Cardiovascular risk stratification and antihypertensive therapy according to guidelines in the outpatient setting.

UNLABELLED: BASIC CONCEPTS AND
METHODOLOGY: Acceptance of the ESH/ESC 2007 hypertension guidelines and their reappraisal 2009 are not known by Austrian practitioners. Therefore, within the frame of a noninterventional trial we investigated 3,488 ambulatory hypertensive patients. Primary goal was the evaluation of the assignment to cardiovascular risk categories according to the ESH/ESC charts by office-based physicians compared to an independent risk adjudication using the same data and method. Further goals were assessment of compliance with the recommendation to start combination treatment in grade 2 and 3 hypertension and efficacy and tolerability of treatment with candesartan.
RESULTS: The comparison revealed incorrect physicians' risk assessment for approximately 60% of the patients with a strong tendency for underestimation. Despite guidelines recommending an initial combination therapy for hypertension ≥160/90 mmHg, 15.4% of these patients still received candesartan as a monotherapy. Target blood pressure ≤140/90 mmHg could be well achieved (in 81.6%) with candesartan as monotherapy or combined with hydrochlorothiazide (HCTZ) for hypertension grade 1-3.
CONCLUSIONS: Guidelines for assessment of individual risk and derived therapy algorithms should be better communicated in the outpatient setting. Candesartan alone or combined with HCTZ is an effective and well tolerated therapeutic option to control blood pressure in the majority of patients.