Proportion Of Uncontrolled Hypertension Research Articles

HYPERTENSION AWARENESS, TREATMENT, AND CONTROL IN AUSTRALIA. A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Research from the NCD Risk Factor Collaboration indicated that the hypertension control rates in Australia are lagging behind other high-income countries, and a call to action to improve blood pressure (BP) control has been published. To understand the size of the problem, we will systematically examine contemporary evidence of hypertension awareness, treatment and control rates in Australia. Design and method: We performed a systematic literature search of reports of hypertension awareness, treatment and control rates in Australia. We undertook an individual participant data meta-analysis (IPDMA) shared by the NCD Risk Factor Collaboration. Where possible, data were pooled for meta-analysis by random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 23 studies, the pooled proportion of hypertension awareness, treatment and control rates in Australia was 61% (95% confidence interval: 47%–74%), 58% (53%-63%), 40% (33%-47%), respectively. The National Health Survey data (n = 61799) shows a higher proportion of hypertension among males than females was observed until the 7th decade of life, and among those with lower socioeconomic status in Australia. The proportion of hypertensive subjects who were on 1, 2, and 3 or more types of antihypertensives was 44.4%(43.5%-45.2%), 18.4% (17.7%-19.0%), 7.7%(7.3%-8.2%), respectively. Our IPDMA was of 12598 (26.3%, n = 57104) hypertensive subjects, among whom 7227 (57.4%) were on antihypertensives and 58.6% had uncontrolled hypertension (SBP equal to or greater than 140 mmHg or DBP equal to or greater than 90 mmHg, n = 4238). The proportion of uncontrolled hypertension was higher among males (62.7%) than females (55.5%, p<0.0001). Conclusions: The hypertension burden in Australia is substantial, with a significant proportion of people with high BP who were unaware, untreated and uncontrolled. There is a lack of high-quality studies to identify barriers and enablers for hypertension treatment and control in Australia. These results will be key to informing the actions of the National Hypertension Taskforce that the Federal Minister of Health newly established.

CHARACTERISTICS OF THE HIGH BLOOD PRESSURE IN A TYPE 2 DIABETIC POPULATION IN THE AREA OF BLIDA (ALGERIA)

Objective: The association diabetes-high blood pressure (BP) is frequent. It increases the cardiovascular risk and accelerates the onset of degenerative complications of diabetes. The aim of the present study was to test the effect of the hypertension-diabetes association on the degenerative complications of diabetes and to determine the proportion and the factors associated with uncontrolled hypertension. Design and method: This was a cross-sectional study conducted among 2129 type 2 diabetic hypertensive patients aged 40 years or over, followed in the internal medicine department of hospital of Blida (Algeria), between February 2020 to November 2022. Results: The average age was 46 ± 6.6 years, with a female predominance (73.5%). Hypertension was present in 60.4% of normal weight patients, in 55.1% of overweight patients and 62.8% of obese patients with a significant difference (p = 0.03). Macroangiopathy was observed in 57% of patients with mainly ischemic heart disease (44%). It was significantly more frequent in patients with LDL-c greater than 1.3 g/l and hypoHDLemia less than 0.35 g/l. The proportion of uncontrolled hypertension (BP > 140/90) was 55% including 13% of cases of severe hypertension (BP > 180/110). Resistant hypertension was found in 21% of cases. This poor blood pressure control was correlated with insulin treatment (p = 0.05), insufficient physical activity (p = 0.03), treatment duration greater than 10 years (p = 0.01) and a number of tablets greater than 2 (p = 0.031). We did not find a significant difference between the level of BP control and the seniority of diabetes, the body mass index, the presence of degenerative complications, the intellectual and socioeconomic level. The analytical study showed no positive association between the onset of hypertension and the following factors: the HbA1c level and the duration of diabetes progression. We found a strong correlation between the degenerative complications of diabetes and the presence of hypertension: retinopathy (p = 0.05), neuropathy (p = 0.02), nephropathy (p = 0.001), coronary artery disease (p = 0.001), cerebrovascular accidents (p = 0.01). Conclusions: Our study highlights the positive effect of hypertension on the degenerative complications of diabetes. Optimal control of blood pressure figures is imperative to limit the development of these complications and improve life expectancy.

