HYPERTENSION MANAGEMENT IN GEORGIA: BRIDGING GAPS IN CARDIOVASCULAR RISK ASSESSMENT AND BLOOD PRESSURE CONTROL (SNAPSHOT STUDY)

Abstract

Objective: To assess management of hypertensive patients in Georgia, including cardiovascular (CV) risk and blood pressure (BP) control. Design and method: SNAPSHOT is a cross-sectional observational multicenter epidemiological study that included 607 hypertensive patients in Georgia. The assessment of CV risk and BP control performed by investigators was compared to evaluations based on recommendations from European guidelines (SCORE 2&OP). Results: Patients were recruited by 31 investigators, of which 74.2% were cardiologists, 12.9% endocrinologists, 9.7% neurologists, and 3.2% general practitioners. The analysis included 606 patients with a mean (standard deviation [SD]) age of 63.0 (11.6). Half patients were female (51.7%). Most patients were overweight or obese (81.8%) and non-smokers (68.8%). They had no (11.5%), one (36.6%), 2 (37.5%), 3 (14.2%), or 4 (0.2%) risk factors for hypertension. Most patients (68.4%) had additional comorbidities, mainly dyslipidemia (46.6%), coronary artery disease (35.0%) and diabetes mellitus (24.3%). Hypertension was treated in 93.9% of patients, with the most common treatments consisting of angiotensin-converting enzyme inhibitors (63.0%), diuretics (59.0%), and/or beta blockers (55.5%). The co-administration of these treatments, along with other BP-lowering medications, occurred in 37.3% (combination of 2) and 36.8% (combination of 3) of patients. Moreover, 63.9% of patients used a single-pill combination. Mean (SD) systolic and diastolic BP were 141.2 (20.8) mmHg and 84.7 (11.6) mmHg, respectively. BP was considered controlled according to the investigator in 72.0% of patients, while it was actually controlled according to guidelines in 19.1% of patients. CV risk was assessed by the investigator as low, moderate, high, or very high in respectively 21.0%, 30.9%, 27.1%, and 21.0% of patients. According to guidelines, CV risk was mainly categorized as high (15.2%) or very high (84.6%). Therefore, there was an agreement between the 2 risk assessments in only 33.3% of cases, while the investigators underestimated the risk for 64.6% of patients. Conclusions: This study brought attention to significant disparities in hypertension and CV risk assessment compared to guideline recommendations. This emphasized the importance of adhering to established guidelines for medical assessments to enhance the effectiveness of hypertension management in Georgia.