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Published on: October 22, 2014
Cardiovascular risk assessment and risk factor control in patients with hypertension in Europe: the SNAPSHOT study
Dragos Vinereanu1,2, Miquel Camafort3,4, Anastase Dzudie5,6
1Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, Bucharest 020021, Romania.
Insights
Physicians often underestimate cardiovascular risk in hypertensive patients, leading to poor control of blood pressure, LDL cholesterol, and HbA1c. Improved guideline implementation is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Underestimating cardiovascular risk in hypertension can lead to inadequate management of key health indicators.
- This study addresses the gap in understanding cardiovascular risk assessment and control in routine clinical practice.
Purpose of the Study:
- To investigate cardiovascular risk assessment accuracy among physicians treating hypertensive patients.
- To evaluate the control rates of blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin in this population.
Main Methods:
- An observational, cross-sectional epidemiological study (SNAPSHOT) involving 9307 adult hypertensive patients across six European countries.
- Cardiovascular risk was assessed using physician practices, guidelines, and SCORE1/SCORE2/SCORE2-OP models.
- Control rates for blood pressure, LDL cholesterol, and HbA1c were evaluated.
Main Results:
- Physician risk assessment was accurate in only 38.0% (SCORE1) and 26.7% (SCORE2/SCORE2-OP), with underestimation in 54.3% and 71.8% of patients, respectively.
- Suboptimal control rates were observed: blood pressure (<25%), LDL cholesterol (<12% in dyslipidaemia), and HbA1c (<50% in type 2 diabetes).
- Most patients (91.3%) had at least one additional cardiovascular risk factor; 81.8% had dyslipidaemia and 33.3% had type 2 diabetes.
Conclusions:
- Physicians tend to overestimate control rates for blood pressure and LDL cholesterol while underestimating cardiovascular risk.
- Overall control rates for blood pressure, LDL cholesterol, and HbA1c remain low in hypertensive patients.
- Enhanced implementation of clinical guidelines is necessary for improved cardiovascular risk management.
Aims:
Underestimated cardiovascular (CV) risk may lead to inadequate control of blood pressure (BP), LDL cholesterol, and glycated haemoglobin. This study investigated CV risk assessment and BP, LDL cholesterol, and glycated haemoglobin control among patients with hypertension in routine clinical practice.
Methods And Results:
In the observational, cross-sectional, epidemiological SNAPSHOT study (conducted in Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain), CV risk was assessed in adults with hypertension according to the physician clinical practices, guidelines, and the risk assessment models valid when the study was performed (SCORE1 and SCORE2/SCORE2-OP). Blood pressure, LDL cholesterol, and glycated haemoglobin control rates were also assessed. Of 9307 patients (aged 65.8 ± 10.5 years, 43.1% male), most (91.3%) had ≥1 additional CV risk factor; 7610 (81.8%) had dyslipidaemia and 3097 (33.3%) had type 2 diabetes (T2D). Compared with guideline recommendations, assessment of patient CV risk by physicians, relative to the risk obtained using SCORE1 and SCORE2/SCORE2-OP, was accurate in only 38.0 and 26.7% of patients, respectively, and was underestimated in 54.3 and 71.8% of patients. Control rates of BP, LDL cholesterol, and glycated haemoglobin were suboptimal [<25%, <12% (in those with comorbid dyslipidaemia), and <50% (in those with comorbid T2D), respectively].
Conclusion:
Physicians from six European countries tended to overestimate control rates of BP and LDL cholesterol, while underestimating CV risk in their patients with hypertension. Overall, BP, LDL cholesterol, and glycated haemoglobin control rates were low. Better implementation of clinical guideline recommendations is needed.
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