Real-world characterization of clinical management and achievement of the recommended risk-based low-density lipoprotein cholesterol and blood pressure goals in patients with arterial hypertension and dyslipidemia. The SNAPSHOT study

Abstract

Background

Arterial hypertension and dyslipidemia are two of the most relevant modifiable cardiovascular risk factors (CVRFs), and they often coexist. No recent studies specifically evaluating the achievement of LDL-C and blood pressure (BP) targets in hypertensive patients with dyslipidemia are available in Spain.

Methods

The SNAPSHOT study was a multicenter, cross-sectional observational study conducted in cardiology and internal medicine (IM) departments/clinics and primary care (PC) centers in Spain. The study enrolled consecutive adult patients (≥18 years of age) diagnosed with both hypertension and dyslipidemia. The primary endpoint was the percentage of patients achieving both the LDL-C goals recommended by the 2021 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines and the BP targets established in the 2018 ESC/European Society of Hypertension (ESH) guidelines. Cardiovascular (CV) risk (very high, high, low-to-moderate) was centrally assessed according to the updated Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Person (OP) algorithms recommended in the 2021 ESC guidelines.

Results

Between December 2021 and April 2022, a total of 443 evaluable patients were enrolled (males: 54%; ≥65 years of age: 66.1%; obesity: 37.4%; diabetes mellitus: 37.3%; coronary artery disease [CAD]: 25.7%). Out of the 388 patients in whom CV risk could be assessed, 34.3% and 56.4% were considered as having high and very high risk, respectively. Overall, 24% of the patients had achieved their risk-based LDL-C goals (21.8% of the patients at high-CV risk and 25.1% of those at very high risk), and 30.3% of the patients had reached the recommended BP targets (27.1% of the patients at high risk and 36.1% of those at very high risk). A total of 8.8% of the patients had achieved both the LDL-C and BP targets. Overall, 51.4% of the patients with concurrent diabetes had achieved glycemic control (HbA1c <7%), while only 9.4% of the diabetic patients had reached simultaneous control of LDL-C, BP and HbA1C targets (7.8% of the patients at high risk and 10.4% of those at very high risk).

Conclusion

The attainment of LDL-C and BP goals is still suboptimal in patients with dyslipidemia and hypertension in the real-world setting in Spain, with approximately 75% of the patients at very high risk of cardiovascular disease failing to reach their risk-based LDL-C and BP targets. Additionally, the rate corresponding to simultaneous control of LDL-C, BP and HbA1c is likewise very low. The present study thus highlights the current challenge of controlling multiple CVRFs that significantly contribute to atherosclerotic cardiovascular disease events and mortality and emphasizes the need for more effective management of CVRFs in the real-world setting.