478
GENERAL PRACTICE, MEDICAL TRAINING
Zdrav Vestn | september – october 2021 | Volume 90 | https://doi.org/10.6016/ZdravVestn.3069
Copyright (c) 2021 Slovenian Medical Journal. This work is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License.
Treatment of patients with arterial hypertension 
in family medicine in Slovenia – Assessment of the  
situation after the introduction of modal practices
Obravnava bolnikov z arterijsko hipertenzijo v ambulantah družinske medicine   
v Sloveniji – Ocena stanja po uvedbi referenčnih ambulant
Marija Petek Šter,1,2 Breda Barbič Žagar3
Abstract
Background: Most patients with uncomplicated arterial hypertension are treated by family physicians. The purpose of 
the research was to discuss how to consider patients with arterial hypertension in Slovenia and to assess blood pressure 
control.
Methods: In a prospective observational survey, in 21.11.2017 to 28.3. In 2019, six months observation time were reviewed 
for previously untreated patients with essential arterial hypertension in 158 family medicine clinics in Slovenia. On the end 
of follow up period, blood pressure (BP) control was evaluated.
Results: A total of 1060 patients were included, with the mean age 58.6 ± 12.1 years old. Among the patients included, 579 
(55%) were men and 481 (45%) were women. The mean systolic BP on entry was 165.2 ± 14.5 mm H, diastolic 96.2 ± 10,0 
mm Hg. 751 patients (70.8%) had associated cardio-vascular disease factors. 408 (38.5%) patients had assessed cardiovas-
cular risk as high or very high. Antihypertensive medication was initiated in 1046 (98.7%) patients; in 418 patients (39.4%) 
combinatory antihypertensive therapy with two or more antihypertensive drugs in free or fixed drug combinations was 
initiated. 331 patients (31.6%) had a visit to a practice nurse.
929 (87.6%) patients completed the study. The mean systolic BP at the conclusion of the study was 135.4 ± 10.9 mm Hg and 
diastolic 81,8 ± 8,0 mm Hg. 63.3% of patients received target BP.
1 Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
2 Community Health Centre Trebnje, Trebnje, Slovenija
3 Krka d.d., Novo mesto, Slovenia
Correspondence / Korespondenca: Marija Petek Šter, e: marija.petek-ster@mf.uni-lj.si
Key words: arterial hypertension; family medicine; reference clinics; teamwork; combined therapy
Ključne besede: arterijska hipertenzija; družinska medicina; referenčne ambulante; timsko delo; kombinacijsko zdravljenje
Received / Prispelo: 24. 4. 2020 | Accepted / Sprejeto: 28. 4. 2021
Cite as / Citirajte kot: Petek Šter M, Barbič Žagar B. Treatment of patients with arterial hypertension in family medicine in Slovenia – 
Assessment of the situation after the introduction of modal practices. Zdrav Vestn. 2021;90(9–10):478–87. DOI: https://doi.org/10.6016/
ZdravVestn.3069
eng slo element
en article-lang
10.6016/ZdravVestn.3069 doi
24.4.2020 date-received
28.4.2021 date-accepted
General practice, medical training Splošna medicina, medicinsko izobraževanje discipline
Original scientific article Izvirni znanstveni članek article-type
Treatment of patients with arterial hyperten-
sion in family medicine in Slovenia – Assess-
ment of the situation after the introduction of 
modal practices
Obravnava bolnikov z arterijsko hipertenzijo v am-
bulantah družinske medicine v Sloveniji – Ocena 
stanja po uvedbi referenčnih ambulant
article-title
Treatment of patients with arterial hyperten-
sion in family medicine in Slovenia
Obravnava bolnikov z arterijsko hipertenzijo v 
ambulantah družinske medicine v Sloveniji alt-title
arterial hypertension, family medicine, refer-
ence clinics, teamwork, combined therapy
arterijska hipertenzija, družinska medicina, ref-
erenčne ambulante, timsko delo, kombinacijsko 
zdravljenje
kwd-group
The authors declare that there are no conflicts 
of interest present.
