Likelihood Of Hypertension Control Research Articles

Relationship of depressive disorders with hypertension, its control and other metabolic risk factors in the Tyumen Oblast population of men and women. Data from the study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation” (ESSE-RF)

Aim. To study the association between depression and metabolic cardiovascular risk factors, hypertension (HTN) and its control in a random sample of Tyumen Oblast population of men and women aged 25-64 years.Material and methods. The study object was a random sample of the population of the Tyumen and the Tyumen Oblast aged 25-64 years, examined as part of the ESSE-RF epidemiological study. The study included 1658 participants. Among them, 30,3% (n=503) were men, while 69,7% (n=1155) — women. Mean age was 48,9±11,4 years. The prevalence of metabolic risk factors (hyperlipidemia, carbohydrate metabolism disorder, obesity), hypertension and the likelihood of its control in men and women with different levels of depressive disorders diagnosed using the HADS scale were assessed.Results. Compared with participants without depression, persons with psychological disorders were significantly more likely to have HTN (55,5% vs 47,6%, p<0,01), elevated levels of total cholesterol (TC) (63,9% vs 54,0%, p<0,01) and low-density lipoproteins (LDL) (66,7% vs 60,3%, p<0,05), carbohydrate metabolism disorders (8,3% vs 5,2% p<0,05), obesity (49,2% vs 37,7%, p<0,01). Significantly more often hypertensive subjects without depression took antihypertensive drugs effectively (odds ratio (OR) — 1,747, 95% confidence interval (CI), 1,001-3,053) and controlled blood pressure (OR — 1,533, 95% CI, 1,05-2,36). There was no association between the use of antihypertensives and the level of depressive disorders. Among women with depression (HADS>7), dyslipidemia (65,5% vs 57,4% for TC, p<0,05; 71,0% vs 62,9% for LDL, p<0,05), carbohydrate metabolism disorders (10,1% vs 5,2%, p<0,01), obesity (53,3% vs 43,2%, p<0,01), HTN (60,6% vs 45,6%, p<0,01) were more common. Men with clinical depression were more likely to have HTN (69,0% vs 47,7%, p<0,05), with a high level of depression — hyperlipidemia (58,9% vs 46,7% for TC, p<0,05; 67,1% vs 53,9% for LDL, p<0,05). Women with elevated depression levels were less likely to take antihypertensive drugs (30% vs 49,4%, p<0,01) and control hypertension (13,8% vs 21,2%, p<0,05).Conclusion. The data obtained confirm the association of depressive disorders with metabolic risk factors and the likelihood of HTN control, which is especially significant among women.

Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control

Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal. To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates. This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019. An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group). Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up. A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups. This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

Hypertension Control at Physicians' Offices in the United States

Uncontrolled hypertension is a common and important risk factor for heart disease and stroke. Nevertheless, the control rate among patients taking prescribed medication and/or therapeutic lifestyle modification has remained about the same for the past several decades. We analyzed 2003 and 2004 National Ambulatory Medical Care Survey (NAMCS) data to determine hypertension control in the physician offices in the United States. All visits for hypertension with measured blood pressure levels were included in the analyses. Survey weights were applied to obtain national estimates. Characteristics associated with hypertension control status were identified. About 176 million hypertension-related office visits occurred (9.7% of total office visits) during 2003 and 2004. Of these, 17, 44, and 62% of visits had blood pressure <130/80 mm Hg, 140/90 mm Hg, and 145/95 mm Hg, respectively. The likelihood of hypertension control (<140/90 mm Hg) was associated with a diagnosis of coronary heart disease (odds ratio (OR) 1.54, 95% confidence interval (CI) = 1.01-2.35), visits with increased serum cholesterol (OR = 1.34, 95% CI = 1.09-1.65), visits with patients' primary care physician vs. those with non-primary care physicians (OR = 1.49, 95% CI = 1.05-2.10), and visits with internists (OR = 1.32, 95% CI = 1.05-1.67) or cardiologists (OR = 1.70, 95% CI = 1.17-2.471) vs. those with family physicians. Age, gender, race/ethnicity, health insurance status, and prescription of types of antihypertensive medicine were not associated with hypertension control in office visits. The hypertension control rate of 44% in US office visits leaves substantial room for improvement. A strong emphasis on improving hypertension management is needed to reduce hypertension-related morbidity and mortality.