1. IS OCCASIONAL CONSULTATION AT A SPECIALIZED HYPERTENSION CLINIC BENEFICIAL FOR CARDIOVASCULAR RISK PROFILE IN HYPERTENSIVES DURING 5-YEAR FOLLOW-UP? M. Marciniak, K. Słupek, J. Kolbusz, Scientific supervisors: P. Jędrusik, B. Symonides, Z. Gaciong Students' Research Group at the Department of Internal Medicine, Hypertension and Angiology Medical University of Warsaw

2. OBJECTIVE To assess cardiovascular (CV) risk profile during 5- year follow-up of patients with hypertension (HTN) remaining in the care of family physicians (GPs) and additionally only occasionally attending a specialized HTN day-clinic in our tertiary referral center.

3. DESIGN & METHODS  Studied population n=200  114 women  86 men  Mean age: 51,8 ± 14,1 yrs  Median HTN duration: 5 yrs  Preexisting CV disease - 33%  Diabetes mellitus - 13%  Proteinuria and/or renal dysfunction- 9%

4. DESIGN & METHODS  Recrutation  Patients attending specialized HTN day-clinic in 2000  Single consultation ≤1/year at the request of a GP  Follow-up : invitation in 2005  Invitation by mail  Phone questionnaire  Statistical analysis  t-Student test, Chi² – test  p<0,05

5. THE DAY-CLINIC  Indications for referral:  - Newly diagnosed HTN  - Suspicion of secondary HTN  - HTN resistant to treatment  Frequency of consultations : 1/year / patient

6. THE DAY-CLINIC  Routine evaluation/intervention during visit: –Ambulatory blood pressure monitoring (ABPM) –ECG, routine clinical biochemistry, search for secondary causes of HTN when clinically indicated –Modification of pharmacotherapy –Advice on lifestyle modification

7. ABPM

8. RESULTSP20052000ABPM P=0.04169±1171±12 Night DABPM P=NS 119±17120±17 Night SABPM P<0.000180±1185±11 Daytime DABPM P=0.0061133±15136±14 Daytime SABPM P<0.000176±1081±11 DABPM 24 P=0.02128±14132±14 SABPM 24

9. RESULTS

10. RESULTS

11. RESULTSP<0.0001 18%31% Current smokers Ns 28.23±5.6127.67±5.07BMI P<0.0001 84±2171±15 GFR P=0.0026 100±17106±24 GLU P<0.0001 112±31127±34 LDL P=0.0026 57±1553±14 HDL P=0.03 127±66138±89TG P<0.0001 195±36206±39 CHOL P20052000

12. RESULTS

13. RESULTS

14. AVERAGE NUMBER OF DRUGS TAKEN 2000 2,0±1,3/ patient 2005

15. CONCLUSIONS  Even infrequent consultations at a specialized HTN clinic result in improved BP control, lipid levels and lower global CV risk in hypertensives at 5-year follow-up despite advancement in age.  No increase in the average number of drugs taken may result from better choice of therapy applied.  Such a “backup” for primary care physicians might represent a feasible, possibly relatively low-cost strategy to reduce CV disease burden in general population.

16. Thank you for your attention