Diabetes, suboptimal dyslipidaemia control impede attainment of BP goals in Asian patients

Almost half of Asian patients with dyslipidaemia and hypertension, as well as half of those on pharmacotherapy, have achieved their blood pressure (BP) treatment goals, a Singapore study has shown. Moreover, BP goal attainment is significantly associated with type 2 diabetes mellitus (T2DM) and low-density lipoprotein (LDL-C) control.

“Overall, about half of our study population with concomitant hypertension and dyslipidaemia failed to attain their BP treatment goals, despite established disease management guidelines,” the researchers said. “The presence of DM and suboptimal dyslipidaemia control were associated with suboptimal BP control.”

Of the 851 patients whose complete data were analysed, 49.7 percent attained their BP goals. Thirty-seven percent of these patients were on monotherapy, 57.6 percent on two or more BP-lowering medications, and 5.5 percent did not receive pharmacologic treatment. Among those on pharmacotherapy, more than half (51.2 percent) did not attain their BP goals. [Singapore J Med 2019;doi:10.11622/smedj.2019102]

Patients without T2DM were more likely to attain BP goals (odds ratio, 2.27, 95 percent CI, 1.61–3.13), as were those who successfully controlled their LDL-C levels (OR, 2.02, 1.45–2.81), were solely on dietary control (OR, 2.19, 1.09–4.39) and received monotherapy (OR, 1.71, 1.18–2.48).

“Managing patients with multiple cardiovascular risk factors such as hypertension and dyslipidaemia should involve simultaneous management and attainment of their BP and lipid goals,” the researchers said.

In addition to BP-lowering medications, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) recommends a combination of two or more lifestyle modifications for effective BP control. These include the Dietary Approaches to Stop Hypertension eating plan, dietary sodium reduction, physical activity, and weight reduction in overweight or obese patients. [JAMA 2003;289:2560-2572]

For some hypertensive patients, two or more BP-lowering medications are needed to achieve their BP goal. An earlier study by Chopra and colleagues found that those taking one or more antihypertensive medications were less likely to attain BP goals and dual BP/LDL-C goals. [Hosp Pract 2014;42:77-88; JAMA 2003;289:2560-2572; Med Clin North Am 2017;101:219-227]

“Multiple medications may be required as the disease progresses with time, but such prescriptions may impact patients’ medication adherence,” the researchers noted. “Lack of compliance with these behavioural modifications, coupled with a complex, multiple-medication regimen, might result in a lower likelihood of attaining BP goals.”

A study by Chapman and colleagues showed that only 36 percent of patients were adherent to both BP- and lipid-lowering medications after 1 year of treatment. This partly explained the lack of foal attainment in most patients prescribed several medications. [Arch Intern Med 2005;165:1147-1152]

The current study included a sub-analysis of the Lipid HEALTH study, a questionnaire survey focusing on adult Asian patients with both dyslipidaemia and hypertension. Demographic and clinical information were obtained using an interview-administered questionnaire. Laboratory and prescription data were retrieved from electronic health records.

BP goals were defined using international guidelines. The researchers audited and analysed data and conducted logistic regression analysis to identify factors determining BP goal attainment.