Management of hypertension and hypercholesterolaemia in primary care in the Netherlands

Objective: Screening, treatment and monitoring guidelines for hypertension and hypercholesterolaemia have been developed to assist physicians in providing evidence-based health care. We conducted a retrospective study to assess the management of patients with these single or combined conditions. Research design and methods: This was a retrospective cohort study conducted using data from the Integrated Primary Care Information (IPCI) project based in the Netherlands. Management of hypertension and hypercholesterolaemia was assessed from 2000-2003 by measuring the numbers of patients screened for these conditions, treated pharmacologically and monitored for treatment success. Results: Approximately 11%, 3% and 10% of participants were eligible for screening for hypertension alone, hypercholesterolaemia alone and both conditions, respectively. Blood pressure screening was high in patients eligible for both blood pressure and cholesterol screening (> 86%), whereas cholesterol screening was low (< 56%). Among patients newly identified with hypertension or hypercholesterolaemia who were eligible for pharmacotherapy, 29% and 43% respectively were not treated within one year of diagnosis. Undertreatment was significantly lower in patients with both conditions (24% and 37% for antihypertensive and lipid-lowering treatment, respectively and 28% were not treated for both), Among newly treated patients, in the first year of treatment there was no record of a blood pressure or cholesterol assessment, for 35% and 72%, respectively. Conclusion: Management was sub-optimal in patients with hypertension or hypercholesterolaemia as well as in those with both of these conditions. The results of this study are likely to be widely applicable, particularly to other European and industrialised countries that have similar free-access health care systems to the Netherlands.

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