Hypertension: a cross-sectional study of the role of multimorbidity in blood pressure control.

Chandra Sarkar,James Crompton,Patrick White,Christopher Millett,Peter Schofield,Hiten Dodhia,Mark Ashworth

doi:10.1186/s12875-015-0313-y

Chandra Sarkar, James Crompton + Show 5 more

Open Access

https://doi.org/10.1186/s12875-015-0313-y

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Abstract

BackgroundHypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investigate the relationship between multimorbidity and systolic blood pressure (SBP) in patients with hypertension.MethodsA cross-sectional analysis of anonymised primary care data was performed for a total of 299,180 adult patients of whom 31,676 (10.6 %) had a diagnosis of hypertension. We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP. We constructed a regression model to identify the determinants of SBP control.ResultsThe strongest predictor of mean SBP was the number of comorbidities, β −0.13 (p < 0.05). Other predictors included Afro-Caribbean ethnicity, β 0.05 (p < 0.05), South Asian ethnicity, β −0.03 (p < 0.05), age, β 0.05 (p < 0.05), male gender, β 0.05 (p < 0.05) and number of hypotensive drugs β 0.06 (p < 0.05). SBP was lower by a mean of 2.03 mmHg (−2.22, −1.85) for each additional comorbidity and was lower in MM regardless of the type of morbidity.ConclusionHypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP. We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity. Further research is needed to determine whether consultation rate, “white-coat hypertension” or medication adherence influence BP control in MM.

Highlights

Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM)
Patients with hypertension alone had a mean systolic blood pressure (SBP) of 139.4 mmHg whereas those with any multimorbidity had a mean SBP of 136.3 mmHg
The specific comorbidity made no difference to the mean SBP

Summary

Introduction

Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity (MM), the presence of more than one long-term condition (LTC), is common, increases with age, occurs 10–15 years earlier in deprived populations and is twice as prevalent in the non-white population [1,2,3]. A fairly narrow definition of MM has been adopted by the Quality and Outcomes Framework (QOF), a pay-for-performance incentive scheme introduced into the United Kingdom in 2004 with a focus on a series of clinical targets for the management of LTCs [5]. This scheme currently incorporates targets for 19 LTCs and in terms of blood pressure it is important to note that there.

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