Cardiovascular risk profile of the Spanish hypertensive population attended in primary care medicine compared to that attended by specialists. CONTROLRISK study

Abstract

CONTROLRISK is an ongoing study designed to compare the cardiovascular risk (CVR) profile of the Spanish hypertensive population attended in primary care medicine (PCM) to that of patients who attend a specialist outpatient clinic (SOC). For CVR stratification we used the WHO/ISH 1999 classification in low, medium, high and very high risk. We present the preliminary data of the first enrolled patients. To date, 6.858 patients have been included, 3.694 from SOC and 3.164 from PCM. The demographic characteristics are: age 63.1±11 vs 63.3±11 (SOC vs PCM; p=ns); females 52.1% vs 56.6% (p<0.05); BMI 28.5±4.5 vs 29±4.8 kg/m2 (p=ns). Systolic blood pressure (BP) was higher in the SOC patients: 160.5±16 vs 159.5±16 (p=0.017). However, diastolic BP was similar in both groups: 93.1±10 vs 92.7±10. Accordingly to WHO/ISH 1999, 81% of SOC and 78.5% of PCM patients presented one or more CVR factors (being the age the most frequent in both groups). Target organ damage was present in 53% and 32.5% of SOC and PCM patients respectively (left ventricular hypertrophy was the commonest in both). 36% (SOC) and 27% (PCM) suffered from associated clinical conditions (mainly ischemic heart disease). Following the data provided by the physicians, the stratification in SOC patients showed that 8% (CI 95%: 7.2–9.0) were of low risk, 21% (19.9–22.7) medium, 33% (31.3–34.5) high, and 38% (36.1–39.3) of a very high risk. In PCM group, the CVR was low in 11% (9.7–11.8), medium in 35% (33–36.4), high in 24% (22.8–25.8) and very high in 30% (28.7–31.9). The rate of patients with high and very high risk was significantly higher in SOC group than in PCM (71% vs 54%, p<0.05). Conclusions: More than a half of the hypertensive patients who attend a primary care outpatient clinic in Spain belongs to the group of high or very high risk (54%). As expected, the patients who attend a specialist outpatient clinic are even of a higher risk (71% of high or very high risk). This is mainly due to a higher incidence of target organ damage and associated clinical conditions in the group of patients attended by specialists.