Blood pressure control among hypertensive patients of tribal origin attending a primary care centre in Kerala

Background: High blood pressure increases the risk for significant health issues including heart attack and stroke. According to studies, the tribal population in India is likewise going through a transformation and has increasing prevalence of high blood pressure. Therefore, this study was done with the objective to determine the proportion of hypertensives with uncontrolled blood pressure among persons of tribal origin attending a primary care centre in Kalpetta, Wayanad, Kerala. To study the factors responsible for the control of hypertension. To assess the adherence to anti-hypertensive medicine using the Morisky Green Levine Scale (MGLS).Methods: A cross-sectional study was conducted at Amrita Kripa Charitable Hospital, Kalpetta, among 167 adult hypertensives of tribal origin. A semi-structured questionnaire and MGLS were used for data collection. Data analysis was done using SPSS version 21.Results: The proportion of uncontrolled hypertension among the tribal population was found to be high (70.7%). There was a significant association with uncontrolled hypertension and lower education (p value 0.036) and also with alcohol (p value 0.007). Among participants with uncontrolled blood pressure, poor adherence was found to be 31.7% while 68.3% of participants had good adherence. Alcohol consumption (aOR- 4.10, 95% CI 1.12-14.98) and lower education (aOR-6.74, 95% CI 1.28-35.46) were independent predictors of uncontrolled hypertension on multivariate analysis.Conclusions: Seven in ten hypertensives attending the primary care centre had uncontrolled hypertension. Larger studies among persons of tribal origin are necessary at the community level through reducing alcohol use is imperative.

Facteurs associés à un mauvais contrôle tensionnel chez les patients hypertendus marocains

Study aimHypertension is a major public health concern worldwide and non-controlling it can lead to various cardiovascular complications. Controlling blood pressure and reducing overall cardiovascular risk are two main goals of treatment. Thus, this study aimed to determine the proportion and factors associated with uncontrolled hypertension in hypertensive patients living in the Beni Mellal city. Patients and methodsThe cross-sectional survey took place between June and March 2019. It involved 580 hypertensive patients attending the primary health care facilities in Beni Mellal city, using systematic sampling. ResultsA total of 580 hypertensive patients were recruited, with a mean age of 55.78 (± 10.82 years) and of which 66.89% were female. The proportion of poor blood pressure control was 74.1% and was associated in multivariate analysis with a family history of hypertension(OR = 1.60; 95% CI = [1.02-2.50]), dyslipidemia (OR = 2.05; 95% CI = [1.32 -3.20]), non-adherence to a regular BP measurement (OR = 4.13; 95% CI = [2.49 -6.86]), to treatment (OR = 3.64; 95% CI = [2.34-5.65]) and regular biological monitoring (OR = 2.45; 95% CI = [1.46-4.08]). ConclusionDespite the free and available of treatment, the proportion of uncontrolled hypertension was high. This might be linked to a lack of awareness and education concerning disease self-management.

Variation in the diagnosis and control of hypertension is not explained by conventional variables: Cross-sectional database study in English general practice.

