[Relationship between cardiovascular risk profile and anti-hypertensive drug use. GEDEC (Spanish group of cardiovascular studies].
BACKGROUND
Hypertension guidelines emphasize the selection of antihypertensive treatment on the basis of absolute cardiovascular risk. Moreover, compelling and possible indications for each antihypertensive drug class are recommended for patients with other concomitant conditions. The aim of the present study was to analyze the relationship between the cardiovascular risk profile and co-morbid conditions on antihypertensive drug class use.


METHODS
This is an observational, multicenter, cross-sectional study performed in 2,850 essential hypertensive patients. Antihypertensive drug treatment has been evaluated on the basis of the presence of other cardiovascular risk factors, target organ damage or cardiovascular diseases, as well as the absolute cardiovascular risk profile.


RESULTS
Patients with diabetes were treated more frequently with calcium channel blockers (CCB) and ACE inhibitors. However, the presence of hypercholesterolemia or smoking habit did not influence the use of antihypertensive drug classes. The presence of cerebrovascular disease increased the use of CCB and ACE inhibitors, whereas coronary disease increased the use of CCB and betablockers. The use of diuretics and angiotensin II receptor antagonists was increased in patients with cardiac failure, whereas neither betablockers nor ACE inhibitors were affected by this concomitant disease. Patients with the highest cardiovascular risk received more antihypertensive treatment than those with lower risk, but this was not accompanied by switching from old classes to new ones.


CONCLUSIONS
Cardiovascular risk profile seems to have little influence on the use of antihypertensive drug classes, particularly the presence of hypercholesterolemia or cardiac failure. It seems adequate to emphasize the necessity of an individualization of antihypertensive treatment, based on the presence of concomitant conditions that influence the absolute cardiovascular risk.
de la Sierra
A
A
Unidad de Hipertensión, Hospital Clínic, Barcelona. iserte@medicina.ub.es
Ruilope
L M
LM
Coca
A
A
Luque-Otero
M
M
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000959:Antihypertensive Agents