Prevalence, treatment, and control of chest pain syndromes and associated risk factors in hypertensive patients.

BACKGROUND Prevalence of chest pain syndromes (CPS)-chest pain, angina pectoris, chronic angina, and preinfarction angina/intermediate coronary syndrome (ICS)-among hypertensive patients and medical management of these disorders in primary care are not well defined. METHODS The Hypertension Initiative primary care database with 72,508 hypertensives was analyzed to characterize prevalence and management of CPS. Patients with more than one CPS were categorized by the most severe diagnosis. RESULTS Eleven percent of hypertensives had a CPS. Of these patients, 66% (5284) were diagnosed with chest pain only, 15% (1204) with angina, and 19% (1508) with ICS. More men than women were diagnosed with angina (18% v 4%) and ICS (21% v 10%). More women than men were diagnosed with chest pain only (86% v 61%). African Americans received more chest pain diagnoses (71% v 62%), similar angina diagnoses (14% v 16%), and slightly fewer ICS diagnoses (15% v 22%) than whites. Most striking, women and African Americans with CPS received fewer medications than men and whites, both overall and within diagnostic categories. Prescription rates differed more by gender (male/female) than by ethnic group (white/African American) for angiotensin-converting enzyme inhibitor, diuretics, aspirin, statins, and nitrates. Hypertensives with CPS received more medications and achieved better risk factor control than non-CPS hypertensives, but the majority remained above goal levels. CONCLUSIONS Primary care physicians treat cardiovascular risk factors relatively aggressively in hypertensives with CPS. However, substantial numbers of these patients do not reach goal levels. Demographic differences in treatment represent opportunities to reduce disparities.