Cardiovascular risk in patients with uncontrolled hypertension and its estimation in outpatient setting in Poland. Results of nationwide RAPORT NT programme

Abstract

Background The aim of the study was to assess how physicians estimate cardiovascular (CV) risk in patients with uncontrolled hypertension, on an outpatient basis in Poland.
Material and methods The study was a part of educational grant of Servier-Poland. Demographic data, history of diabetes, associated clinical conditions, smoking habit and family history were obtained from patients with uncontrolled hypertension, who visited general practitioners and specialists. Laboratory measurements and occurrence of target organ damage (TOD) were checked in medical records. Blood pressure (BP) and waist circumference, were measured. BP levels were classified and CV risk was estimated according to the Polish Society of Hypertension guidelines 2003. CV risk estimated by physicians and real risk were compared in three groups of uncontrolled hypertension: grade 1-3 (Bowker’s Test of Symmetry). Similar analysis was performed in subgroup of patients with diabetes and/or renal insufficiency.
Results 11 745 patients (mean age - 59.0 ± 11.3, 50.1% men) were examined. CV added risk estimated by physicians was very high in 38.2%, high in 30.4%, moderate in 27.9%, and low in 3.6%, but risk calculated according to the guidelines was 49.6%, 25.1%, 24.2%, 1.1% (respectively), (p < 0.001). Physicians overestimated low, moderate and high risk and underestimated very high added risk. High BP values were strong predictor of underestimation. The same tendency was observed in diabetic patients, but low and moderate risks were incidentally estimated by physicians.
Conclusions Estimation of CV risk according to current guidelines by physicians is imprecise what may influence the intensity of treatment. Educational programs are needed to improve the situation.