Abstract Body: Introduction: Uncontrolled blood pressure (BP) is the main risk factor that increases morbidity and mortality, especially in patients with high or very high cardiovascular (CV) risk, in whom this control is often notably low.
Hypothesis: Lack of adherence and therapeutic inertia have been proposed as barriers to achieving BP control. Our objective is to evaluate the impact of hypertension (HTN) in a Spaniard population with high-very high CV risk, how many of them are out of target, and how we can improve it.
Methods: Multicenter, prospective and interventional study, carried out under usual clinical practice in patients selected by random sampling from 88 primary care or hospital outpatient clinics throughout Spain. Patients who met the conditions of high or very high CV risk were included. BP control criteria were considered using standardized measurements, according to European guidelines (<140/80mmHg in patients >65 years and <130/80mmHg in patients <65 years). After the baseline, patients were followed monthly for 4 months. BP, anthropometric measures, adherence and laboratory test were collected. Treatments could be freely modified in case of loss of control.
Results: 1287 patients (821M, 466W) were included, mean age 67±13y. 970 (75.3%) had a very high CV risk and 317 (24.6%) had a high CV risk. They were current smokers 18%, obese 36%, overweight 38%, sedentary 62%. A total of 1117 patients (86.7%) were hypertensive, although 7% of those considered non-hypertensives had their BP targets out of control. 32% had resistant HTN (three or more drugs). Initially, BP (137/77 mmHg) was only controlled in 39% of patients. After the intervention, BP (131/74 mmHg) control increased to 54% (p<0.01). Most of prescribed drugs were diuretics (56%) and 32% used fixed-dose antihypertensive combination therapy. Non-compliance was reduced from 18.5% to 8% at the end of study. Therapeutic inertia reached 60%, only 40% of investigators modified the doses or combinations of antihypertensives during the study.
Conclusions: Among our Spaniard population with high cardiovascular risk, hypertension control is deficient. However, despite a favorable evolution in compliance, only slightly more than half of the analyzed sample achieved blood pressure control according to international guidelines. Increased use of fixed-dose antihypertensive combinations may improve these results. Therapeutic inertia remains an obstacle to achieving these goals, so measures to reduce it are needed.