Abstract
Blood pressure (BP) remains poorly controlled among hypertensive patients with coronary heart disease (CHD) in China. Improvement of its management will require an understanding of the patient characteristics and treatment factors associated with uncontrolled hypertension. A cross-sectional survey of 3,279 patients from 52 centers in China was performed to examine potential barriers to adequate blood pressure control of hypertensive patients with CHD. Uncontrolled hypertension was defined as blood pressure ≥130/or 80 mmHg. Multivariable logistic regression was used to identify factors associated with poor blood pressure control. Mean age of the patients was 65 years, 40% were women, and mean BMI was 25 kg/m2. Mean systolic blood pressure was 136±18 mmHg and mean diastolic blood pressure was 80±11 mmHg. Only 18% of patients had a mean blood pressure <130/80 mmHg during the study period. Multivariate analysis revealed several independent factors of poor blood pressure control: body mass index ≥23 kg/m2, the presence of stable angina pectoris (SAP), family history of diabetes, and use of calcium channel blockers (CCB). Further analysis showed that non-dihydropyridine calcium antagonist was significantly correlated with low BP control rate. Some of these may be amenable to modification. The results of our study suggest that overweight, the presence of SAP and family history of diabetes are important factors for tight BP control in primary care. In addition, non-dihydropyridine calcium channel blockers appear less effective than other therapies in control of blood pressure and should not be the first choice among hypertensive patients with CHD. Further identification of patients at risk of poor BP control can lead to targeted interventions to improve management.
Highlights
Hypertension is an important risk factor for cardiovascular disease and has become a major global burden on public health [1]
The study represents the first analysis of factors that may be associated with blood pressure control in hypertensive patients with coronary heart disease (CHD)
Results from multivariate logistic regression analysis show that overweight, the presence of stable angina pectoris (SAP), and family history of diabetes contribute to low blood pressure (BP) control rate in these populations
Summary
Hypertension is an important risk factor for cardiovascular disease and has become a major global burden on public health [1]. In 2002, one-sixth of all Chinese adults were found to be hypertensive, and in most cases, hypertension was uncontrolled [2]. Hypertension has often clustered with coronary heart disease (CHD). 46% of hypertensive patients had a history of CHD in the Valsartan Antihypertensive Longterm Use Evaluation (VALUE) trial [3]. Hypertensive patients with CHD often had uncontrolled blood pressure (BP) as well as higher cardiovascular morbidity and mortality. Uncontrolled blood pressure could augment cardiovascular risk in hypertensive individuals with CHD, so it is important to identify the factors that influence blood pressure control in hypertensive patients with CHD
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