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Therapeutic goal attainment in patients with hypertension and dyslipidemia
Michael L Johnson1, Kenneth Pietz, David S Battleman
1Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center and Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas 77030, USA. mjohnson@bcm.tmc.edu
Insights
Despite pharmacological treatment for hypertension and dyslipidemia, fewer than 50% of patients achieved therapeutic goals. This highlights a need for improved management strategies for individuals with multiple cardiovascular risk factors.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Recent guidelines advocate for comprehensive cardiovascular disease risk management by addressing multiple risk factors concurrently.
- Assessing treatment patterns and goal attainment is crucial for patients with hypertension and dyslipidemia, especially those with diabetes mellitus (DM) or symptomatic cardiovascular disease.
Purpose of the Study:
- To evaluate treatment patterns and achievement of therapeutic goals in patients with isolated and concomitant hypertension and dyslipidemia.
- To analyze these outcomes in the presence or absence of diabetes mellitus (DM) and symptomatic cardiovascular disease.
Main Methods:
- Analysis of inception cohorts comprising over 41,000 patients diagnosed with hypertension and/or dyslipidemia.
- Evaluation of treatment patterns and attainment of low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) goals at one year, stratified by DM and symptomatic cardiovascular disease status.
Main Results:
- Treatment rates for hypertension and dyslipidemia varied, ranging from 31.5% to 91.3% depending on the condition(s) and patient group.
- Blood pressure (BP) goal attainment was suboptimal, particularly in patients with diabetes mellitus (DM) and isolated hypertension (20.6%).
- Low-density lipoprotein cholesterol (LDL-C) goal attainment was slightly better in patients with DM and concomitant hypertension (52.8%), but overall goal achievement for both BP and LDL-C was low (<40% for symptomatic patients, and <25% for asymptomatic patients with concomitant disease).
Conclusions:
- While most patients received pharmacological treatment for hypertension and dyslipidemia, therapeutic goal attainment was generally below 50%.
- Further research is necessary to identify factors that can improve the management and outcomes for patients with multiple cardiovascular risk factors.
Background:
Recent guidelines emphasize the need to assess and treat overall risk for cardiovascular disease through the concomitant management of multiple risk factors. We sought to ascertain treatment patterns and attainment of therapeutic goals in patients with isolated and concomitant hypertension and dyslipidemia, both with and without diabetes mellitus (DM) and symptomatic cardiovascular disease.
Methods:
Inception cohorts of more than 41,000 newly diagnosed hypertension and dyslipidemia patients from 6 medical centers of the south-central Veterans Affairs health care system were evaluated. Treatment patterns and goal attainment for low-density lipoprotein cholesterol (LDL-C; Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults guidelines: <160, <130, or
Results:
Treatment rates in patients with and without DM and symptomatic disease ranged from 46.6% to 71.3% in patients with hypertension only, from 31.5% to 64.1% in patients with dyslipidemia only, and from 64.3% to 91.3% in patients with both conditions. Among asymptomatic patients, 40.6% of nondiabetics and 20.6% of patients with DM with isolated hypertension reached BP targets. Attainment of LDL-C goals was slightly higher and reached 52.8% among patients with DM with concomitant hypertension. Among symptomatic patients, attainment of all goals was <40% for all groups. The proportion of asymptomatic patients with concomitant disease reaching goal for both BP and LDL-C was 24.4% among nondiabetics and 15.4% among patients with DM; these proportions decreased to 13.6% and 13.4% respectively, among patients with symptomatic cardiovascular disease.
Conclusions:
The majority of patients were receiving pharmacological treatment of hypertension and dyslipidemia, yet attainment of therapeutic goals was generally <50%. Further work is needed to determine factors related to improvement in management and outcomes of patients with multiple cardiovascular risk factors.
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