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The multiplicative nature of the interaction of cardiovascular risk factors (RF) warrants more aggressive management in multiple (high) risk individuals. In order to test the hypothesis that physicians do not recognize or treat multiple RF patients more aggressively than those with single RF, we measured univariate RF control rates in hypertension, hypercholesterolemia and diabetes, then calculated predicted bivariate and trivariate control rates from univariate values. The predicted rates were subsequently compared to observed values. The study population consisted of 1172 hypertensive diabetics admitted to a general hospital from June 30, 1998–July 31, 1999. ICD9 codes were used to define diabetes and antihypertensive drug use to define hypertension. Patients with heart failure were excluded. Available hospitalized systolic blood pressures on treatment (HSBP), glycated hemoglobin (HbA1c) and LDL cholesterol were related to values recommended by the American Diabetes Association and JNC VI guidelines (SBP#130 mmHg, HbA1c#7% and LDL#100 mg/dL). Results: Population means6SD were as follows: Age566612 years, HSBP5139624mmHg, HbA1c57.961.6%, LDL5102645 mg/dL. The univariate control rates for HSBP, LDL and HbA1c were 42%, 46% and 32% respectively. The predicted and observed control rates for patients with 2 or 3 risk factors controlled to target were:

Assessment of current treatment trends in the management of high risk hypertension