Overall cardiovascular risk still ignored in general practice care of hypertension

Recent guidelines for the management of arterial hypertension have emphasized the importance of total cardiovascular risk for setting the blood pressure (BP) goal to be achieved and the intensity with which it should be pursued.

To assess the degree of BP control in hypertensives receiving long-term antihypertensive treatment according to the presence of major cardiovascular risk factors or diseases and the level of individual total cardiovascular risk, a large sample of general practitioners throughout Italy had to evaluate a random sample of their hypertensive patients.

A clinical history was collected for each patient and BP was measured three times using a reliable automatic instrument. To stratify the cardiovascular risk we used the criteria suggested by the 1999 WHO-ISH guidelines.

Among the 1204 patients recruited (mean age 64.2 +/- 11.4 years, 663 females), only 399 patients (33.1%) had a BP lower than 140/90 mmHg. Except for male sex and previous myocardial infarction, the concomitant presence of major cardiovascular risk factors or diseases was never associated to a better control of hypertension. BP control was unrelated to individual overall cardiovascular risk: BP was < 140/90 mmHg respectively in 44.0, 37.7, 33.5 and 42.1% (P for trend = 0.54) of people aged less than 65 years with low, medium, high and very high risk and in 27.7, 25.9 and 27.1% (P for trend = 0.91) of people aged more than 65 years at medium, high and very high risk.

BP control in Italian hypertensives is still unsatisfactory, even in patients at high and very high cardiovascular risk.