IS OCCASIONAL CONSULTATION AT A SPECIALIZED HYPERTENSION CLINIC BENEFICIAL FOR CARDIOVASCULAR RISK PROFILE IN HYPERTENSIVES DURING 5-YEAR FOLLOW-UP?

M. Marciniak, K. Słupek, J. Kolbusz, M. Marciniak, K. Słupek, J. Kolbusz, Scientific supervisors: P. Jędrusik , B. Symonides, Z. GaciongScientific supervisors: P. Jędrusik , B. Symonides, Z. Gaciong

Students' Research Group at theStudents' Research Group at the

Department of Internal Medicine, Hypertension and Angiology Department of Internal Medicine, Hypertension and Angiology

Medical University of WarsawMedical University of Warsaw

OBJECTIVEOBJECTIVE

To assess cardiovascular (CV) risk profile during 5-To assess cardiovascular (CV) risk profile during 5-year follow-up of patients with hypertension (HTN) year follow-up of patients with hypertension (HTN) remaining in the care of family physicians (GPs) remaining in the care of family physicians (GPs) and additionally only occasionally attending a and additionally only occasionally attending a specialized HTN day-clinic in our tertiary referral specialized HTN day-clinic in our tertiary referral center.center.

DESIGN & METHODSDESIGN & METHODS

Studied populationStudied population n=200 n=200

114 women 114 women

86 men 86 men

Mean age: 51,8 ± 14,1 yrs Mean age: 51,8 ± 14,1 yrs

Median HTMedian HTNN duration: 5 yrs duration: 5 yrs

Preexisting CV disease - 33%Preexisting CV disease - 33%

Diabetes mellitus - 13%Diabetes mellitus - 13%

Proteinuria and/or renal dysfunction- 9%Proteinuria and/or renal dysfunction- 9%

DESIGN & METHODSDESIGN & METHODS

RecrutationRecrutation

Patients Patients attendingattending specialized HTN day-clinic in 2000 specialized HTN day-clinic in 2000 Single consultation Single consultation ≤≤1/year at the request of a GP1/year at the request of a GP

Follow-up : invitation in 2005 Follow-up : invitation in 2005 Invitation by mailInvitation by mail

Phone questionnairePhone questionnaire

Statistical analysisStatistical analysis

t-Student test, Chi² – testt-Student test, Chi² – test

p<0,05p<0,05

THE DAY-CLINICTHE DAY-CLINIC

Indications for referIndications for referrral:al:

- Newly diagnosed HTN- Newly diagnosed HTN

- Suspicion of secondary HTN - Suspicion of secondary HTN

- HTN resistant to treatment- HTN resistant to treatment

Frequency of consultations : 1/year / patient Frequency of consultations : 1/year / patient

THE DAY-CLINICTHE DAY-CLINIC

Routine evaluation/intervention during visit:Routine evaluation/intervention during visit:

– Ambulatory blood pressure monitoring (ABPM)Ambulatory blood pressure monitoring (ABPM)

– ECG, routine clinical biochemistry, search for ECG, routine clinical biochemistry, search for secondary causes of HTN when clinically secondary causes of HTN when clinically indicatedindicated

– Modification of pharmacotherapyModification of pharmacotherapy

– Advice on lifestyle modificationAdvice on lifestyle modification

ABPMABPM

RESULTSRESULTS

PP200520052000 2000 ABPM ABPM

P=0.041P=0.04169±1169±1171±1271±12Night DABPMNight DABPM

P=P=NSNS119±17119±17120±17120±17Night SABPMNight SABPM

P<0.0001P<0.000180±1180±1185±1185±11Daytime DABPMDaytime DABPM

P=0.0061P=0.0061133±15133±15136±14136±14Daytime SABPMDaytime SABPM

P<0.0001P<0.000176±1076±1081±1181±11DABPM 24DABPM 24

P=0.02P=0.02128±14128±14132±14132±14SABPM 24SABPM 24

RESULTSRESULTS

132128

8176

136 133

8580

120 119

71 69

60

70

80

90

100

110

120

130

140

150

160

mm

Hg

2000 2005 2000 2005 2000 2005 2000 2005 2000 2005 2000 2005

SABPM 24 DABPM SDABPM DDABPM SNABPM DNABPM

p=0.02 P<0.0001 P=0.0061 P<0.0001 P=0.86 P=0.041

RESULTSRESULTS

137131

84 78

142135

8882

127123

75 71

020406080

100120140160

mm

Hg

In a group with elevated BP in ABPM in 2000 n=127

2000

2005

RESULTSRESULTS

P<0.0001P<0.000118%18%31%31%Current smokersCurrent smokers

NsNs28.23±5.6128.23±5.6127.67±5.0727.67±5.07BMIBMI

P<0.0001P<0.000184±2184±2171±1571±15GGFRFRP=0.0026P=0.0026100±17100±17106±24106±24GGLULUP<0.0001P<0.0001112±31112±31127±34127±34LLDLDLP=0.0026P=0.002657±1557±1553±1453±14HHDLDL

P=0.03P=0.03127±66127±66138±89138±89TGTGP<0.0001P<0.0001195±36195±36206±39206±39CCHOLHOL

PP2005200520002000

RESULTSRESULTS

0

50

100

150

200

250

2000

2005

RESULTSRESULTS

0

50

100

150

200

250

Group of patients with LDL>130mg% at baseline n=67

AVERAGE NUMBER OF DRUGS AVERAGE NUMBER OF DRUGS TAKEN TAKEN

20002000

2,02,0±1,3/ patient±1,3/ patient

20052005

2,0±1,3/ patient2,0±1,3/ patient

CONCLUSIONSCONCLUSIONS Even infrequent consultations at a specialized Even infrequent consultations at a specialized

HTN clinic result in improved BP control, lipid HTN clinic result in improved BP control, lipid levels and lower global CV risk in levels and lower global CV risk in hypertensives at 5-year follow-up despite hypertensives at 5-year follow-up despite advancement in age. advancement in age.

No increase in the average number of drugs No increase in the average number of drugs taken may result from better choice of therapy taken may result from better choice of therapy applied.applied.

Such a “backup” for primary care physicians Such a “backup” for primary care physicians

might represent a feasible, possibly relatively might represent a feasible, possibly relatively

low-cost strategy to reduce CV disease burden low-cost strategy to reduce CV disease burden

in general population.in general population.

Thank you for your attentionThank you for your attention