Avtorji so izjavili, da ne obstajajo nobeni 
konkurenčni interesi. conflict
year volume first month last month first page last page
2021 90 9 10 478 487
name surname aff email
Marija Petek Šter 1,2 marija.petek-ster@mf.uni-lj.si
name surname aff
Breda Barbič Žagar 3
eng slo aff-id
Department of Family Medicine, 
Faculty of Medicine, University 
of Ljubljana, Ljubljana, Slovenia
Katedra za družinsko medicino, 
Medicinska fakulteta, Univerza v 
Ljubljani, Ljubljana, Slovenija
1
Community Health Centre 
Trebnje, Trebnje, Slovenija
Zdravstveni dom Trebnje, 
Trebnje, Slovenija 2
Krka d.d., Novo mesto, Slovenia Krka d.d., Novo mesto, Slovenija 3
Slovenian Medical Journallovenian Medical Journal
479
ORIGINAL SCIENTIFIC ARTICLE
Treatment of patients with arterial hypertension in family medicine in Slovenia
1 Introduction
Almost half of the adult population in Europe has ar-
terial hypertension (1); we do not have precise data on 
the prevalence of arterial hypertension in Slovenia. How-
ever, according to an epidemiological study carried out 
between 2007-2009, the estimated proportion of adults 
with arterial hypertension was as high as 64.3% (2), with 
significant regional differences in prevalence (3).
With respect to the number of deaths, arterial hyper-
tension is the most important individual risk factor, with 
10 million people dying each year from consequences 
associated with this condition (4,5).
Due to this high frequency, significant impact on 
morbidity and mortality, and easy identification and 
treatment of uncomplicated essential arterial hyperten-
sion, arterial hypertension is a public health problem. 
Early diagnosis, appropriate treatment, and monitoring 
of this and concomitant conditions are key to preventing 
complications of arterial hypertension (6).
By using a specific approach that includes prevention 
as well as detection and treatment of complications of 
arterial hypertension, most patients can be successfully 
managed at the primary health care level (7). A holistic 
approach to a patient with arterial hypertension, which 
also includes prevention and early diagnosis, requires a 
Conclusion: We recognized some room for improvements. In the future, it will be necessary to strengthen the team man-
agement of patients and to encourage doctors to introduce combination therapy, preferably in a fixed dose combination 
of two or three drugs in one tablet.
Izvleček
Izhodišča: Večino bolnikov z nezapleteno arterijsko hipertenzijo obravnavamo zdravniki družinske medicine. Namen raz-
iskave je bil ugotoviti, kako poteka obravnava bolnikov z arterijsko hipertenzijo v timu družinske medicine v Sloveniji ter 
oceniti urejenost krvnega tlaka.
Metode: V prospektivni opazovalni raziskavi smo v obdobju od 21. 11. 2017 do 28. 3. 2019 šest mesecev spremljali obravna-
vo dotlej še nezdravljenih bolnikov z esencialno arterijsko hipertenzijo v 158 ambulantah družinske medicine v Sloveniji. 
Ob koncu spremljanja smo ocenili urejenost krvnega tlaka (KT).
Rezultati: Vključenih je bilo 1.060 bolnikov, katerih povprečna starost je bila 58,6 ± 12,1 let. Med vključenimi bolniki je bilo 
579 (55 %) moških in 481 (45 %) žensk. Povprečna vrednost sistoličnega KT ob vstopu je bila 165,2 ± 14,5 mm Hg, diasto-
ličnega pa 96,2 ± 10,0 mm Hg. 751 bolnikov (70,8 %) je imelo pridružene dejavnike tveganja za bolezni srca in ožilja. 408 
(38,5 %) bolnikov je imelo ocenjeno srčno-žilno tveganje kot veliko oz. zelo veliko. Antihipertenzivna zdravila so bila uve-
dena pri 1.046 (98,7 %) bolnikih; pri 418 bolnikih (39,4 %) je bilo uvedeno kombinacijsko zdravljenje dveh ali več učinkovin 
v prosti ali fiksni kombinaciji. 331 bolnikov (31,6 %) je med spremljanjem opravilo obisk pri diplomirani medicinski sestri.
