P-370: Management of high-risk hypertensive patients in Spain. The Tarvest study

• Published in: American journal of hypertension Vol. 18; no. S4; p. 140A
• Main Authors: Barrios, Vivencio, Hernandez, Ramon, Ruilope, Luis M., Redon, Josep M., De la Figuera, Mariano, Calderon, Alberto
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-05-2005
• Subjects: Global Cardiovascular risk; Guidelines; Risk Factors
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.03.388

Clinical guidelines clearly define the management of high risk hypertensive patients (HRP). Since these recommendations are often poorly followed, we aimed to assess the management of HRP in daily clinical practice. We evaluate two clinical healthcare settings, primary care (PC) and specialist clinic (SC) in Spain. An epidemiologic crossectional study in hypertensive patients (HP) with diabetes and/or cardiovascular disease: coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral artery disease (PAD) or chronic renal failure (CRF). HRP who fulfilled inclusion criteria were recruited from a registry of the HP attended in an outpatient clinic one day. Data of HRP were collected in a case report form. Quality of the collected data were strictly controlled by an external CRO. Results: Out of the registry of 12964 HP, 5552 were recruited as HRP (age 67 years; 51% men). 2958 (53.4%) from PC and 2564 from SC. 58% diabetics (69.1% PC vs 51% SC; p<0.001); 36% CAD (25.9 vs 47.4; p<0.001); 14% CVD (11.9 vs 15.7; p<0.001); 11% PAD (10.5 vs 11.8; p=ns); 10% CRF (5.2 vs 14.9; p<0.001). Risk factors: 59% sedentarism, 56% dyslipidaemia, 49% obesity; 18% smoking. Mean BP: 145.7/84.4 mmHg; total cholesterol: 208 mg/dl; c-LDL: 128. According to the investigators, 79.3% patients were classified as high risk, 11.9% as very high risk. According to WHO/ISH criteria, 89.4% were very high risk patients (p <0.001). Therapy: 97% antihypertensives, 52% antiplatelets, 47% antidiabetics. Some significant differences were observed between population from PC and SC. Conclusions: Cardiovascular risk is often underestimated. BP and c-LDL controls are very poor and strongly differ from internationally accepted recommendations in HRP. The use of antiplatelets is lower than recommended. All these findings demonstrate that application of guidelines for HRP management is scarce in daily clinical practice in Spain.