Perfil de riesgo cardiovascular de los pacientes con hipertensión arterial no controlada. Estudio Control-Project

Background and objective: To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP] >= 140/90 mmHg or >= 130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem. Patients and method: Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients. Results: Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3 ± 11.4 years; 56.7% women). Normal BP values (< 140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (>= 180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI = 94.7-97.2%), target organ damage in 34.5% (95% CI = 31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI = 33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI = 31.5-38.2%) were at very-high risk; 29.4% (95% CI = 26.4-32.8%) at high risk; 30.4% (95% CI = 27.2-33.7%) at moderate risk and 5.4% (95% CI= 3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI = 28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs. Conclusions: Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.