Objective: To assess correlation between patient reported outcomes (PRO: socio-economic factors, depression level, and treatment adherence) and control of blood pressure (BP) and LDL-cholesterol (LDL-C). Design and method: This cross-sectional, observational, multicenter, epidemiological (SNAPSHOT-1) study included 2469 hypertensive patients with dyslipidemia, from outpatient clinics, recruited by cardiologists, diabetologists and general practitioners. Patients completed a three-part questionnaire including: (1) questions on socio-economic factors (education, marital status, working status, socio-professional category, incomes, and physical activity); (2) Patient Health Questionnaire (PHQ-9) (Depression scale); and (3) Hill-Bone Medication Adherence Scale (HBMAS) for hypertension and dyslipidemia (according to scoring guide, patients were considered as adherent if they answered “none of the time” or “some of the time” to specific questions). The correlations between PRO and control status and those between self-reported adherence and other PRO were assessed by logistic regression models (including variables with p-value<0.2 in univariate analyses on top of age, gender, and ethnicity). Results: Study population included 40.9% men, aged 65.0±10.0 years. Half of patients had depression symptoms (53.3%). The majority of patients self-reported being adherent to their hypertension (91.8%) and dyslipidemia (89.6%) treatments. Socio-economic factors are described in Table 1. Patients with higher socio-professional category (managerial), without depression symptoms, and good adherence to treatment were more likely to have their BP controlled. Patients with good adherence to treatment were more likely to have their LDL-C controlled (Table 2). Patients with higher socio-professional category, not married/not in relationship, physically active, and without depression symptoms were more likely to be adherent to antihypertensive treatment. Patients not married/not in relationship, physically active, and without depression symptoms were more likely to be adherent to lipid-lowering treatment. Higher education highly correlated with adherence to antihypertensive treatment (Table 3). Conclusions: Patient reported outcomes (PRO) correlate with BP and LDL-C control. Self-reported adherence to treatment also correlates with some socio-economic factors and with depression level. Thus, relevance of PRO assessment in routine clinical practice in patients with hypertension and dyslipidemia needs to be further evaluated.
Background Blood pressure (BP) and LDL-cholesterol control worldwide is still suboptimal. New European and American guidelines have introduced more strict recommendations regarding BP and LDL-cholesterol goals, but data of how difficult is to reach them in routine clinical practice is missing. Triple combination (preferably in a single pill) has been recommended as the 2nd step for the BP control, but data on its efficacy and treatment adherence is limited. Purpose To assess BP control at baseline, and after 6 months of optimized treatment with a single pill triple combination (of perindopril, amlodipine, and indapamide), and to assess associated risk factors control and treatment adherence. Methods In an observational, multicentric, prospective study, involving 209 investigators, we included 2077 patients (62±10 years; 49% men) with primary hypertension, in sinus rhythm, on current treatment with a single pill triple combination for at least one month prior to inclusion. General characteristics, cardiovascular risk factors, concomitant diseases, concomitant medications, fixed triple combination dosage, and adherence score were collected at baseline (V1), one month (V2), and 6 months (V3). Standardized office BP was measured with a single type sphygmomanometer, at each visit. Lipid profile was collected, if available. At V1 and V2, non-pharmacological and pharmacological treatment was optimized, according to the current guidelines. Results At baseline, BP control was suboptimal: only 37% of patients (38% of non-diabetic and 33% of diabetic patients) had optimal BP control as per ESC guidelines 2013, whereas only 10% of patients (11% of non-diabetic and 10% of diabetic patients) had optimal BP control as per ESC guidelines 2018. However, after 6 months of optimized treatment, 75% of patients (78% of non-diabetic and 67% of diabetic patients) had optimal BP control as per ESC guidelines 2013, while 33% of patients (33% of non-diabetic and 33% of diabetic patients) had optimal BP control as per ESC guidelines 2018. At baseline, despite that 52% of patients were on a statin, only 12% of patients at very high cardiovascular risk had an LDL-cholesterol<70 mg/dl, while only 25% of patients at high cardiovascular risk had a LDL-cholesterol<100 mg/dl; at 6 months, 13% of patients at very high cardiovascular risk had an LDL-cholesterol<70 mg/dl, while 30% of patients at high cardiovascular risk had a LDL-cholesterol<100 mg/dl. Single pill triple combination dose was increased at V1 in 29% of patients, and at V2 in 7% of patients. Adherence score increased from 7.0±1.6 at V1 to 7.4±1.1 at V3 (p<0.001). Conclusion BP control and LDL-cholesterol control, according to the new guidelines, is far from optimal. However, by optimizing non-pharmacological treatment and increasing dosing and adherence of a single pill triple combination, BP control can be markedly improved. Acknowledgement/Funding Servier Pharma
Objective: To assess cardiovascular (CV) risk measurement, blood pressure (BP) and LDL-cholesterol (LDL) control rates, in hypertensive patients with dyslipidemia, based on current recommendations of guidelines, and compare them with assessment provided by physicians. Design and method: Cross-sectional, observational, multicenter epidemiological study (SNAPSHOT-1), conducted in Romania, involved 130 investigators (general practitioners, cardiologists, and diabetologists), and included 2469 hypertensive patients with dyslipidemia. Results: Study population (65±10 years; 40.9% men) had the following characteristics: 12.1% smokers; 40.9% overweight and 45.2% obese (BMI 30.1±5.2 kg/m2); 80.0% had comorbidities, most frequently diabetes mellitus (45.0%), angina (28.8%), and chronic kidney disease (18.8%). Mean systolic / diastolic BP were 137.6±17.1 / 81.0±10.4 mmHg, total cholesterol was 199.1±54.3 mg/dL, HDL-C 51.2±15.9 mg/dL, LDL-C 118.4±46.4 mg/dL, and triglycerides 162.1±92.4 mg/dL. CV risk was estimated by the investigators as “high” or “very high” for 34.3% and 35.4% of patients, respectively, whereas calculated CV risk according to the SCORE chart 1 was “high” or “very high” for 12.6% and 81.8% of patients. Thus, only 41.5% of the investigators estimated CV risk accurately, while 54.2% underestimated it. Hypertension was treated in 98.1% of patients. BP was considered controlled by investigators in 71.2% of patients, whereas BP control based on European recommendations was achieved by only 25.0% of patients. Dyslipidemia was treated in 90.9% of patients. LDL-C was considered controlled by investigators in 46.1% of patients, whereas LDL-C control based on European recommendations was achieved by only 8.8% of patients. Both BP and LDL-C were considered controlled by investigators in 39.6% of patients, whereas both targets were controlled based on European recommendations in only 3.3% of patients (Figure). 44.7% of patients were treated with a single-pill combination for hypertension, and only 9.0% received treatment for both hypertension and dyslipidemia in a single pill. Conclusions: This study showed that CV risk is underestimated by physicians in more than half of patients. BP and LDL-C control is markedly overestimated by physicians, while real control rates remain very low. Use of single-pill combinations is still low.
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