Gaps Between Guidelines and Practice in Patients with Hypertension and Type 2 Diabetes: A Nationwide Cross-Sectional Study (SNAPSHOT-Brazil Study).
| Title: | Gaps Between Guidelines and Practice in Patients with Hypertension and Type 2 Diabetes: A Nationwide Cross-Sectional Study (SNAPSHOT-Brazil Study). |
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| Authors: | Colombo FMC; Hypertension Unit, Heart Institute of Medical School, University of São Paulo, São Paulo 05403-900, Brazil.; Précoma DB; Sociedade Hospitalar Angelina Caron, Campina Grande do Sul 83430-000, Brazil.; Camazzola FE; Instituto de Pesquisas em Saúde (IPS), Fundação Universidade de Caxias do Sul (FUCS), Caxias do Sul 95070-561, Brazil.; Abib Junior E; Scentryphar Pesquisa Clínica, Campinas 13026-501, Brazil.; Franco DR; CPclin-Centro de Pesquisas Clínicas, São Paulo 01228-200, Brazil.; Magalhães LBNC; Faculdade Zarns, Salvador 41741-590, Brazil.; de Souza Spinelli AC; Cardiocentro Natal, Natal 59020-300, Brazil.; Gemelli JR; Clínica Gemelli, Brasília 76804-094, Brazil.; Borges JLC; Centro de Pesquisa Clínica do Brasil, Brasília 71625-009, Brazil.; Montenegro Junior RM; Walter Cantidio University Hospital, Federal University of Ceará/Ebserh, Fortaleza 60110-110, Brazil.; Dourado PMM; Pró Coração Cardiologia Preventiva, São Paulo 05021-010, Brazil.; do Nascimento Lima RV; Medical Affairs Department, Servier Brazil Laboratories, Rio de Janeiro 22641-700, Brazil.; da Silva ML; Medical Affairs Department, Servier Brazil Laboratories, Rio de Janeiro 22641-700, Brazil.; Gewehr DM; Postgraduate Program in Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba 80060-000, Brazil.; Nogueira A; Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre 90010-150, Brazil.; de Freitas Pereira ET; Medical Affairs Department, Servier Brazil Laboratories, Rio de Janeiro 22641-700, Brazil.; Lima Junior E; Postgraduate Program in Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba 80060-000, Brazil. |
| Source: | Journal of clinical medicine [J Clin Med] 2026 Apr 15; Vol. 15 (8). Date of Electronic Publication: 2026 Apr 15. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Basel, Switzerland : MDPI AG, [2012]- |
| Abstract: | Background/Objectives: The guideline targets for blood pressure (BP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) are frequently unmet, and physicians often misjudge control. This study aimed to characterize the real-world control of BP, HbA1c, and LDL-C in patients with type 2 diabetes (T2D) and hypertension, herein called cardiometabolic multimorbidity (CMM), and to compare guideline-based versus physician-perceived disease control. Methods: We conducted SNAPSHOT-Brazil, a nationwide, multicenter, cross-sectional study to gather real-world data on patients with CMM. The ESC guidelines defined the cardiovascular (CV) risk and control targets. Results: We included 451 patients with hypertension and T2D (median age 65 years; 60% female; 54% White). Most patients (98%) were on pharmacotherapy and reported high adherence (according to the Hill-Bone Medication Adherence Scale). A very high CV risk predominated (78%); 22% of the patients were at a high risk. The guideline-defined control was achieved in 27% for BP, 34% for HbA1c, 13% for LDL-C, and 6% for both BP and LDL-C; only 3% met all three targets simultaneously. The physicians accurately stratified the CV risk in 49% of patients, while 50% had their CV risk underestimated. They systematically overestimated control in 29% of cases for BP, 35% for LDL-C, and 25% for both. The sensitivity ranged from 0.88 to 0.98; the positive predictive values ranged from 0.19 to 0.48, and the positive likelihood ratios ranged from 2.16 to 3.65. Conclusions: The SNAPSHOT-Brazil study revealed a low attainment of BP, HbA1c, and LDL-C targets, despite the widespread pharmacotherapy and the high self-reported adherence. The physicians consistently overestimated disease control and underestimated the CV risk. |
| Grant Information: | 0 Servier Brazil Laboratories |
| Contributed Indexing: | Keywords: LDL; LDL-C control; cholesterol; diabetes mellitus; essential hypertension; glycemic control; hypertension control; medication adherence; physician perception; risk assessment |
| Entry Date(s): | Date Created: 20260504 Date Completed: 20260504 Latest Revision: 20260507 |
| Update Code: | 20260507 |
| PubMed Central ID: | PMC13117057 |
| DOI: | 10.3390/jcm15083022 |
| PMID: | 42074821 |
| Database: | MEDLINE |
Journal Article