Cardiovascular risk assessment and risk factor control in patients with hypertension in Europe: the SNAPSHOT study

Abstract

BACKGROUND AND AIMS: Underestimated cardiovascular risk may lead to inadequate control of blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin. This study investigated cardiovascular risk assessment and blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin control among patients with hypertension in routine clinical practice. METHODS: In the observational, cross-sectional, epidemiological SNAPSHOT study (conducted in Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain), cardiovascular risk was assessed in adults with hypertension according to the physician clinical practices, guidelines, and the risk assessment models valid when the study was performed (SCORE1 and SCORE2/SCORE2-OP). Blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin control rates were also assessed. RESULTS: Of 9307 patients (aged 65.8 ± 10.5 years, 43.1% male), most (91.3%) had ≥1 additional cardiovascular risk factor; 7610 (81.8%) had dyslipidaemia and 3097 (33.3%) had type 2 diabetes. Compared with guideline recommendations, assessment of patient cardiovascular risk by physicians, relative to the risk obtained using SCORE1 and SCORE2/SCORE2-OP, was accurate in only 38.0% and 26.7% of patients, respectively, and was underestimated in 54.3% and 71.8% of patients. Control rates of blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin were suboptimal (<25%, <12% [in those with comorbid dyslipidaemia], and <50% [in those with comorbid type 2 diabetes], respectively). CONCLUSIONS: Physicians from six European countries tended to overestimate control rates of blood pressure and low-density lipoprotein cholesterol, while underestimating cardiovascular risk in their patients with hypertension. Overall, blood pressure, low-density lipoprotein cholesterol, and glycated haemoglobin control rates were low. Better implementation of clinical guideline recommendations are needed.