Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain

Abstract

H ypertension accounts for a substantial portion of cardiovascular disease (CVD) and mortality in the general population.1,2 However, the mortality gap between adults with and without hypertension has remained relatively constant over time in some countries.2 Consequently, efforts are needed to accelerate the decrease in the mortality rate among hypertensive adults.In this vein, clinical guidelines on hypertension management not only focus on blood pressure (BP) but have also proposed lifestyle and treatment targets for associated CVD risk factors.3,4 Some organizations are also launching multifaceted interventions on health factors and behaviors to reduce the burden of CVD. 5,6 However, the achievement of targets for CVD risk factors associated with hypertension 7,8 has been studied much less than the control of hypertension itself. 9-11 Previous research focused on only a few additional risk factors screened in primary care clinics, 7 generally lipids and glucose profile, or reported the association of BP control with lifestyle and some metabolic abnormalities in clinical settings. 8,[12][13][14][15] Lastly, little is known as to whether the diagnosis of hypertension is related to the degree of attainment of cardiometabolic goals.In this study, we examined the nationwide degree of awareness of hypertension in the adult population of Spain and the achievement of cardiometabolic goals according to awareness of the hypertensive condition of the individuals. We also presented the prevalence and control of all hypertensive patients. To our knowledge, no previous study has reported a comprehensive assessment of the attainment of Abstract-Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index <25 kg/m 2 , 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c <6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein <115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-develop...

Cost of poor adherence to anti-hypertensive therapy in five European countries

“…The total cost of CV events attributable to hypertension was estimated to exceed €51.3 [18] 81,843,743 [19] 46,815,916 [20] 65,281,000 [21] 52,642,500 [22] Percentage of females 51.48 % [18] 50.87 % [19] 50.65 % [20] 51.57 % [21] 50.84 % [22] Percentage of females; age C 30 years 71.76 % [18] 70.86 % [19] 69.37 % [20] 64.76 % [21] 63.54 % [22] Percentage of males; age C 30 years 68.59 % [18] 68.33 % [19] 67.05 % [20] 61.39 % [21] 61. 17 Percentage of diagnosed and treated hypertensive subjects 73.00 % [30] 77.00 % [31] 59.40 % [26] 56.92 % [27,29] 58.38 % [32] Percentage of diagnosed patients with adherence C80 % 41.50 % [9] 66.90 % [13] 39.40 % [14] 39.00 % [12] 56.85 % [11] billion over a time span of 10 years (range €5.0 in England and €17.1 in Germany). Considering only the costs associated with diagnosed and treated patients, drug cost is estimated, on average, to represent 37 % (range 10 % in England and 71 % in Spain) of the total cost of the disease and the remaining part being attributed to hospitalisations (Table 5).…”

Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain

“…1,3,5 In contrast, body mass indices, prevalent obesity, and prevalent diabetes mellitus are lower in Spain, whereas low-density lipoprotein cholesterol is lower in the United States. Among hypertensive patients in Spain, diabetes mellitus control, defined as a hemoglobin A1c <6.5%, is excellent at 59.6%.…”

“…[1][2][3] More specifically, the prevalence of hypertension is marginally higher in Spain than in the United States, whereas awareness, treatment, and control of hypertension are much lower in Spain than in the United States. Hypertension prevalence, awareness, and control were defined similarly in both countries (Table 1), although blood pressure was measured in triplicate in 2 sets of measurements separated by 90 minutes in the Spain cohort and in triplicate in only 1 set of readings in the US cohort.…”

“…Such an approach is costly and susceptible to failure at several points as the clinical epidemiological data show (Table 1). [1][2][3] If health promotion and disease prevention goals are to be achieved 15 without an effective public health mass strategy campaign, then ever lower levels of risk will require medical management. 16 Given constrained resources, population health can be advanced by re-energizing the public health/ mass strategy approach 13 and/or transitioning to more efficient, less costly medical interventions for reducing global cardiometatolic risk, for example, a polypill with minimal medical monitoring for most adults.…”

“…T he article by Banegas et al 1 published in the present issue of Hypertension provides important population-based data for improving cardiovascular health. The data from a population-based sample of adults in Spain during 2008-2010 include the clinical epidemiology of hypertension and concomitant cardiovascular risk factors, evidence-based pharmacotherapy for cardiovascular risk factor reduction and target organ protection, medical advice, and lifestyle factors.…”