure at either time (Figure 2). At the study visit, almost all patients (99.5%) were treating their hypertension, took their treatment once or twice daily (94.7%). The most used medications were beta blockers (61.2%), diuretics (57.5%), and/or angiotensin-converting enzyme inhibitors (48.6%) and medications were mostly combined as bitherapy (32.2% patients) or as combination of 3 drugs (36.4% patients). No change in therapy was recorded for most patients (68.1%) between the medical records and the study visit one year later. However, a mean systolic BP of 150.6 mmHg triggered a treatment dose increase in 13.8% of patients, while the number of antihypertensive drug class was increased in 15.3% of patients in response to mean systolic BP of 148.0 mmHg. There was a switch from free combinations to a single pill combination in 7.1% of patients. Conclusion This study revealed a concerning prevalence of uncontrolled hypertension, with similar rates observed in one year observation. This emphasised the need for more effective management strategies to improve BP control in patients with hypertension. Figure 1 Figure 2