MISSED OPPORTUNITIES FOR THE PREVENTION OF CARDIOVASCULAR-DISEASE AMONG BRITISH HYPERTENSIVES IN PRIMARY-CARE

Background. High-risk strategies for the prevention of cardiovascular disease (CVD) among hypertensive patients require knowledge of the pre valence and interaction of modifiable risk factors to ensure effective targeting of interventions. Comparatively little is known of risk-fac tor profiles and their modification among hypertensives in primary car e. Aim. The present study was designed to explore relationships betwee n patients' knowledge of CVD risk factors, their perception of persona l risk and health behaviours, and their use of lifestyle interventions . Method. A cross-sectional survey of 2676 men and women with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg), and thei r general practitioners, recruited from 1044 general practices through out the UK, was conducted.Results. Levels of modifiable risk factors w ere high, although there was considerable variation by age and sex; mo st (98.5 %) patients had at least one additional CVD risk factor. A lo wer standard of living was associated with a higher prevalence of 'unh ealthy' behaviours. Out of those with a current lifestyle problem, 85 % of obese patients, 59 % of smokers, 47 % of excess drinkers, 49 % of those with dietary risk factors and 32 % of inactive patients claimed to have adopted healthier behaviours within the past 3 months. Older subjects and those with a lower standard of living were less likely to acknowledge risks, and those who did were less likely to report impro ving their lifestyles. While 71 % of patients recalled receiving lifes tyle advice, the coverage and targeting of specific interventions was generally poor. Overall, 60 % of the sample had received advice on wei ght control, 47 % on diet, 38 % on exercise, 38 % on smoking and 36 % on alcohol. Women and older people were less likely to be given releva nt counselling, and there was no evidence of targeting with respect to subjects' social class, level of hypertension or duration of diagnosi s. Conclusion. Lifestyle interventions are welcomed and are viewed as helpful by patients receiving them. Potential health gains among high- risk hypertensives are being lost because of poor targeting and covera ge of those at greatest risk.