A systematic approach to managing hypertension and the metabolic syndrome in primary care.
OBJECTIVE
Obesity is driving a high prevalence of hypertension and metabolic syndrome-related risk and disease. This report summarizes the impact of a standardized, evidence-based approach to managing high blood pressure and associated metabolic syndrome abnormalities that was developed and implemented by one Clinical Hypertension Specialist.


METHODS
Longitudinal data on blood pressure, low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), cardiovascular and renal comorbidities, and treatment medications were obtained on all 817 hypertensive patients seen from January 1, 2000 to June 30, 2003.


RESULTS
The hypertensive patients were 72 +/- 11 (SD) years old, and more than 55% of them were high risk based on target organ damage, clinical cardiovascular disease, or diabetes mellitus. Blood pressure was < 140/90 mm Hg in 77% of all patients. Among the high-risk patients, mean blood pressure was 126 +/- 14/71 +/- 10 on 2.8 +/- 1.4 antihypertensive medications, with 88% on angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 59% on diuretics, 49% on calcium channel blockers, and 36% on beta-blockers. Among dyslipidemic hypertensives, LDL-C was controlled to < 130 mg/dL in 84% (510/605) overall and to < 100 mg/dL in 70% of the high-risk group (299/427). Among diabetic hypertensives, the mean HbA1c was 6.8%, with 64% (155/242) less than 7%. New patients demonstrated improved blood pressure, LDL-C, and hemoglobin A1c control over time as the management algorithm was applied.


CONCLUSIONS
A high prevalence of complicated hypertension was documented. Blood pressure, LDL-C, and HbA1c were controlled to goal in a high proportion of patients. The findings demonstrate that application of an evidence-based management algorithm can facilitate higher rates of cardiovascular risk factor control than are generally reported in primary care practices.
Bestermann
William H
WH
Low Country Medical Group, Beaufort, SC, USA. whbester@islc.net
Lackland
Daniel T
DT
Riehle
Jessica E
JE
Egan
Brent M
BM
D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003920:Diabetes Mellitus; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D011320:Primary Health Care; D012307:Risk Factors
D000959:Antihypertensive Agents