Raziskavo je zaključilo 929 (87,6 %) bolnikov. Povprečna vrednost sistoličnega KT ob zaključku raziskave je bila 135,4 ± 10,9 
mm Hg, diastoličnega pa 81,8 ± 8,0 mm Hg, ciljni KT je dosegalo 63,3 % bolnikov.
Zaključek: Prepoznali smo nekatere priložnosti za izboljšanje vodenja. V prihodnje bo potrebno še okrepiti timsko obrav-
navo bolnikov ter spodbujati zdravnike k uvajanju kombinacijskega zdravljenja, najbolje v obliki dveh oziroma treh zdra-
vilnih učinkovin v eni tableti.
team approach. Team treatment of patients with arterial 
hypertension has been shown to be successful in many 
studies from abroad; a nurse’s involvement has contrib-
uted to a greater reduction in blood pressure and im-
proved blood pressure control (8-11).
Family medicine model practices were introduced to 
Slovenia in 2011 under a model practices project, where, 
in addition to a family physician and a health care as-
sistant, the team also included a practice nurse for half 
of the working time (12). Practice nurses (PN) perform 
preventive examinations and are involved in the man-
agement of patients with certain common conditions, 
including arterial hypertension. Practice nurses follow 
pre-defined work protocols when treating patients (13) 
and are adequately trained for their work with additional 
compulsory education (14).
The team approach to the treatment of patients with 
arterial hypertension has a number of advantages and 
has been well received by patients (15). Data on the 
evaluation of patient management performance, which 
were also considered by a nurse, were obtained on a 
small sample of patients from individual clinics. This 
data indicates that a contribution of an additional team 
member would enhance the quality of management of 
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patients with arterial hypertension (16). The most recent 
data available on the success of blood pressure control 
in family medicine practices in Slovenia comes from 
the period before the introduction of model practices 
(17-19).
The purpose of the study was to determine how pa-
tients with arterial hypertension are treated by the team 
of the family medicine after introducing the model prac-
tices in Slovenia and to assess blood pressure control.
2 Methods
2.1 Research method
In the prospective observational study, for six months 
we monitored the treatment of previously untreated pa-
tients with essential arterial hypertension in family med-
icine practices in Slovenia, in whom we newly identified 
arterial hypertension. 158 family physicians from all 
over Slovenia participated, who also had a PN in their 
team with specific knowledge for working in a family 
medicine practice.
The study lasted from the 21st November 2017, when 
the first patient was included, to the 28th March 2019, 
when the last patient completed the study. We moni-
tored both the process and the outcome of the treatment, 
which was evaluated by the value of blood pressure at 
the end of the six-month follow-up.
2.2 Subjects
Sequential adult patients with essential arterial hy-
pertension who were not treated for arterial hyperten-
sion at the time of inclusion were then included. 1,060 
patients from all over Slovenia participated.
2.3 Research process
Due to the observational research methodology, phy-
sicians were asked to manage their patients the same way 
they do in their normal clinical practice.
In accordance with the guidelines and the protocol 
for the management of patients with arterial hyperten-
sion in family medicine practices, the patient was ex-
pected to undergo at least one follow-up visit in addition 
to the visit at the beginning of treatment within the first 
6 months; however, the number of control visits was left 
to the doctor to decide. The only wish was for all the 
patients to make their final visit 6 months after the in-
clusion in the study.
The data were provided by the participating family 
physicians in an electronic data entry form that did not 
allow blank fields or more than one answer to questions 
where only one answer had to be selected.
The standard for appropriate treatment at the time 
the study was implemented was the Slovenian guidelines 
for the treatment of patients with arterial hypertension 
from 2013 (20) and the protocol for the management of 
arterial hypertension in model practices, modified in 
2017 (21).
2.4 Observed variables
We collected the following data:
• Basic demographic characteristics
• Additional risk factors for cardiovascular disease, 
organ damage or pre-existing cardiovascular disease 
(according to medical records)
• Calculated cardiovascular risk (according to medical 
documentation)
• Method of treatment of arterial hypertension 
(non-pharmacologically, drugs)
• Number of visits to the family physician
• Number of visits to a PN in a family medicine prac-
tice
• The regulation of blood pressure was determined by 
measuring blood pressure in the clinic. The patient’s 
blood pressure was measured under standard proto-
col twice in a row one minute apart at each visit, and 
the average value of both measurements was taken 
into account (22).
