Factors associated with uncontrolled hypertension and cardiovascular risk in hypertensive 60-year-old men and women—a population-based study

Abstract

The objective of this study was to describe cardiovascular risk profiles of 60-year-olds with uncontrolled diagnosed hypertension (X140/90 mm Hg) in comparison with individuals with controlled diagnosed hypertension. To study how medical, lifestyle and socioeconomic factors are associated with uncontrolled diagnosed hypertension in men and women separately, a populationbased, cross-sectional study of 4228 60-year-olds in Sweden, of whom 503 men and 445 women had previously diagnosed hypertension, was conducted. Physical examination including measuring blood pressure was carried out, and a medical/lifestyle/ socioeconomic questionnaire was completed. Only 22% of the men and 33% of the women with diagnosed hypertension had a blood pressure below 140/90 mm Hg. Both men and women had multiple cardiovascular risk factors in addition to hypertension. Antihypertensive monotherapy was more common in men and women with controlled hypertension. None of the participants without pharmacological treatment had a controlled blood pressure. Four factors were independently associated with uncontrolled hypertension in men: waist circumference above 97 cm (odds ratio (OR)¼1.85, confidence interval (CI)¼1.17-2.92), coronary heart disease (CHD) (OR¼0.28, CI¼0.17-0.46), no health care for financial reasons (OR¼2.71, CI¼1.09-6.78) and daily intake of fruit (OR¼0.59, CI¼0.37-0.93). In women, three factors remained independently associated: waist circumference above 78 cm (OR¼1.93, CI¼1.09-3.43), CHD (OR¼0.36, CI¼0.18-0.72) and living in an apartment (OR¼0.55, CI¼0.35-0.85). More efforts are warranted to reduce blood pressure and to modulate associated risk factors to be able to reduce the high morbidity and mortality observed in individuals with hypertension. INTRODUCTIONHypertension is a major risk factor for cardiovascular diseases. 1 Antihypertensive treatment has been shown to reduce the occurrence of total major cardiovascular events, and the larger the reduction of blood pressure that is achieved, the larger is the reduction in mortality and cardiovascular events is observed. 2 Despite this established knowledge and benefits of blood pressure reductions, many hypertensive patients do not reach the goal for blood pressure reduction (below 140/90 mm Hg). [3][4][5][6] A recent study reported different factors associated with newly diagnosed high blood pressure in men and women. 7 Risk profiles, lifestyles and metabolic characteristics differed in men and women with normal and newly diagnosed high blood pressure. Cardiovascular risk profile in men and women with hypertension is highly important, as the risk of serious cardiovascular events is higher when additional cardiovascular risk factors are present. 1 A study of hypertensive Americans showed that women have more cardiovascular risk factors

Neighborhood deprivation and warfarin, aspirin and statin prescription — A cohort study of men and women treated for atrial fibrillation in Swedish primary care

“…Warfarin is generally considered to be under-prescribed in AF patients [35], and was prescribed in about half of the patients AF patients in the present study, which is in line with what is common in other Western countries [17]. The findings of the present study can possibly be extrapolated to pharmacotherapies in other patient groups as well, such as those with hypertension and dyslipidemia [32, 36], although this was not the scope of the present study. In fact, some of our results were more salient after adjustments for co-morbidities.…”

“…Individuals in neighborhoods with low socio-economic status, despite the relatively low annual fee, are however likely to have small financial margins [31], and may refrain from seeking healthcare because of the cost. Men who refrained from health care because of the costs have been shown to more often have uncontrolled diagnosed hypertension [32], and it is possible that similar group of individuals are more common in neighborhoods with low SES, and have fewer recommended pharmacotherapies prescribed when diagnosed with AF. Aspirin is not considered to be effective in preventing stroke in high risk groups, such as patients with AF [12].…”

Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation

“…A Swedish population-based study in hypertensive 60-year-old persons with and without diabetes by Carlsson et al found an inverse, direct association of high waist circumference with uncontrolled hypertension [40]. The same seems to be true for patients in primary care irrespective of diabetes status [41].…”

“…In contrast, living in an apartment instead of a house (as an indicator of lower socio-economic status) remained a significantly protective factor in an adjusted model in women (OR = 0.55, 95%CI 0.35-0.85). The authors stated that the finding was puzzling and offered no explanation [40]. …”

“…Carlsson et al confirmed that previous cardiovascular disease or coronary heart disease has a protective effect on uncontrolled hypertension, probably because of more intense treatment, better medication adherence and/or symptom relief of angina pectoris [40]. …”