Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study

Abstract

OBJECTIVES: Hypertension is common among patients with dyslipidemia but is often poorly treated. The objective of this analysis was to evaluate how a decision aid, used by primary care physicians to improve lipid therapy, impacted on the treatment of hypertension.STUDY DESIGN: Data were analyzed from patients enrolled in a randomized trial focusing primarily on the treatment of dyslipidemia. Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and/or pharmacotherapy to treat dyslipidemia. Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines.RESULTS: There were 2,631 subjects who completed the study. Among 1,352 patients without diagnosed hypertension, 30% were above target on at least three consecutive visits. Among 1,279 individuals with known hypertension, 69% were above target on at least two consecutive visits. Overall, patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy (OR=1.40, 95% CI 1.11 -1.78) compared to those receiving usual care. After adjustment for inter-physician variability and potential confounders, the use of the risk profile was associated with an increased likelihood of starting therapy (OR=1.78, 95% CI 1.06 -3.00) or modifying therapy (OR=1.40, 95% CI 1.03 -1.91). CONCLUSIONS:In this clinical trial of dyslipidemia management, inadequately controlled hypertension was common, occurring in nearly 50% of individuals. Ongoing coronary risk assessment was associated with more appropriate blood pressure management. Cardiovascular risk assessment decision aids should be further evaluated in a randomized trial of hypertension therapy.

Lifestyle Educational Program Strongly Increases Compliance to Nonpharmacologic Intervention in Hypertensive Patients: A 2‐Year Follow‐Up Study

“…This observation is in agreement with previous findings regarding the effectiveness of discussing coronary risk in order to improve pharmacologic BP control 18 or drug treatment of dyslipidemia. 19 In our experience, however, it is much more difficult to maintain adherence to the nonpharmacologic treatment than to drug therapy since lifestyle changes are frequently considered stressful conditions in daily life, particularly in the case of maintaining BW control in obese patients.…”

Perceived Lifetime Risk for Cardiovascular Disease (from the Dallas Heart Study)

“…It has been shown that patients’ awareness of cardiovascular risk level is a motivating factor for them to make lifestyle changes (6), and to take blood pressure (8) and cholesterol-lowering medications (7), resulting in a reduction in CVD risk factor burden (19). Self-perception of low cardiac risk, on the other hand, decreases motivation to engage in lifestyle modification (6).…”

“…Therefore, national guidelines have recently encouraged the use of long-term or lifetime risk as an adjunct to short-term risk communication in the primary prevention setting (3–5). Prior studies have observed that knowledge of short-term risk has been associated with healthy lifestyle patterns (6) and the effectiveness of cholesterol (7) and blood pressure lowering therapy (8). However, little is known about the perception of lifetime risk for CVD in the general population.…”

The Effect of Giving Global Coronary Risk Information to Adults

“…Several fair-to goodquality studies demonstrate that providing global risk presentation at only 1 time point seems to be ineffective in promoting risk reduction. 22,26,31,34 In addition, only a single study 20,21 examined and demonstrated the benefit of repeated presentations of global risk (with a minimum of accompanying education) on predicted CHD risk and lipid levels. Current data preclude definitive conclusions on the effects of global CHD risk information on adherence, BP reduction, smoking cessation, and initiation of aspirin, diet, and exercise, although it should be noted that prevention guidelines for many of these outcomes (excluding those related to aspirin and lipids) are not currently risk based and may reduce the likelihood of finding an effect.…”