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Cardiovascular risk stratification and antihypertensive therapy according to guidelines in the outpatient setting

Jörg Slany1, Günther Nirnberger, Lothar A Pittrow

  • 1Specialist for Internal Medicine, Cardiology & Angiology, Vienna, Austria.

Wiener Medizinische Wochenschrift (1946)
|September 30, 2011
PubMed

Insights

Austrian physicians often underestimate cardiovascular risk in hypertension patients. Guidelines for combination therapy are not always followed, but candesartan effectively controls blood pressure.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Practice Guidelines

Background:

  • The adoption of the European Society of Hypertension/European Society of Cardiology (ESH/ESC) 2007 hypertension guidelines and their 2009 reappraisal among Austrian practitioners is not well-documented.
  • A non-interventional trial was conducted to assess the understanding and application of these guidelines in clinical practice.

Purpose of the Study:

  • To evaluate the accuracy of cardiovascular risk categorization by office-based physicians compared to independent adjudication using ESH/ESC charts.
  • To assess compliance with combination therapy recommendations for grade 2 and 3 hypertension.
  • To evaluate the efficacy and tolerability of candesartan treatment.

Main Methods:

  • A non-interventional trial involving 3,488 ambulatory hypertensive patients in Austria.
  • Physicians' risk assessment was compared against an independent risk adjudication using the same data and ESH/ESC methodology.
  • Compliance with combination therapy and the effectiveness of candesartan (alone or with hydrochlorothiazide) were assessed.

Main Results:

  • Physicians incorrectly assessed cardiovascular risk in approximately 60% of patients, with a significant tendency towards underestimation.
  • Despite guidelines recommending initial combination therapy for hypertension ≥160/90 mmHg, 15.4% of these patients received candesartan monotherapy.
  • Candesartan, alone or with hydrochlorothiazide (HCTZ), achieved target blood pressure (≤140/90 mmHg) in 81.6% of patients with grade 1-3 hypertension.

Conclusions:

  • There is a need for improved communication of hypertension guidelines regarding individual risk assessment and therapy algorithms in outpatient settings.
  • Candesartan, as monotherapy or in combination with HCTZ, demonstrates effectiveness and good tolerability for blood pressure control in most hypertensive patients.
Abstract

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