WHAT POTENTIAL CARDIOVASCULAR RISK REDUCTION COULD BE ACHIEVED WITH BLOOD PRESSURE AND LIPID LOWERING TREATMENT? A SIMULATION BASED ON BP-PROACTION BG OBSERVATIONAL STUDY

Objective: For patients at high or very-high risk of cardiovascular (CV) events, the 2023 ESH guidelines recommended blood pressure (BPT) and lipid-lowering therapy (LLT) to achieve a BP levels 120-130/70-80 mmHg and an LDL-C level below 1.8/1.4 mmol/l according to the risk.Design and method: The purpose of the study was to assess: 1) the risk profile of the patients with difficult to control hypertension and the dynamics of CV risk during the BP-proAction BG study and 2) the treatment gap between the achieved risk and the estimated benefits if all patients were to achieve BP and LDL-C target levels. All individuals underwent office and repeated out of office BP measurements during the 3-month observational period. For the patients without CV events we used LIFE-CVD and for those with - SMART-REACH model in order to calculate/predict 10 years and lifetime risk. Results: A total of 220 treated, but uncontrolled patients were included. The mean SCORE 2/SCORE2 OP was 17.2% among individuals in the primary prevention setting, 19% had previous cardiovascular events. Following therapy escalation (mean 3.4 drug classes) 79% of the patients achieved office BP levels <140/90 mmHg. The stricter targets for BP and LDL-C in the 2023 guidelines were reached in 31% and 9.1%, respectively. For the primary prevention patients, the mean LIFE 10 years risk was reduced from 6.6% to 5.1% (p<0.001), mainly driven by an effect in the 50 to 70 and over 70 age groups. The corresponding risk reduction in patients with previous CV events was from 43.3% to 33% (p<0.001). Further reduction of BP and LDL targets had small influence on 10 year risk, but significantly modify the lifetime risk, an effect that was most pronounced in individuals under 50 years of age. Conclusions: In a contemporary cohort of patients with difficult to control hypertension the residual risk is high and many patients either do not reach targets or therapy is not escalated enough to meet the new, more rigorous targets. The latter has significant potential for beneficial long-term effects, especially if started at an early age and continued thereafter.