Treatment and Control of BP and Lipids in Patients with Hypertension and Additional Risk Factors

Abstract

NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines recommend that for patients at high risk for cardiovascular disease (CVD), lipid-lowering therapy should be considered even at relatively low cholesterol levels (low-density lipoprotein-cholesterol>or=100 mg/dL). Furthermore, the ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm) has demonstrated the importance of statin therapy in the primary prevention of major cardiovascular events in people with hypertension and>or=3 cardiovascular risk factors with total cholesterol levels of<or=250 mg/dL (<or=6.5 mmol/L). To analyze the utilization of antihypertensive and lipid-lowering medications, and associated rates of BP and cholesterol goal attainment, in the primary prevention of CVD among patients with hypertension. Retrospective cross-sectional analysis of data from outpatient medical records (including BP, co-morbidities, and medications) abstracted for visits between 1 October 2001 and 30 September 2003 to the Atlanta Veterans Affairs Medical Center (VAMC). Patients were tracked for at least 1 year. Veterans newly diagnosed with hypertension, with lipid levels<or=240 mg/dL (<or=6.2 mmol/L) and no prior coronary heart disease, and who were seeking care at the VAMC were included in the analysis. Patients were grouped by the presence of<3 or>or=3 cardiovascular risk factors in addition to hypertension. The frequency of utilizing antihypertensive and lipid-lowering medications, and attainment of BP targets were assessed based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines (<140/90 mm Hg, or<130/80 mm Hg for patients with diabetes mellitus or chronic kidney disease) and a ratio of total cholesterol/high-density lipoprotein-cholesterol (HDL-C)<6. A total of 7839 veterans were included. Mean age was 58.7+/-13.2 years, and 93.8% were men. Among patients with>or=3 cardiovascular risk factors, 81.9% received any antihypertensive medication and 60.4% were prescribed multiple antihypertensive agents compared with 69.7% and 44.3% of patients, respectively, in the group with<3 cardiovascular risk factors. Lipid-lowering medications were prescribed to 55.3% of patients with>or=3 cardiovascular risk factors, and to 33.8% of those with<3 cardiovascular risk factors. Overall, 14.3% of patients met both BP and lipid targets (8.1% and 17.4% of patients with>or=3 and<3 cardiovascular risk factors, respectively [p<0.0001]). JNC 7 goals were attained in 27.9% of patients with>or=3 cardiovascular risk factors and 41.7% of those with<3 cardiovascular risk factors (p<0.001). Total cholesterol/HDL-C ratio<6 was achieved by 32.3% of patients with>or=3 cardiovascular risk factors and 52.1% of those with<3 cardiovascular risk factors (p<0.001). Veterans with>or=3 risk factors for CVD were treated more intensively, but levels of goal attainment were lower compared with patients with<3 cardiovascular risk factors. Our results suggest that the therapeutic strategies used by physicians in the Atlanta VAMC need to be adapted in order to improve lipid goal attainment among patients with hypertension, and thereby further reduce the risk of cardiovascular events.