• Blood pressure measurement was performed by a 
physician with an automatic blood pressure mon-
itor, which gives the measured blood pressure val-
ues with an accuracy of 1mm Hg. The brand of the 
blood pressure monitor was not determined, but the 
meters were those used in the participating practic-
es and checked in accordance with the rules on the 
procedure of regular verification of blood pressure 
monitors (23). Blood pressure was measured in a sit-
ting position, in the arm with higher blood pressure 
in the event that the measured difference in blood 
pressure values between the left and right arm was 
greater than 10 mm Hg. The target values of blood 
pressure were set for each patient by his or her cho-
sen physician, taking into account the definition of 
blood pressure target values in accordance with the 
2013 guidelines, namely:
 » blood pressure below 140/90 mm Hg (or for pa-
tients with diabetes, blood pressure below 140/85 
mm Hg and, exceptionally in elderly patients, be-
low 150/90 mm Hg).« 
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ORIGINAL SCIENTIFIC ARTICLE
Treatment of patients with arterial hypertension in family medicine in Slovenia
The target blood pressure set by the family physi-
cian was below 140/90 mm Hg in 900 patients (84.9%), 
below 140/85 mm Hg in 132 patients (12.5%) (diabetic 
patients), and below 150/90 mm Hg (exceptions) in 15 
patients (1.4%). For the rest of the patients, the target 
blood pressure as determined by the treating physi-
cian was not provided.
2.5 Statistical analysis of data
For numerical variables, the number (patients with 
data), maximum value (max), minimum value (min), 
the average, sample standard deviation (SD) are given. 
For categorical variables, the number and proportion 
by individual categories are given.
A basic statistical analysis of the data was per-
formed, the average values of the variables and stan-
dard deviations (SD) were presented, and the propor-
tions were calculated. No method was used to replace 
the missing values. All patients were treated for each 
variable with a numeric corresponding to the number 
of patients with specific data.
Calculations were performed using Microsoft Of-
fice Excel 2016 ©.
2.6 Ethical approval of the study
The study design was approved by the Republic of 
Slovenia National Medical Ethics Committee (deci-
sion No. 0120-111/2017-3 on 14. 3. 2017).
3 Results
3.1 Demographic and clinical characteristics of 
patients
1,060 patients were included, of whom 481 (45.0%) 
were women and 579 (55.0%) were men aged 22 to 94; 
the average age was 58.6 (SD 12.1 years).
867 (81.8%) of 1,060 patients had not been treat-
ed for arterial hypertension (AH) before, and 168 pa-
tients (15.8%) had previously received AH therapy, 
but had discontinued treatment for various reasons 
and did not receive antihypertensive drugs at the time 
of inclusion in the study; no previous treatment data 
were recorded for 25 (2.4%) patients.
The clinical characteristics of patients at inclusion 
in the study are shown in Table 1.
751 (70.8%) patients had at least one additional risk 
Clinical features of the patients involved Number (proportion)
Dyslipidaemia 506 (47.7%)
Obesity 375 (35.4%)
Diabetes 139 (13.1%)
Family history of early cardiovascular disease 233 (22.0%)
Smoking 225 (21.2%)
The presence of cardiovascular disease 68 (6.4%)
Proportion of patients with impaired one or more target organs 96 (9.1%)
Table 1: Clinical characteristics of patients at the inclusion in the study.
Degree of arterial hypertension Number (proportion) of patients
Mild (140-159 and/or 90-99 mm Hg) 171 (16.1%)
Moderate (160-179 and/or 100-109 mm Hg) 464 (43.8%)
Severe (≥180 and/or ≥110 mm Hg) 212 (20.0%)
Isolated systolic (≥140 and <90 mm Hg) 201 (19.1%)
Table 2: Patients included according to the degree of arterial hypertension.
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factor for cardiovascular disease, most commonly dys-
lipidaemia. A high or very high cardiovascular risk was 
found in 408 (38.5%) participants based on risk factors, 
target organ damage or pre-existing cardiovascular 
disease.
