Underestimated versus accurate assessment of cardiovascular risk in hypertensive patients: a sub-analysis of the SNAPSHOT study in Europe

Abstract

Abstract Background/Introduction In 2021, ESC guidelines set new recommendations for cardiovascular (CV) risk assessment (SCORE2&2-OP)1. However, there is a discrepancy between CV risk perceived by the physicians and CV risk calculated according to the ESC guidelines with a tendency of physicians to underestimate it, resulting in insufficient preventive measures. Purpose This sub-analysis of the SNAPSHOT study aims to provide descriptive data on hypertensive patients with underestimated vs. accurate CV risk assessment in Europe. Methods SNAPSHOT is a cross-sectional, multicentre study, conducted in patients with hypertension from six European countries (Bulgaria, Croatia, Georgia, Romania, Serbia and Spain). The accuracy of CV risk assessment was evaluated by comparing perceptions of physicians (based on their clinical practice) with those calculated using SCORE2&2-OP. Results Of 9290 patients analysed, 71.8% had underestimated, 26.7% accurate and 1.5% overestimated CV risk. Characteristics of patients with underestimated vs. accurate CV risk assessment are described in Table 1. Patients with underestimated CV risk were more often women, less obese, reported less frequently dyslipidaemia and type 2 diabetes, and received more often only one drug for hypertension, dyslipidaemia and type 2 diabetes compared to those with an accurate assessment (all p<0.001). Regarding risk factors (male gender, age≥65years, BMI≥30kg/m2, and smoking), patients with underestimated CV risk had less risk factors than those with an accurate assessment (p<0.001). When physicians perceived BP as controlled, proportion of patients with underestimated CV risk was higher (76.9%) compared to those with an accurate assessment (69.7%), whereas rate of BP control according to the ESC guidelines was lower in these patients (23.4%), compared to those with an accurate assessment (26.8%), all p<0.001. Similarly, when physicians perceived LDL-C as controlled, proportion of patients with underestimated CV risk was higher (58.2%) compared to those with an accurate assessment (46.0%), whereas rate of LDL-C control according to the ESC guidelines was lower in these patients (4.7%), compared to those with an accurate assessment (13.2%) (Figure 1), all p<0.001. Conclusions This sub-analysis showed that some factors such as being female, non-obese, and having a low number of risk factors or comorbidities, were more often associated with an underestimation of the CV risk by physicians. This resulted in lower control rates of BP and LDL-C. There is an urgent need to consider these key elements and to improve assessment and management of hypertensive patients by accurately assessing CV risk using properly SCORE2&2-OP tools.