Suboptimal Outcome of Management of Metabolic Cardiovascular Risk Factors in Hispanic Patients With Essential Hypertension

Abstract

Abstract We studied outcome of management of metabolic cardiovascular risk factors in 155 randomly chosen Hispanic hypertensive patients (mean age, 63±1 years; 79% female) screened for dyslipidemia. Hypertriglyceridemia (n=12) or high risk–adjusted low-density lipoprotein cholesterol (LDL-C) (n=89) was found in 65%. Triglycerides did not change (6.16±0.58 to 7.44±2.34 mmol/L; P =NS) over 2.2±0.5 years. Only 58 patients with high LDL-C were treated, and 8 had no follow-up lipid tests. In the other 50, LDL-C decreased by 10±3% ( P <.001) over 2.8±0.2 years but attained goal in only 12. In a subset of 24 patients with extended follow-up (3.8±0.2 years), there was an initial marked decline in LDL-C, followed by a rebound to baseline levels. In 29 of 54 patients with normal LDL-C, lipid testing was markedly overused compared with recommendations. Obesity (n=94, 61%) did not improve in those with repeated data (+0.6±0.8 kg; P =NS; n=40) over 2.7±0.3 years. Forty-four of 63 patients with type II diabetes had repeated measurement of glycosylated hemoglobin, with no change (10.5±0.5% to 11.2±0.5%; P =NS) over 2.2±0.3 years. Ten-year risk of coronary events (Framingham cohort parametric regression) calculated for 61 patients with known untreated blood pressures (169±3/98±1 mm Hg) was 21.0±1.7%, with a skewed distribution reaching high values (66%) and attributable in large part (72%) to modifiable risk factors. With the use of the model, hypothetical correction of metabolic risk factors was more powerful than reduction of systolic blood pressure to 140 mm Hg (Δrisk, −8.3±0.9% versus −4.2±0.5%; P <.0001) and predicted a reduction in risk 25-fold larger than that actually sustained by the patient sample (−0.3±0.6%; P =NS). In summary, Hispanics with essential hypertension exhibit a multifactorial risk profile, with the potential (as yet unrealized) for large reduction in cardiovascular morbidity. Our studies make it apparent that in this population, adequate treatment of concomitant metabolic illnesses is equally as important as or even more important than management of blood pressure.