Comparison of profile and treatment of patients with uncontrolled arterial hypertension and/or dyslipidemia in specialist care and primary care in the Czech Republic: comparison of the results of the LipitenCliDec 1 and LipitenCliDec 2 studies

Overview

In previous issues of this journal the results of the LipitenCliDec study phase 1 and 2. Phase 1 (LipitenCliDec 1) performed in general practitioners practices were published, the study aim of was to map the characteristics of patients with decompensated arterial hypertension (AH) and/or dyslipidemia (DLP), identify possible explanatory causes of poor compensation of these risk factors (RF), evaluate changes in their control 3–6 months after the initial intervention and last but not least also selection of patients with suspected familial hypercholesterolemia (FH). Due to the importance of previously obtained data from primary care, essentially the same project was launched at the workplaces of outpatient specialists, i.e. cardio­logists and internists, named LipitenCliDec 2. The aim of this paper is to compare patient populations of both LipitenCliDec studies, especially pharmacotherapy. Unfortunately, the comparison of the results of both studies was complicated by the update of the recommendations for the diagnosis and treatment of DLP in August 2019, when the target values of LDL-cholesterol (LDL-C) were tightened. LipitenCliDec 2 study yields even more positive results, although it was a riskier population compared to the previous study. The assumption was fulfilled that outpatient specialists generally receive more polymorbid patients, who are, however, relatively more intensively treated compared to primary care. From the results of the follow-up study LipitenCliDec 2 we can see again that even in a relatively short time (3–6 months) it is possible to achieve better compensation of both AH and DLP. Both RFs were controlled in almost four times more patients after the initial intervention. Similar to the previous study, the EUROASPIRE or LipiCONTROL study series, we observe better control of AH, when combination therapy (ACEi + BKK + diuretic) is correctly indicated, while DLP is correctly treated with modern statins (atorvastatin or rosuvastatin), but unfortunately in relatively small doses (on average around 20 mg) and the use of combination therapy to affect LDL-C) levels is not so common, so the percentage of patients with uncontrolled DLP is much higher than with AH. The LipitenCliDec 2 study, ie a study mapping specialized care in the Czech Republic, points to a satisfactory penetration of current guidelines into routine clinical practice, where adequate cardioprotective treatment is correctly chosen, but this is again often titrated with too caution and slowly or neglected appropriate combination therapy.

Keywords:

arterial hypertension – dyslipidemia – cardiovascular risk – familial hypercholesterolemia – cardiovascular prevention