Dual Blood Pressure, Lipid Control Could Help Millions

March 17, 2006

March 17, 2006 (Atlanta) — As many as three fourths of adverse coronary heart disease (CHD) events could be prevented by optimal control of blood pressure and lipid levels, a new study suggests.
"We know from NHANES [the National Health and Nutrition Examination Survey] that less than 10% of patients have dual lipid and blood pressure control," said coinvestigator Simon Tang, MPH, a statistician at Pfizer, Inc, in New York City. "This study uses the latest data to quantify the magnitude of the improvement that could be gained if all patients had optimal dual control."

"What we found is that aggressive control of both blood pressure and cholesterol could avert about three quarters of, or 2 million, CHD events over 10 years," he said.

Mr. Tang spoke to Medscape during his poster presentation here at the American College of Cardiology 55th Annual Scientific Session.

For the study, the researchers analyzed the records of 1921 people, aged 30 to 74 years, without known heart disease who participated in NHANES 2001-2002.

Using Framingham Heart Study risk algorithms, they predicted the number of CHD events — angina pectoris, myocardial infarction, or death due to heart disease — that could be expected to occur over 10 years. Next, they estimated the number that could potentially be prevented over the same time period if blood pressure and cholesterol were normalized. The data was then projected to a population of 85.2 million US adults.

The algorithms take into account age, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, smoking status, and diabetes mellitus. Separate risk scores were created for men and women.

Of the total, 676 people had hypertension, defined as blood pressure readings of 140/90 mm Hg or greater, or 130/80 mm Hg or greater if diabetes was present or the person was on medication for high blood pressure. This represents 30.6% of the study population, which, projected nationally, translates to 26.1 million people.

Mr. Tang said that 16% to 25% of CHD events in male hypertensive patients and 12% to 22% in female hypertensive patients could be prevented by nominal control of blood pressure — ie, to less than 140/90 mm Hg. If there was optimal control — blood pressure less than 120/80 mm Hg — 26% to 41% of CHD events in male patients and 41% to 50% in female patients could be prevented.

Even more events could be averted if both blood pressure and lipids levels were optimized, Mr. Tang said. If blood pressure is treated to less than 120/80 mm Hg, LDL cholesterol levels brought to less than 100 mg/dL, and HDL cholesterol levels to higher than 60 mg/dL, 75% of events would be prevented.

Chief investigator Nathan D. Wong, PhD, professor and director of the heart disease prevention program at the University of California, Irvine, said the findings reinforce the need for clinicians to treat both high blood pressure and high cholesterol aggressively.

"We really should increase our efforts to identify and treat patients to recommended goal levels," Dr. Wong told Medscape. "Many patients suffer from both problems, but there's a disconnect and often only one is treated. We need to treat both."

Judith Hsia, MD, professor of medicine at George Washington University School of Medicine in Washington, DC, agreed.

The study "is an important analysis that actually tells you just how great a public health benefit would follow if lipids and blood pressure were treated to existing goals," said Dr. Hsai, who was not involved with the research.

The study was funded by Pfizer, Inc.

ACC 55th Annual Scientific Session: Abstract 915-210. Presented March 12, 2006.

Reviewed by Ariana Del Negro


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