Via practica 3/2024

The imperative need to change the routine approach in the management of the patient with arterial hypertension and dyslipidemia. Image of a realistic practice – DISCOVERY study

Introduction: Reducing mortality from cardiovascular diseases (CVD) is an ambition of European countries. Arterial hypertension (AH) and dyslipidemia (DLP) are considered the main risk factors (RF). DISCOVERY Slovakia is an epidemiological study with the goal to map the achievement of recommended blood pressure (BP) values, target values of lipid spectrum parameters, accompanying treatment and therapeutic procedures in patients with AH and DLP in primary and specialized outpatient care in real conditions. Methodology: Data collection took place at the health care providers offices over a period of 11 months (10/2022 to 08/2023) using a standardized CAWI (Computer aided web interviewing) electronic questionnaire available on the website: www.discoveryslovakia.sk. Data were obtained from 91 doctors (37.36% GP, 62.64% specialists), including 1428 respondents (717 men, 711 women) with AH, DLP or both RF/diseases. Collected data from the initial visit (1st collection, basic data) were evaluated and then the follow up (checkup) was carried out – according to the protocol – within 6 months (2nd data collection) from the primary visit. Results: The primary goal of achieving BP ≤ 140/90 mmHg was met by 73% of patients with AH, due to age compared to only 3%. The monotherapy in the treatment of AH was represented in 40.21%. Up to 66% of patients had one molecule in one tablet, 19% had a free combination. The remaining percentages were made up of the treatment regimen mix (combination with monotherapy). In the treatment of AH, monotherapy still dominates (66.46%), while fixed double combinations are used by 26.5%, triple combinations by 7.63%. The target LDLc value was reached by 13.65% of patients. Only 8.88% of patients met the target LDLc in primary prevention, and 16.22% in secondary prevention. AH simultaneously with DLP occurred in 54.41% of patients. Polypill antihypertensive and hypolipidemic were used in only 1%. At the initial examination, 36% of the newly detected hypertensive patients were, in patients with known AH, 21% did not achieve BP control. Together, these groups represented up to 56.41%. Newly diagnosed patients with DLP accounted for 46%, uncontrolled ones were up to 82.91%. 71% of patients with AH and only 57% of patients with DLP use the treatment regularly. Conclusion: The obtained epidemiological data are a starting point and at the same time an appeal for an accelerated change in routine practice not only in the management of patients with AH, but especially in patients with DLP. The use of fixed combinations (FC) and polypills is one of the most effective approaches targeting the two most important pharmacologically susceptible RFs. A patient with AH and simultaneously with present DLP requires an individual strategic approach to the highest degree.

Keywords: arterial hypertension, dyslipidemia, target values, treatment, fixed combinations