On-target antihypertensive treatment in Italy: The ISPIT (Indagine Sicoa Paziente Iperteso a Target) survey study Maurizio Volterrani a, ⁎, Ferdinando Iellamo a , Giuseppe Rosano a , Pasquale Guarini b , Enrico Pusineri c , Stefano Bonassi a , Claudio Chimini d , Fabio Zaccà e , Cesare Proto d on behalf of the SICOA (Società Italiana Cardiologia Ospedalità Accreditata) Investigators a Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy b Ospedale Villa dei Fiori-Acerra, Napoli, Italy c Istituto di Ricovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Milano, Italy d Istituto Clinico Sant'Anna, Brescia, Italy e Ospedale Villa Torri, Bologna, Italy article info Article history: Received 27 April 2013 Accepted 4 May 2013 Available online 6 June 2013 Keywords: Arterial hypertension Blood pressure control Survey Risk factors Hypertension represents the most important risk factor for incident cardiovascular events [1], and as such it represents a major problem for the National Health Care systems. However, 30–40% of hypertensive patients lack an adequate blood pressure (BP) control, as defined by BP values b 140/90 mm Hg [1], in spite of therapy. Notwithstanding optimal BP control represents the goal of treatment independently on drugs administered, the results of recent RCT gave indications for using specific classes of drugs in specific patients' population [1] and this should be considered. In addition, other factors which have been poorly investigated systematically might be implicated in the lack of adequate BP control, such as the presence of risk factors, the frequency and modalities of BP measurements, life style etc. The present survey was conceived to provide an overall picture on the extent to which BP is at target in the Italian population of hypertensive patients, and to ascertain what are the conditions linked to the lack (or achievement) of BP control. 29 cardiology units located in different Italian areas belonging to SICOA Association (Società Italiana Cardiologia Ospedalità Accred- itata) only participated to the study that included consecutive patients referred in a 3-month period. All information were collected at the time of enrollment using a questionnaire. Target BP was defined as BP b 140/90 mm Hg, as measured by sphygmomanometry at the time of enrollment [1]. Patients were considered physically active if they referred to perform regular aerobic physical activity for at least 30 min at least 3 days per week. Age was summarized in three classes (18–65; 66– 75; ≥76), and drugs assumption in three categories (1, 2 and 3 or more drugs). Group comparisons were performed using univariate non- parametric statistics. The association between failure in achieving BP control and potential explanatory variables was modelled by means of unconditional logistic regression. All estimates were adjusted for confounders, e.g., age, gender, etc. [2]. A P value of b 0.05 was considered significant. The authors complied with the Principles of Ethical Publishing in the International Journal of Cardiology. The population consisted in 1539 patients, 45% females and 55% males. No significant difference in BP between center–south and north Italy was found. The percentage of patients achieving target BP was 60% independently on geographic distribution and age class. SBP and DBP values were 127.5 ± 11.7/76.7 ± 7.4 mm Hg in patients at target vs 152.4 ± 16.8/87.1 ± 9.7 mm Hg in patients not at target, respectively. 75% of patients featured at least one risk factor, and 36% two or more risk factors. The most common was the lack of physical activity (70%). Diabetes and dyslipidemia were present in 48% and 24% of patients, respectively.17% of patients were smokers. Table 1 summarizes significant associations from logistic regression analysis. Among all variables investigated, diabetes and overweight were the only predictors of the lack of BP control. Odds ratio (OR) for BP not at target was 1.44 (IC 1.13– 1.82, P =0.003) in patients with diabetes and 1.40 (IC 1.08–1.82, P = 0.01) and 1.80 (IC 1.32–2.39, P = 0.001) in overweight and obese patients, respectively. The lack of physical activity showed a strong trend for BP not at target, (OR 0.81, IC 0.64–1.02, P = 0.06). Fig. 1 illustrates the modality and frequency of BP measurements. The majority of patients (67%) declared to measure BP by themselves, with a most common frequency of once a week (41%). Only a small percentage had BP measured by a specialist and a relatively large percentage measured BP occasionally (8%). The univariate analysis revealed as BP self-measurement was associated to a significantly greater probability to reach BP target (56 vs 37%, P = 0.008). Beta- blockers were the drugs more frequently prescribed (44%), followed by ACE-inhibitors (33%), ARBs (29%) and calcium channel blockers (28%). No relationship was found between the class of drugs or their number and the achievement of target BP. This survey confirms that also in Italy the proportion of hypertensive patients not at target for BP is around 40% [1], without differences related to geographical distribution [3]. It also confirms that comorbidity ⁎ Corresponding author at: Cardiovascular Research Unit, Department of Medical Sciences, IRCCS San Raffaele—Roma, via della Pisana 235, 00163 Roma, Italy. E-mail address: maurizio.volterrani@sanraffaele.it (M. Volterrani). Table 1 Variables that predict failure in achieving target BP within those collected by the ISPIT study. Covariates Patients achieving BP target Patients not achieving BP target Odds ratio (95% confidence interval) P-value Comorbidity None/others 734 434 1.00 Diabetes 196 171 1.35 (1.06–1.72) 0.015 BMI ≤25 310 156 1.00 Overweight 431 277 1.40 (1.08–1.82) 0.01 b 25–30 189 172 1.80 (1.32–2.39) 0.001 Obese N 30 Treatment Others 694 415 1.00 Calcium 236 190 1.29 (1.02–1.61) 0.04 Antagonist An unconditional logistic regression model was applied to ISPIT dataset, all models were adjusted by age, gender, center, and actual confounders (n. 1535; Log likelihood -1013.01; LR χ 2 32.62 P b 0.001; Pseudo-R 2 0.0158). 4403 Letters to the Editor