Prevalence and treatment of chest pain syndromes, hypertension and high LDL-cholesterol in primary care

The purpose of this study was to define the prevalence and medical management of chest pain, angina pectoris, chronic angina, and pre-infarction angina/intermediate coronary syndrome (ICS) among hypertensive patients in primary care. The Hypertension Initiative database (N=72,508 records) was analyzed to characterize prevalence and management of chest pain syndromes (CPS) and control of blood pressure (<140/90 mm/Hg) and LDL-cholesterol (<100 mg/dL). Patients with more than one CPS were categorized by the most severe diagnosis. Eleven percent of patients had a CPS diagnosis. Of these, 66% (5,284) were diagnosed with chest pain only, 15% (1204) with angina, and 19% (1508) with ICS. More men than women were diagnosed with angina (18% vs. 4%) and ICS (21% vs. 10%). More women than men were diagnosed with chest pain only (86% vs. 61%). African Americans had more chest pain diagnoses (71% vs. 62%), similar angina diagnoses (14% vs. 16%), and fewer ICS diagnoses (15% vs. 22%) than Caucasians. Women and African-Americans received strikingly fewer medications than men and Caucasians in each diagnostic category. Prescription rates also differed more by gender than by racial group for angiotensin converting enzyme inhibitors, diuretics, aspirin, statins, and nitrates. (Table 1) Hypertensives with CPS received more medications and achieved better risk factor control (blood pressure <140/90 mm/Hg and LDL-cholesterol <100 mg/dL) than hypertensives without CPS but the majority in both groups were above target levels. Primary care physicians treat these high-risk hypertensive patients relatively aggressively. However, large numbers do not reach BP or LDL-c goals and substantial differences between gender and racial groups represent opportunities to reduce disparities. See Table 1. Percent of patients receiving prescription medications of interest by diagnostic category and gender Percent of patients receiving prescription medications of interest by diagnostic category and gender