Implementation of the 2018 ESC/ESH Guidelines for the management of hypertension in primary care: the HYPEDIA study
Authors: Kollias Anastasios , Foukarakis Emmanouil , Karakousis Konstantinos ,   The HYPEDIA Study Group, Adamopoulos Eleftherios , Afaras Georgios , Aggelopoulos Giorgos , Alexandropoulos Theodoros , Alexiadis Stavros , Alexoudis Apostolos , Anastasiou Evangelia , Antoniadis Antonios , Antoniou Ilias , Apazidis Georgios , Apostolidis Dimitrios , Arvanitakis Georgios , Arvanitis Panagiotis , Chager Ieronymos , Chalkiadakis Emmanouil , Charalampous Symeon , Charmpas Christos , Chatziadamidou Thekla , Chountis Dimitrios , Choursalas Ioannis , Chrysis Dimitrios , Chrysomallis Nikolaos , Dalakidou Vasiliki , Dermitzakis Ioannis , Diakomichalis Ioannis , Dimitriadis Konstantinos , Dimoulis Nikolaos , Dolapsakis Paulos , Douvitsas Theodoros , Elisavet Papalymperi , Efstathiou Athanasios , Exarchos Petros , Feggos Paulos , Feloukas Theodoros , Floros Dimitrios , Fourla Eleni , Fragkiadakis Charalampos , Gavriilidou Marianna , Georgakopoulos Dimitrios , Georgiadis Euaggelos , Georgiadis Ilias , Georgopoulos Kosmas , Georgopoulou Chrysoula , Giannadakis Emmanouil , Giannadakis Ioannis , Giavazis Ιgnatios , Gkalapis Alexandros , Gkinis Thomas , Eliopoulos Dimitrios , Imamoglou Imprahim , Ioannidou Vaia , Kapagiannidou Olympia , Kapernopoulos Charalampos , Kapetanios Konstantinos , Karachalios Theodoros , Karakatsani Soultana , Karanikolas Eustratios , Karlis Dimitrios , Karonis Theodoros , Karydakis Andreas , Kasotakis Emmanouil , Katsoulas Triantafyllos , Kipouridis Nikolaos , Keryttopoulos Petros , Kleiousis Vasileios , Kokkalas Ioannis , Kokkinos Spyros , Konstantinidis Ilias , Konstantinidis Stauros , Kontoroupis Georgios , Kosmaoglou Eleni , Kostalas Leonidas , Kourtis Tsampikos , Koutrolos Konstantinos , Krontira Charikleia , Kypriotakis Kimonas , Kyventidis Anastasios , Lappos Spyridon , Leontaridis Ioannis , Liavas Christos , Malliaros Stauros , Markaki Ioanna , Markopoulou-Drosou Georgia , Mavrepis Ioannis , Mauridis Vasilis , Maziotis Fotis , Mazokopakis Elias , Melidoniotis Alkiviadis , Maramveliotakis Nikolaos , Mitakidou Anastasia , Mitropoulos Dimitrios , Moschou Antonia , Mousoutzani Kyriaki , Mperoukas Antonis , Botsas Kosmas , Mpougiatiotis Euaggelos , Mpourneles Nikos , Migias Georgios , Nikiforos Savvas , Nikolaidis Vasileios , Nikopoulos Christos , Nioti Kadiani , Oikonomidis Nikolaos , Palmos Euaggelos , Panagos Christos , Pantelidi Maria , Papadimitriou Georgios , Papadopoulos Achilleas , Papadopoulos Panagiotis , Papaioannou Nikolaos , Papanastasiou Soultana , Papapavlou Marianthi , Papas Panagiotis , Paulidis Vasileios , Pechlivanidis Georgios , Pelekanos Ilias , Peltekis Leonidas , Pergaminou Anna , Plastiras Vasilis , Platis Athanasios , Poulopoulos Nikolaos , Prokopis Petros , Risggits Ali , Rosmarakis Euaggelos , Roumpanis Konstantinos , Roussis Ioannis , Samentzas Alexis , Santipantaki Katerina , Sarafianos Periklis , Sarris Isidoros , Savvalas Dimitrios , Sdralias Georgios , Sfiniadakis Ioannis , Siachos Simos , Sinos Loukas , Sitta Ourania , Skanavis Andreas , Skias Ioannis , Skiathitis Panagiotis , Skoutas Dimitrios , Srateh Dimitrios , Stathis Ioannis , Stathopoulos Christos , Staurotheodoros Christos , Stefanakis Emmanouil , Stroumpoulis Prokopis , Svolis Konstantinos , Tapinis Petros , Taxiarchou Efstathios , Thoma Maria , Thomaidis Konstantinos , Timosidis Michail , Toloudis Paraschos , Touroukis Nikolaos , Triantafyllidis Ioannis , Tsalkitzis Simon , Tsamouras Nikolaos , Tsavdaris Konstantinos , Tserkis Ilias , Tsiantis Ioannis , Tsirekas Emmanouil , Tzavaras Ploutarchos , Tzemanakis Eutychios , Tziovas Aristeidis , Vagena Aikaterini , Vakalis Ioannis , Vardakis Konstantinos , Vavoulis Panagiotis , Vlachos Stefanos , Voliotis Euaggelos , Voukelatou Europia , Vrogkistinos Konstantinos , Xafenias Michail , Xenos Dionysios , Zacharakis Ioannis , Zacharia Natasa , Zafeiris Christos , Zafeiris Ioannis , Zakopoulos Charilaos , Zoi Vaia , Zolof Ioannis , Stergiou George S. 
Published: July 2022

The HYPEDIA study aimed at evaluating the implementation of the 2018 European guidelines for treating hypertension in primary care. A nationwide prospective non-interventional cross-sectional study was performed in consecutive untreated or treated hypertensives recruited mainly in primary care in Greece. Participants’ characteristics, office blood pressure (BP) (triplicate automated measurements, Microlife BPA3 PC) and treatment changes were recorded on a cloud platform. A total of 3,122 patients (mean age 64 ± 12.5 [SD] years, 52% males) were assessed by 181 doctors and 3 hospital centers. In 772 untreated hypertensives (25%), drug treatment was initiated in the majority, with monotherapy in 53.4%, two-drug combination in 36.3%, and three drugs in 10.3%. Angiotensin receptor blocker (ARB) monotherapy was initiated in 30%, ARB/calcium channel blocker (CCB) 20%, ARB/thiazide 8%, angiotensin converting enzyme inhibitor (ACEi)-based 19%. Of the combinations used, 97% were in single-pill. Among 977 treated hypertensives aged <65 years, 79% had BP ≥ 130/80 mmHg (systolic and/or diastolic), whereas among 1,373 aged ≥65 years, 66% had BP ≥ 140/80 mmHg. ARBs were used in 69% of treated hypertensives, CCBs 47%, ACEis 19%, diuretics 39%, beta-blockers 19%. Treatment modification was decided in 53% of treated hypertensives aged <65 years with BP ≥ 130/80 mmHg and in 62% of those ≥65 years with BP ≥ 140/80 mmHg. Renin-angiotensin system blocker-based therapy constitutes the basis of antihypertensive drug treatment in most patients in primary care, with wide use of single-pill combinations. In almost half of treated uncontrolled hypertensives, treatment was not intensified, suggesting suboptimal implementation of the guidelines and possible physician inertia.