Table 2 shows the patients included according to the 
degree of arterial hypertension. The largest group was pa-
tients with moderate arterial hypertension.
Arterial hypertension was detected in 403 patients 
(38.0%) at the first examination by a physician at a ran-
dom visit, in 230 patients (21.7%) through a preventive 
examination by a  PN in a family medicine practice, in 
166 patients (15.7%) based on home-measured blood 
pressure or measurements in a pharmacy, 163 patients 
(15.4%) had problems associated with high blood pres-
sure, in 49 patients (4.6%) AH was detected at a preven-
tive examination by an occupational medicine specialist, 
and in 22 patients (2.1%) it was detected in another way. 
For 27 patients (2.5%) there is no data on the method of 
detecting AH.
3.2 Patient management in a family medicine 
practice
Table 3 shows the treatment of patients with arteri-
al hypertension at inclusion in the study and after a six 
months’ follow-up. The proportion of patients receiving 
a combination of two or more antihypertensive agents 
increased from the first to the final visit.
During follow-up, 398 visits were made to a PN by 
331 patients (31.6%), and most patients visited PN only 
once.
Table 4 shows the number of intermediate visits made 
by patients to the physician. Almost two thirds of patients 
made only one intermediate visit (median 1, mode 1).
3.3 Blood pressure values and achieving target 
blood pressure values
Table 5 shows the blood pressure values at the start 
of the study, at the first follow-up and at the end of the 
Treatment of arterial hypertension When included in the study, 
number (proportion)
After six months of monitoring 
number (proportion)
Only non-pharmacologically 14 (1.3%) 0
Antihypertensive drug in monotherapy 628 (59.3%) 401 (43.2%)
Combination of two or more antihypertensive agents 
(free combination or a combination tablet) 418 (39.4) 528 (56.8%)
Total 1060 929
Table 3: Treatment of patients with arterial hypertension.
Number of intermediate visits Number of patients Proportion in % relative to the total 
number of patients
1 677 63.9%
2 206 19.4%
3 32 3.0%
4 9 0.8%
5 4 0.4%
6 1 0.1%
No final visit 131 12.4%
Total 1,060 100%
Table 4: Number of intermediate visits to the doctor from inclusion to the completion of a 6-month follow-up.
483
ORIGINAL SCIENTIFIC ARTICLE
Treatment of patients with arterial hypertension in family medicine in Slovenia
follow-up after six months. There was a significant drop 
in blood pressure during six months of treatment: sys-
tolic BP of 30 ± 16.1 mm Hg, and diastolic BP of 14.4 ± 
10.5 mm Hg.
Figure 1 shows how the value of systolic BP ranged 
from the first to the final visit with respect to the initial 
stage of hypertension.
Figure 2 shows how the value of diastolic BP ranged 
from the first to the final visit with respect to the initial 
stage of hypertension.
At the final visit, 588 patients reached the target BP, 
which represents 63.3% of patients who completed the 
study.
Number 
of 
patients
Maximum 
BP value 
(mm Hg)
Minimum 
BP value 
(mm Hg)
Mean BP 
value (mm 
Hg)
SD (mm 
Hg)
95% confidence 
interval (mm Hg)
Visit at the inclusion in the 
research (systolic, diastolic) 1,057
250
133
120
53
165.2
96.2
14.5
10.0
(164.4 ; 166.1)
(95.6 ; 96.8)
First control visit (systolic, 
diastolic) 967
216
125
105
57
144.3
84.5
14.7
9.3
(143.3; 145.2)
(85.8 ; 87.0)
Visit at the end of the research 
(systolic, diastolic) 929
192
115
90
45
135.4
81.8
10.9
8.0
(134.7 ; 136.1)
(81.3 ; 82.3)
Table 5: Measured blood pressure values at the beginning of the study, at the first control and at the end of monitoring.
Figure 1: Demonstration of systolic blood pressure movement with respect to the degree of arterial hypertension between 
the first and final visit.
Legend: AH – arterial hypertension, ISH –  isolated systolic hypertension.