BackgroundHypertension is a major cause of preventable disability and death globally and affects more than one in four adults in England. Unwarranted variation is variation in access, quality, outcome or value which is unexplained by differences in the condition or patient characteristics and which reduces quality and efficiency. Distinguishing unwarranted from variation due to clinical, organisational or patient factors can be challenging. We carried out this study to explore inter-practice variation in the diagnosis and management of hypertension in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, a large, representative surveillance database.Methods and findingWe carried out a cross-sectional study using primary care data extracted from the electronic health records of 1,271,419 adults registered at RCGP RSC general practices on 31st December 2016. Logistic regression was used to indirectly standardise practice-level hypertension prevalence and control against the RCGP RSC population, adjusted for age, gender, ethnicity, deprivation, co-morbidity, NHS region and practice size. Inter-practice variation was demonstrated using funnel plots with 95% and 99.8% control limits. The prevalence of detected hypertension was 18.4% (95% CI 18.4–18.5), n = 234,165. Uncontrolled hypertension was present in 146,553 of 196,052 individuals, 25.2% (25.1–25.4), in whom blood pressure had been recorded in the previous year. Hypertension management varied markedly between practices with a three-fold difference in prevalence, 13.5–38.4%, and a four-fold difference in the proportion of uncontrolled hypertension, 11.8–47.9%. Despite adjustment for sociodemographic and practice characteristics funnel plots demonstrated marked over-dispersion.ConclusionsSubstantial variation in the prevalence of diagnosed hypertension and the management of hypertension was only partially explained by characteristics captured within a routine dataset. The over-dispersion suggests variation is not fully explained by these factors and that context, behaviour and processes of care delivery may contribute to variation. Routine data sources in isolation to not provide sufficient contextual data to diagnose the causes of variation.

Prevalence and Correlates of Hypertension among Japanese Adults, 1975 to 2010.

We investigated the prevalence and factors associated with hypertension, its treatment, and control using individual-level data from 300,249 respondents aged 20 years and older from the Japanese National Health and Nutrition Survey for the period of 1975–2010. We applied multivariate random effects logistic regression to assess associations between the risk factors and the prevalence of hypertension, the proportion of uncontrolled hypertension, and the proportions of respondents seeking treatment and controlling hypertension. The trends in the effect of the birth cohort on uncontrolled hypertension were also examined. Having hypertension was associated with being male, older, obese, drinking alcohol, and working in the primary industry and a higher proportion of middle-aged men than women were found being obese and drinking alcohol. Seeking treatment was associated with being older, obese, drinking alcohol, working in a primary industry and exercising. Controlling hypertension was associated with being younger, underweight and exercising. The proportion of individuals with uncontrolled hypertension declined for cohorts born in later years with a steeper decline for women than men. Raising awareness in the hypertensive population, especially among men, could help further reduce the prevalence of hypertension in Japan.

Abstract P137: Socioeconomic Status And Hypertension Control In Sub-saharan Africa: The Multination Eight Study

Introduction: Systemic hypertension is a rapidly growing epidemic in Sub-Saharan Africa. Adequacy of blood pressure(BP) control and the factors influencing it, especially the role of socio-economic status(SES) have not been well studied in this part of the world. Hypothesis: We therefore aimed to quantify the association of SES both at the individual and at the country level with BP control in Sub-Saharan Africa. Methods: We conducted a cross-sectional survey in urban clinics of twelve countries, both low-income and middle-income, in Sub-Saharan Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. Country income was retrieved from the World Bank database and patient’s individual wealth status was documented by the treating physician. The separate association between SES (both country-level income and individual patient wealth) and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on sex and age. Results: A total of 2198 hypertensive patients (58.4±11.8years; 39.9% male) were included, of whom 1017(46.3%) were from low-income and 1181(53.7%) from middle-income countries. Individual wealth level was low, mid and high in 376(17.6%), 1053(49.2%) and 713(33.3%) patients respectively. Uncontrolled hypertension was present in 1692 patients(77.4%) including 1044(47.7%) with ≥grade 2 hypertension. The proportion of uncontrolled hypertension progressively increased with decreasing level of patient individual wealth, respectively 72.8%, 79.3% and 81.8%(p for trend<0.01). Stratified analysis shows that these differences of uncontrolled hypertension according to individual wealth index were observed in low-income countries(p for trend=0.03) and not in middle-income countries(p for trend=0.26). In low-income countries the odds of uncontrolled hypertension increased 1.37 fold(OR=1.37 [0.99-1.90]) and 1.88 fold(OR=1.88 [1.10-3.21]) in patients with middle and low individual wealth as compared to high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth(p for trend <0.01). Conclusions: Low individual wealth was significantly associated with poor hypertension control, especially in low-income countries. Strategies for hypertension control in Sub-Saharan Africa should especially focus on people in the lowest individual wealth groups who also reside in low-income countries.

