Implicaciones clínicas y de salud pública del proyecto CARDIORISC

Abstract

Adequate control of hypertension is known to be low in population and medical settings. However, physicians frequently misclassify patients’ blood pressure (BP) status at the office compared with ambulatory BP monitoring (ABPM). Information from ABPM is important for better knowledge of BP management in clinical practice, as well as for public health purposes. In this article, we present the burden of underestimation and overestimation of BP control, respectively, revealed by ABPM, by using the Spanish Society of Hypertension ABPM Registry, based on a large-scale network of Spanish physicians trained in ABPM (CARDIORISC project). Approximately 24% of treated hypertensive patients (with indications of ABPM) had BP controlled in the office, and approximately 52% were controlled according to daytime ABPM. These findings convey an important clinical implication, an encouraging message to clinicians, namely, that they are actually doing better than evidenced by office-based data. Furthermore, ABPM revealed that, at the office, BP control is underestimated by physicians in one out of every three hypertensive patients and is overestimated in one out of every 20 patients. In other words, the burden of undetected controlled and uncontrolled hypertension is substantial. Moreover, based on data from the CARDIORISC project, approximately 4 million hypertensives are estimated to be truly controlled (ABPM-based) instead of 2 million (office-based), while a further 4 million are actually uncontrolled instead of 6 million. Hence, physicians should be aware that assessment of BP control may well be inadequate if based on office BP measurement alone. Furthermore, knowledge of these data may contribute to more efficient planning of health resources, since many hypertensive patients previously believed to be uncontrolled are in fact controlled. However, the use of ABPM also identifies previously undetected uncontrolled hypertensive patients, who are at higher cardiovascular risk than estimated by office-based methods, thereby implying additional costs. ABPM is rarely available at clinics, and an effort is thus needed to extend its use and indication in the future. Fortunately, in general, ABPM is more cost-effective than office BP in the follow-up of hypertension.