A Systematic Approach to Managing Hypertension and the Metabolic Syndrome in Primary Care

OBJECTIVES: 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.