100
110
120
130
140
150
160
170
180
190
1st visit 2nd visit
All patients St. 1 AH St. 2 AH St. 3 AH ISH
Final visit
Sy
st
ol
ic
 b
lo
od
 p
re
ss
ur
e 
(m
m
 H
g)
4 Discussion
By monitoring the treatment of patients with arteri-
al hypertension in family medicine practices, we gained 
insight into the management of patients with arterial hy-
pertension and the achievement of the target blood pres-
sure. We identified some opportunities for improving 
treatment management. We were particularly surprised 
that treatment of only a third of patients with arterial 
hypertension included a PN. Given the proportion of 
patients with moderate and severe hypertension, a high-
er proportion would be expected to be treated with com-
bination therapy, and thus possibly reach target blood 
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pressure values in some patients. This was achieved in 
almost two-thirds of patients who completed the fol-
low-up, indicating significantly better blood pressure 
control than more than a decade ago (17-19). This is a 
comparable proportion of patients treated for hyperten-
sion, which was found by a broad-based campaign to 
measure blood pressure led by the International Society 
of Hypertension (24).
Among our subjects, the majority of patients were 
those who had not yet been treated for arterial hyperten-
sion. Many had concomitant risk factors present for car-
diovascular disease, some had organs already affected by 
hypertension, and even pre-existing cardiovascular dis-
ease; a significant proportion had the cardiovascular risk 
estimated as high or very high. The data are comparable 
with the data from the European EURIKA study (25).
Preventive programs include screening patients to 
detect high blood pressure, therefore we would expect a 
higher frequently of detection during a preventive exam-
ination; however, in a large proportion of patients, high 
blood pressure was only identified during a random visit 
to the doctor. This is due to the fact that some clinics 
have only just begun to incorporate the new protocol, 
therefore only a small part of the defined population 
Figure 2: Demonstration of diastolic blood pressure movement with respect to the degree of arterial hypertension between 
the first and final visit.
Legend: AH – arterial hypertension, ISH –  isolated systolic hypertension.
75
80
85
90
95
100
105
110
All patients St. 1 AH St. 2 AH St. 3 AH ISH
1st visit 2nd visit Final visit
Di
as
to
lic
 b
lo
od
 p
re
ss
ur
e 
(m
m
 H
g)
has received a preventive examination. Given the grow-
ing awareness of people about blood pressure manage-
ment due to high-profile health education campaigns 
and projects, such as the month of May being the blood 
pressure measurement month (24), and the high prev-
alence of blood pressure measurement at home (26), it 
is encouraging that a significant proportion of patients 
recognize elevated blood pressure values themselves and 
subsequently visit a physician.
At the first visit, physicians prescribed antihyperten-
sive treatment to most patients and more than half were 
prescribed antihypertensive medication as monother-
apy; however, during the six-month follow-up period, 
the proportion of patients who were prescribed combi-
nation therapy increased, so that almost two-thirds of 
patients received combination therapy. The established 
way of prescribing antihypertensive drugs probably still 
reflects the recommendations of the 2013 guidelines val-
id at the time of the study (20), which offered the pos-
sibility of either prescribing monotherapy or combina-
tion therapy at the beginning of treatment. It is expected 
that the implementation of the new recommendations 
for the treatment of arterial hypertension (27,28), which 
recommend the introduction of combination therapy in 
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ORIGINAL SCIENTIFIC ARTICLE
Treatment of patients with arterial hypertension in family medicine in Slovenia
most patients at the beginning of treatment, preferably 
in a combination tablet, will increase the proportion of 
patients with combination therapy already with the in-
troduction of antihypertensive drugs.
On average, there was a significant reduction in 
blood pressure in patients regardless of the degree of 
hypertension at the time of diagnosis. Nearly two-thirds 
of the patients who completed the six-month follow-up 
reached the target blood pressure values. The data show 
a significant improvement in blood pressure control 
compared to data published more than a decade ago, 
i.e. before the introduction of model practices in family 
medicine, where a comparable methodology was used to 
find that blood pressure was well controlled in 40.1% of 
patients with hypertension (18).
