Assessment of Hypertension Management in Bulgaria: Demographics, Cardiovascular Risk, and Blood Pressure Control Discrepancies (Snapshot Study)

Objective: To assess the prevalence of hypertensive patients controlled on blood pressure (BP), cardiovascular (CV) risk and comorbidities in Bulgaria. Design and method: The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 129 general practitioners in Bulgaria and included 3366 hypertensive patients. BP control and CV risk were assessed by investigators and compared to the assessment based on recommendations from European guidelines (SCORE chart 2&OP). Results: A total of 3363 patients were analyzed, with a mean (standard deviation [SD]) age of 67.2 (10.8) years. Most patients were female (60.9%), educated at secondary-school level (63.4%), overweight or obese (77.9%), and non-smokers (76.5%). Patients had no (7.7%), one (41.5%), 2 (38.2%), 3 or more (12.6%) risk factors for hypertension. Additionally, patients had comorbidities including dyslipidemia (55.8%), coronary artery disease (32.5%), and diabetes mellitus (27.4%). Mean (SD) systolic and diastolic BP were 143.1 (18.4) mmHg and 84.3 (11.8) mmHg, respectively. Almost all patients (99.5%) had their hypertension treated, took their treatment once (44.4%) or twice daily (50.3%) and had their BP monitored at home (95.6%). Patients predominantly utilized beta blockers (61.2%), diuretics (57.5%), and/or angiotensin-converting enzyme inhibitors (48.6%). The combination of these treatments and/or other BP lowering drugs occurred in groups of 2 and 3 in 32.2% and 36.4% of patients, respectively. Single-pill combination was used in 58.5% of patients. BP was considered controlled according to the investigators in 77.3% of patients, but according to guidelines in 22.8% of patients (39.1% systolic BP/ diastolic BP <140/90 mmHg). CV risk was assessed as mainly moderate (43.0%) or high (31.4%) by investigators, whereas it was high (9.0%) or very high (91.0%) in most patients according to recent guidelines. The concordance between both risk assessments was true in 19.1% of cases, while for 80.5% patients the risk was underestimated by the investigators. Conclusions: While this study provided valuable insights into the demographic and clinical characteristics of a sizable patient population, there was a discordance in CV risk and BP control assessment between investigators and guidelines. This highlighted the importance of aligning assessments with guidelines for hypertension management.