Reducing Global Risk of Ambulatory Assisted Hypertensive Patients – What Could Be Changed in the Practice of a Romanian Preventive Ambulatory System According to New Dyslipidaemia Guidelines?

Reducing the total cardiovascular risk of hypertensive patients is one of the basic targets in hypertension management. A good lipid control is a major contributor of the global risk reduction.
Purpose: To simulate the impact of the ESC/EAS 2011 guidelines for the management of dyslipidaemias on the lipid management practice of a preventive profiled ambulatory cardiology system.
Methods: The study included all the 7413 hypertensive patients examined between 2002–2011 in a preventive ambulatory system. As a part of the simulation patients were stratified to risk categories according to ESC 2011 guidelines. We compared the frequency of prescribed cholesterol lowering medication with that theoretically indicated based on the new guidelines. The study is based on a retrospective simulation of the theoretical effects of the implementation of the new guidelines in a real patient population.
Results: Risk stratification could be performed in 78.74% of the population. Patients were stratified to very high risk 74.82%, high risk 1.96%, moderate risk 8.66%, and low risk 14.56%. Cholesterol lowering treatment was prescribed for 39.58% of the patients. Very high risk patients were treated more frequently (48.8%), than high (37.0%), moderate (26.5%), or low (16.4%) risk patients. According to the new ESC guidelines theoretical indication for cholesterol lowering treatment has been for 52.07% (3860) of patients. The analysis of the yearly trends in prescribing cholesterol lowering drugs showed an increase from 0% in 2002 to 52.7% in 2011.
Conclusions: A yearly improving trend can be observed in the frequency of indicating cholesterol lowering drugs. The future implementation of the new guideline has the potential impact to assure cholesterol lowering medication indication for another 1980 patients in our sample.