Reduction of global cardiovascular risk by continuous care provided to a hypertensive population by a family doctor

Abstract

Introduction: Cardiovascular diseases are the main causes of death in Portugal, as it represents 34% of deaths occurred in 2005. The National Health Department recommends using the table derived from the project SCORE in order to calculate the global cardiovascular risk (GCVR), which allows us to identify patients with a higher risk who benefit the most with the effective control of cardiovascular risk factors (CVRF). The Family Doctor is in the appropriate position to act out on modifiable CVRF of the hypertensive population and hence reduce their GCVR. There are several evidences demonstrating that continuity of care results in health improvement obtained in various chronic conditions, such as hypertension, diabetes mellitus and asthma. Goals: Verify if continuity of care provided to the hypertensive patients by the Family Doctor influence: (1) reduction of GCVR; (2) improvement of major CVRF; (3) higher reduction of blood pressure and lipid profile of the hypertensive patients with an initially high GCVR. Methodology: Quasi-experimental retrospective longitudinal study. Target Population: Hypertensive patients diagnosed until 2004 and usual attendants of the hypertension appointments between 2004 and 2007 (n = 197). Studied variables: BP, lipid profile, smoking and GCVR. Results: Comparing the average values of the GCVR obtained with the SCORE table a significant reduction of 19,2% was obtained during 3 years. Concerning CVRF, we verified: a significant average reduction of 9,3% at the level of systolic blood pressure (SBP) and an increase of 3,2% at the diastolic blood pressure (DBP); a significant average reduction of 6,5% and 13,8% for TC and LDL-cholesterol (LDL-C); a significant increase of HDL-cholesterol (HDL-C) and the triglycerides (TG) of 5,4% and 8,4%, correspondently; and a significant reduction of 50% of smoking status. The hypertensive patients who were initially considered higher risk, obtained a three times reduction of the SBP and TC and a two times reduction of the LDL-C compared to those patients of lower risk. Conclusions: A significant reduction of GCVR and an improvement of major CVRF were verified.There was an adapted performance to the initial levels of risk; which resulted in a great benefit to those with high initial risk.