P-514: From guidelines to clinical practice: reaching objectives in blood pressure control

Abstract

Objectives:

1: To study the feasibility of reaching the blood pressure (BP) levels recommended by the WHO Guidelines in the daily clinical practice. 2: To assess the effect of such BP control on the individual absolute cardiovascular (CV) risk.

Patients and Methods:

Prospective study in the Primary Care setting. Sixty five consecutive, not controlled hypertensive patients classified at baseline according to the WHO CV-risk categories were enrolled. One-year treatment with the Verapamil SR 180 mg/Trandolapril 2 mg (VT) fixed combination was initiated and titration up to 360/4 mg/day when needed, was established.

Results:

The first 6 months follow-up data are available. Mean age (SD) 61.8(9.8) years. 28 patients (42%) males and 38 (58%) females. Mean BP values (SD), mmHg, were: Baseline SBP/DBP: 169(18)/95(8); Month 6 SBP/DBP: 137(12)/81(8), p<0.0005 in both. Mean differences (CI95%) were, SBP: 32(27–36); DBP: 14(12–17).

A “new category” in the WHO risk table was created for patients with BP below 140/90 after treatment (left column, Grade X). Regarding the CV risk evolution, a clear left sifting was observed (p<0.0005, marginal homogeneity test) mainly due to the BP decrease (Table 1).

	Grade X	Grade I	Grade II	Grade III
No other CVRF	0-0	0-0 low risk	0-0 med risk	0-0 high risk
1-2 CVRF	0-12	2-1 med risk	3-2 med risk	4-0 v. high risk
3 CVRF or TOD or diabetes	0-34	9-7 high risk	21-3 high risk	19-0 v. high risk
ACC	0-3	3-3 v. high risk	3-0 v. high risk	1-0 v. high risk

Conclusions:

1: BP control, as recommended by the WHO Guidelines, can be attained in the daily clinical practice in the Primary Care setting. 2: It is possible to reduce substantially the absolute CV risk of hypertensive patients just by BP control.

Cardiovascular Risk, Blood Pressure Control, Verapamil/Trandolapril