Management of hypertension and dyslipidemia in primary care in Italy

Objectives: Guidelines for the screening, treatment, and monitoring of modifiable cardiovascular risk factors such as hypertension (HTN) and dyslipidemia (DYS), have been developed to assist physicians in lowering the global risk of cardiovascular disease (CVD). This study assessed the management of patients with these conditions in a primary care setting in Italy. Methods: This was a retrospective cohort study conducted in 2000–2002 using the Italian Health Search Database (HSD). The management of HTN (blood pressure [BP] 140/90 mmHg) and DYS (total cholesterol 5 mmol/L [193 mg/dL]) was assessed by measuring the numbers of patients screened for one or both conditions, the numbers treated pharmacologically, and the numbers monitored for treatment success. Management patterns were stratified by history of cardiovascular events. Results: Blood pressure screening at a population level was approximately 35% for HTN in each year whereas for DYS, it increased from 26% in 2000 to 32% in 2002. Over the study period, the prevalence of HTN increased from 19% to 23%, whereas the prevalence for DYS doubled (from 14% to 28%). For both HTN and DYS these prevalences were substantially lower than national survey estimates (23% versus 48% for HTN and 16% versus 57% for DYS in 2001). Among patients with newly identified HTN or DYS, eligible for reimbursed pharmacological treatment, 26% and 82%, respectively, were not treated within 1 year of diagnosis. Treatment levels were higher in patients with a history of CVD, but were still far from optimal. Monitoring of BP and cholesterol in the first year of treatment was sub-optimal e.g. 36% of newly-treated HTN patients had no record of a BP evaluation and 32% of newly-treated DYS patients had no record of a cholesterol assessment. Blood pressure monitoring was slightly higher in patients with a history of CVD. Extrapolation to all new HTN and DYS patients showed that less than 50% of patients with HTN and 12% of those with DYS were adequately treated or monitored. Conclusion: The differences between the prevalence of recorded HTN or DYS and national survey results suggest extensive underscreening and underdiagnosis of these conditions. Overall, this study highlights the need to improve the management of patients with HTN and DYS.