Improvements in awareness of the importance of 
blood pressure control have also been found elsewhere 
in the world, with such improvements being more sig-
nificant in the developed world (29). According to data 
published in 2011, on average 38.8% of patients reached 
the target values of blood pressure (ranging from 32.1% 
– 47.5%) (25) among treated patients in Europe.
In England, a significant improvement in awareness 
of this importance of lowering and controlling blood 
pressure was also seen over the 17-year period from 
1994 to 2011. Among patients treated for arterial hyper-
tension based on team treatment with a PN included, the 
proportion of patients with controlled blood pressure in-
creased from 33% to 63%, while blood pressure control 
in all patients diagnosed with arterial hypertension was 
only 37% (30). In neighbouring Austria, where a PN is 
not involved in patient management, 41% of treated pa-
tients with hypertension have controlled blood pressure; 
this data is comparable to the data for Slovenia before 
the introduction of model practices (31).
It is likely that more intensive antihypertensive treat-
ment in patients whose blood pressure has not been ade-
quately controlled would further increase the proportion 
of those patients who would achieve the set treatment 
goals. Therapeutic inertia of physicians by accepting 
higher blood pressure values as an acceptable norm is an 
important factor in not achieving treatment goals (32,33), 
which was also found in a previous study in which physi-
cians took appropriate treatment action in less than half 
of cases of uncontrolled blood pressure (18).
From 2011, when the first family medicine practices 
were introduced in the health care system to the inclu-
sion of the first patients in the study in 2017, strength-
ened by including a PN into the project of model prac-
tices, we expected that the team treatment of patients 
with hypertension would already be established. This 
turned out not to be the case. There are probably several 
reasons, including the problem of a patient’s access to a 
PN, as one PN cares for patients of two clinics, which 
translated to about 4,000 people, both in prevention 
and in the management of patients with chronic con-
ditions. Besides the accessibility of a PN, it is necessary 
to mention the quality of team treatment, which largely 
depends on the appropriate training of the PN and the 
length of time he or she had worked in family medicine 
practices (34).
The advantage of our study is that it took place in 
family medicine practices where a PN also participates 
in the management of patients, and it involved a large 
number of clinics and patients. Therefore, the data can 
reflect the real situation in Slovenia. The treatment goals 
in terms of blood pressure were determined for each pa-
tient by their personal physician, who took into account 
both the patient’s characteristics and the recommenda-
tions written in the guidelines. Based on the literature 
data, a six-month follow-up after initiation of treatment 
is sufficient to assess blood pressure control (35).
Nevertheless, our study also has some limitations. 
The sample of doctors was not random, but pragmati-
cally chosen. We allowed for the possibility that more 
motivated physicians participated in the treatment of 
patients with hypertension. Data provided by participat-
ing physicians were transferred from existing medical 
records, except for blood pressure measurements, which 
were requested to be performed in accordance with the 
protocol of measuring blood pressure in clinics. We do 
not have data on the reasons why some patients did not 
complete the follow-up, but we allowed for the possibil-
ity that among them are patients who have discontinued 
treatment; the proportion of patients who discontin-
ue taking medication for chronic diseases is highest in 
the first six months after starting treatment (36). Blood 
pressure monitoring data are therefore only valid for 
the treatment of patients with arterial hypertension and 
do not replace blood pressure monitoring data in the 
population.
5 Conclusion
In a prospective observational study, we found that 
despite the relatively high proportion of treated patients 
reaching blood pressure targets, there are opportunities 
to improve the treatment approach by combining two or 
three active substances in one tablet, which is support-
ed by the 2018 European hypertension guidelines and 
dictated by the protocol for the management of patients 
with arterial hypertension in family medicine practices, 
486
GENERAL PRACTICE, MEDICAL TRAINING
Zdrav Vestn | september – october 2021 | Volume 90 | https://doi.org/10.6016/ZdravVestn.3069
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modified in 2019. We have also recognized the need for 
greater involvement of a practice nurse in the treatment 
of patients with hypertension, which we consider espe-
cially important in newly identified patients with arte-
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powerment and participation in the treatment process is 
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Conflict of interest
None declared.
Acknowledgment
We would like to thank the pharmaceutical company 
Krka, d.d., Novo mesto, and its experts for assistance in 
organizing the data collection.
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