Hypertension awareness and control in CHD patients from 27 countries. Preliminary results of the ESC-EORP EUROASPIRE V survey

Abstract

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The following companies have supported the EORP programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript. Background Hypertension is a highly prevalent cardiovascular risk factor, and yet a large proportion of patients with coronary heart disease (CHD) have uncontrolled hypertension. Awareness has been proposed as a factor that can influence hypertension management. Understanding factors that may improve hypertension control in CHD patients is essential due to their high cardiovascular risk. Goal: We aim to explore the distribution and association of hypertension control and awareness in hypertensive patients with established CHD. Methods We analysed data from ESC-EORP EUROASPIRE V, a cross-sectional study including 9018 CHD patients in 27 countries, with data collected through medical records, interview and physical examination. Hypertension was defined by blood pressure (BP) level at physical examination, antihypertensive medication use, and hypertension history. Controlled hypertension was defined as BP <140/90mmHg (140/85mmHg in diabetics). Awareness was studied as awareness of the patient’s BP level, and of the patient’s BP target. Patients were considered aware if they reported to be aware of their latest BP level and their target, and if they indicated their actual and target BP levels correctly (±10mmHg). We used logistic regression with hypertension control as outcome and awareness as determinant. Separate models were fit for actual BP level and BP target level awareness as determinants. We additionally performed a subgroup analysis by middle-income (MIC) and high-income (HIC) countries. Results 5896 subjects were considered hypertensive, from which 39.6% were controlled. 79.2% of patients were aware of their BP level, and 84.5% were aware of their BP target. Hypertension control was more common in HICs (41.3%) than in MICs (35.2%). Patients aware of their BP level (OR 0.47, 95%CI 0.39-0.57) and of their target (0.36, 0.28-0.46) were less likely to have controlled hypertension, compared to unaware patients. Furthermore, hypertension control was associated with age <65 years (0.43, 0.37-0.51 own BP awareness model; 0.43, 0.35-0.52 BP target awareness model), BMI <25 kg/m2 (0.46, 0.37-0.56 own BP awareness model 0.5 0.39-0.64, BP target awareness model) and male sex (1.31,1.09-1.58, own BP awareness model; 1.39, 1.1-1.74 BP target awareness model). Higher education was associated with hypertension control in HICs (1.41, 1.01-1.97 own BP awareness model). Conclusion Control was low in the hypertensive study participants, and it was lower in MICs. Awareness levels were generally high, although it is concerning that 20.7% and 15.5%% of hypertensive patients were not aware of their BP level and their target respectively. Patients with uncontrolled hypertension were more likely to be aware of their own BP level and target. Controlled patients may have a lower risk perception. It is important that prevention efforts work on improving the awareness to prevent development uncontrolled hypertension in the future.