Predictors of uncontrolled blood pressure in hypertensive treated individuals–The CONSTANCES cohort study

Abstract

A broad range of factors has been identified to contribute to poor blood pressure (BP) control. But further epidemiologic data in France are needed. We aimed to assess sociodemographic, clinical and behavioral predictors of uncontrolled BP among treated hypertensive individuals. We conducted cross-sectional analysis using data from the CONSTANCES cohort study. We included 11,159 participants previously diagnosed with hypertension and taking antihypertensive medications. Uncontrolled BP was defined as mean systolic BP ≥ 140 mm Hg and/or mean diastolic BP ≥ 90 mm Hg. Alcohol use disorder severity was defined according to the French version of the Alcohol Use Disorders Identification Test (AUDIT). Dietary assessment was done based on adherence to French dietary guidelines using the modified National Program on Nutrition and Health (mPNNS). Depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). Gender specific age-adjusted multivariable analyses were performed using logistic regression models. Adjusted mean systolic BP were studied across selected variables using the General Linear Model. The prevalence of uncontrolled BP was 60.2% and it was higher in men than in women (66.5% vs. 52.5%, P < 0.0001). A higher proportion of men had both SBP and DBP not at goal (42%) compared to women (34%). We found a significantly lower SBP with better dietary compliance ( P = 0.003 in men), high physical activity ( P = 0.048 in women) and low risk of alcohol use disorder ( P < 0.01, both sexes). There was no significant relationship with depression represented by CES-D. In both sexes, predictors of uncontrolled HTN were increasing age, history of CVD and dyslipidemia. In men, additional factors included diabetes (adjusted odds ratio 0.74; P = 0.036), increased BMI (ORa 1.26, P = 0.01), heavy alcohol drinking (ORa 1.59, P < 0.001) and high dietary adherence (ORa 0.69, P = 0.05) In this population-based study, clinical and behavioral characteristics were predictors of uncontrolled HTN. Modifiable risk factors such as weight, diet, alcohol use and physical activity influence the SBP and BP control.