Blood pressure control and cardiovascular risk assessment in patients with hypertension: a pooled analysis of 6 countries in Eastern and Southern Europe (SNAPSHOT study)

Abstract Background Recent guidelines of the European Society of Cardiology (ESC) introduced stricter recommendations regarding blood pressure (BP) control, based on recommended levels following an assessment of cardiovascular (CV) risk. However, data are lacking on perception and actual BP control, and CV risk assessment. Purpose To assess BP control and CV risk assessment in patients with hypertension. Methods This is a cross-sectional multicentre study (SNAPSHOT) including pooled data from 6 countries in Europe. 9466 patients with hypertension were included from 513 participating investigators (69.6% general practitioners [GPs], 17.4% cardiologists, 6.2% endocrinologists). BP control and CV risk were assessed by investigators and compared to the re-assessment based on current ESC guidelines (SCORE1 and SCORE2&2-OP). Results 9443 patients with complete data (65.6±10.7 years, 57.0% female) were analysed from Bulgaria (35.6%), Romania (26.8%), Croatia (13.8%), Serbia (12.5%), Georgia (6.4%), and Spain (4.9%). Most patients had additional risk factors, such as overweight/obesity (81.6%), dyslipidaemia (80.8%), type 2 diabetes (32.8%) or current/former smoking (29.5%). Two or more risk factors (male gender, age ≥65 years, obesity, smoking) were more frequent in patients with very high calculated CV risk (60.9% by SCORE1, 57.7% by SCORE2&2-OP). Systolic and diastolic BPs were 139.3±17.3 mmHg and 82.3±10.9 mmHg, respectively. Almost all patients (98.5%) had their hypertension treated, 54.5% taking a single-pill combination (SPC). The most used drug classes were diuretics (59.6%), angiotensin-converting enzyme inhibitors (59.4%), and beta-blockers (57.0%). Combination therapy of 2 or 3 drug classes (SPC or not) was used in 33.2% and 34.4% of patients, respectively. According to investigators, BP was considered controlled in 75.0% of patients, whereas 48.0% of patients had BP <140/90 mmHg, and only 24.4% of patients were controlled at BP target according to guidelines (Figure 1). CV risk was estimated by investigators as low, moderate, high or very high for 10.1%, 34.9%, 32.0% and 23.0% of patients, respectively, whereas calculated CV risk was very high in most patients (59.1% by SCORE1, 86.8% by SCORE2&2-OP). CV risk estimated by investigators varied by country and by speciality, being high (29.4%, 35.0% and 32.0%) and very high (32.4%, 49.8% and 18.6%) for cardiologists, endocrinologists and GPs, respectively. Compared to calculated CV risk, CV risk estimated by investigators was frequently underestimated (54.4% by SCORE1, 67.6% by SCORE2&2-OP), varying between 30.8% in Spain and 68.2% in Bulgaria for SCORE1, and between 42.1% in Spain and 84.8% in Serbia for SCORE2&2-OP (Figure 2). Conclusion Physicians across 6 European countries tended to overestimate control of BP and underestimate CV risk in patients with hypertension. Our findings highlight the need for better assessment and management of patients according to the latest ESC guidelines.