(Hypertension. 1995;26:1079-1084.)
© 1995 American Heart Association, Inc.
Articles |
Suboptimal Outcome of Management of Metabolic Cardiovascular Risk Factors in Hispanic Patients With Essential Hypertension
From the Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY, and Clinical Hypertension Section, Department of Internal Medicine, University of Texas Medical Branch, Galveston.
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
(
risk, -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.
Key Words: risk factors • hypercholesterolemia • hypertriglyceridemia • hypertension, essential • Hispanic
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