Aims: Underestimated cardiovascular (CV) risk may lead to inadequate control of blood pressure (BP), LDL cholesterol, and glycated haemoglobin. This study investigated CV risk assessment and BP, LDL cholesterol, and glycated haemoglobin control among patients with hypertension in routine clinical practice.
Methods and results: In the observational, cross-sectional, epidemiological SNAPSHOT study (conducted in Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain), CV risk was assessed in adults with hypertension according to the physician clinical practices, guidelines, and the risk assessment models valid when the study was performed (SCORE1 and SCORE2/SCORE2-OP). Blood pressure, LDL cholesterol, and glycated haemoglobin control rates were also assessed. Of 9307 patients (aged 65.8 ± 10.5 years, 43.1% male), most (91.3%) had ≥1 additional CV risk factor; 7610 (81.8%) had dyslipidaemia and 3097 (33.3%) had type 2 diabetes (T2D). Compared with guideline recommendations, assessment of patient CV risk by physicians, relative to the risk obtained using SCORE1 and SCORE2/SCORE2-OP, was accurate in only 38.0 and 26.7% of patients, respectively, and was underestimated in 54.3 and 71.8% of patients. Control rates of BP, LDL cholesterol, and glycated haemoglobin were suboptimal [<25%, <12% (in those with comorbid dyslipidaemia), and <50% (in those with comorbid T2D), respectively].
Conclusion: Physicians from six European countries tended to overestimate control rates of BP and LDL cholesterol, while underestimating CV risk in their patients with hypertension. Overall, BP, LDL cholesterol, and glycated haemoglobin control rates were low. Better implementation of clinical guideline recommendations is needed.
Keywords: Blood pressure control; Cardiovascular risk; Dyslipidaemia; Epidemiological study; Hypertension; LDL-C control.
Patients with high blood pressure (BP) (or hypertension) are at increased risk for cardiovascular (CV) disease, particularly those with high cholesterol (or dyslipidaemia) or type 2 diabetes (T2D). Accurate physician-based assessment of CV risk is essential to ensure that patients with hypertension receive appropriate treatment that targets control of BP, as well as cholesterol and blood glucose levels, in those with dyslipidaemia or T2D. Despite clear recommendations, many patients with hypertension have poor control of BP, cholesterol, and blood glucose levels. Furthermore, underestimation of CV risk by physicians can lead to inadequate treatment and suboptimal control of CV risk factors. Therefore, we conducted the observational SNAPSHOT study in six European countries (Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain) to better understand physicians’ perception of CV risk in patients with hypertension. In our study of 9307 patients with hypertension (of whom 7610 had dyslipidaemia and 3097 had T2D), CV risk was underestimated by physicians compared with two guideline-recommended risk assessments. Furthermore, physicians tended to overestimate control of BP and cholesterol levels, as many patients had persistently high BP, cholesterol, and blood glucose levels. These findings highlight a need for improvements in the assessment and management of CV risk in patients with hypertension, as well as better implementation of the clinical practice guidelines.
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology.