Centro de Salud Puerta Blanca, Servicio Andaluz de Salud, Málaga, Spain.
Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.
BMC Prim Care. 2023 Feb 9;24(1):43. doi: 10.1186/s12875-023-01997-8.
Identifying patients at high risk of cardiovascular disease in primary prevention is a challenging task. This study aimed at detecting subclinical atherosclerosis burden in non-diabetic hypertensive patients in a primary care centre.
Clinical, anthropometric and analytical data were collected from patients with hypertension who were free from clinical vascular disease and diabetes. The cardiovascular risk was assessed using the SCORE system. Subclinical atherosclerosis burden was assessed by carotid ultrasonography (intima-medial thickness [IMT] and plaque) and measurement of the ankle-brachial index (ABI).
Out of 140 patients, 59 (42%) have carotid plaque, 32 (23%) have IMT higher than 75% and 12 (9%) have an ABI < 0.9. Total atherosclerosis burden was present in 91 (65%) of the subjects. Consequently, 59 (42%) patients were re-classified into the very high-risk category. In multivariate analyses, smoking, creatinine levels and duration of hypertension were associated with atherosclerosis burden. In contrast, only smoking and age were associated with the presence of carotid plaque. Almost 90% of patients were treated with hypotensive drugs, half of them combined several drugs and 60% were well-controlled. Only 30% received statins in monotherapy and only less than 20% had an LDL cholesterol < 100 mg/dL.
In non-diabetic hypertensive patients managed at a primary care centre, 4 out of 10 had subclinical atherosclerosis burden and were re-classified into the very high- risk category. There was clear undertreatment with lipid-lowering drugs of most LDL cholesterol inappropriate levels, according to current clinical guidelines.
在初级预防中识别心血管疾病高危患者是一项具有挑战性的任务。本研究旨在检测初级保健中心非糖尿病高血压患者的亚临床动脉粥样硬化负担。
从无临床血管疾病和糖尿病的高血压患者中收集临床、人体测量和分析数据。使用 SCORE 系统评估心血管风险。通过颈动脉超声（内膜中层厚度 [IMT] 和斑块）和踝臂指数（ABI）测量评估亚临床动脉粥样硬化负担。
在 140 名患者中，59 名（42%）有颈动脉斑块，32 名（23%）IMT 高于 75%，12 名（9%）ABI<0.9。91 名（65%）受试者存在总动脉粥样硬化负担。因此，59 名（42%）患者被重新归类为极高危人群。在多变量分析中，吸烟、肌酐水平和高血压持续时间与动脉粥样硬化负担相关。相比之下，只有吸烟和年龄与颈动脉斑块的存在相关。近 90%的患者接受了降压药物治疗，其中一半联合使用了几种药物，60%的患者得到了很好的控制。仅 30%的患者接受了他汀类药物的单一治疗，不到 20%的患者 LDL 胆固醇<100mg/dL。
在初级保健中心治疗的非糖尿病高血压患者中，每 10 人中有 4 人存在亚临床动脉粥样硬化负担，并被重新归类为极高危人群。根据目前的临床指南，大多数 LDL 胆固醇水平不当的患者存在明显的降脂药物治疗不足。