Insulin resistance is an important risk factor for cognitive impairment in elderly patients with primary hypertension.

PurposeInsulin resistance plays a role in the development of dementia and hypertension. We investigated a possible relationship between cognitive impairment and insulin resistance in elderly Chinese patients with primary hypertension.Materials and MethodsOne hundred and thirty-two hypertensive elderly patients (>60 years) were enrolled in this study, and assigned into either the cognitive impairment group (n=61) or the normal cognitive group (n=71). Gender, age, education, body mass index (BMI), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), C-reactive protein (CRP), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr), fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of assessment for insulin resistance index (HOMA-IR), systolic blood pressure, diastolic blood pressure, smoking history, atherosclerosis and the proportion of uncontrolled hypertension were compared between the two groups. Multi-factorial logistic regression analysis was performed.ResultsNo significant differences were found in gender, age, TC, CRP, HDL-C, LDL-C, Cr, BP, smoking history, atherosclerosis and the proportion of uncontrolled hypertension between the two groups. The cognitive impairment group had lower education levels, and higher BMI, WHR, TG, FPG, FINS, and HOMA-IR levels than the control group. Logistic regression analysis revealed the levels of education, BMI, WHR, and HOMA-IR as independent factors that predict cognitive impairment in patients.ConclusionOur study demonstrates that poor education and increased BMI, WHR, and HOMA-IR are independent risk factors for cognitive impairment in elderly patients with hypertension. Insulin resistance plays an important role in the development of cognitive impairment in primary elderly hypertensive patients.

Sex Difference in the Prevalence of Left Ventricular Hypertrophy in Dialysis Patients

Background: Left ventricular hypertrophy (LVH) is an important, independent negative predictor of cardiovascular morbidity and mortality in the general population and in dialysis patients. Previous studies suggest a sex dimorphism in the prevalence of LVH; however, this issue has never been approached in dialysis patients. Methods: This study enrolled 237 prevalent dialysis patients: 49 on hemodialysis (HD) and 188 on peritoneal dialysis (PD) from a single center. LVH was defined by echocardiography measurements, which were normalized to body surface area (BSA) and height^2.7, respectively. Results: The mean ages in HD and PD patients were 60 ± 14 and 60 ± 13 years, with a median dialysis vintage of 43 and 20 months, respectively. Although there was no significant difference in age, diabetes, proportion of uncontrolled hypertension, antihypertensive medication and blood pressure between male and female patients within each dialysis modality, the prevalence of LVH (whether indexed to BSA or height^2.7) was consistently higher in females than in males. When these patients were divided into LVH or non-LVH groups, a significant difference in sex distribution was observed between the two groups (62.0% vs. 41.0% when the BSA-indexed standard was used, p < 0.01; 62.8% vs. 37.1% when the height^2.7-indexed standard was used, p < 0.001). In logistic regression analysis, female sex was identified as a risk factor of LVH (odds ratio, OR = 2.48, 95% confidence interval, CI = 1.33–4.59; when BSA-indexed LVH was treated as dependent variable, and OR = 4.05, 95% CI = 1.96–8.38, when height^2.7-indexed LVH was treated as dependent variable) even after adjustment for age, diabetes, blood pressure and antihypertensive medication. Conclusion: This study showed that the prevalence of LVH determined by echocardiography was significantly higher in female dialysis patients than in male dialysis patients. Compared with males, female patients had a 2.5- to 4-fold higher risk to develop LVH even after adjustment for other potential confounding factors, which may indicate that elderly females in the uremic scenario are more prone to develop LVH than elderly males.

Hypertension: The East European Experience

Some differences (and similarities) between Eastern Europe and the rest of the Continent are presented regarding the treatment of hypertension. Based on data from the WHO Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) study, the prevalence of hypertension, and the proportion of uncontrolled hypertension, is clearly higher in Eastern Europe. According to one local long-term observer, a trend for further increases in prevalence is discernable. Comparative drug consumption studies are desirable. Regarding national experiences with hypertension and health care in general, there are also some important sociocultural differences; anecdotal observations are reported that support this assertion.