Multimorbidity and Blood Pressure Control in 37 651 Hypertensive Patients From Danish General Practice

Abstract

BackgroundPatients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have additional comorbidities, is lacking. We aimed to investigate the association of comorbidities with BP control using a large cohort of hypertensive patients from primary care practices.Methods and ResultsUsing the Danish General Practice Database, we included 37 651 patients with hypertension from 231 general practices in Denmark. Recommended BP control was defined as BP <140/90 mm Hg in general and <130/80 mm Hg in patients with diabetes. The overall control rate was 33.2% (95% CI: 32.7 to 33.7). Only 16.5% (95% CI: 15.8 to 17.3) of patients with diabetes achieved BP control, whereas control rates ranged from 42.9% to 51.4% for patients with ischemic heart diseases or cerebrovascular or peripheral vascular diseases. A diagnosis of cardiac heart failure in addition to diabetes and/or CVD was associated with higher BP control rates, compared with men and women having only diabetes and/or CVD. A diagnosis of asthma in addition to diabetes and CVD was associated with higher BP control rates in men.ConclusionIn Danish general practice, only 1 of 3 patients diagnosed with hypertension had a BP below target. BP control rates differ substantially within comorbidities. Other serious comorbidities in addition to diabetes and/or CVD were not associated with lower BP control rates; on the contrary, in some cases the BP control rates were higher when the patient was diagnosed with other serious comorbidities in addition to diabetes and/or CVD.

Sex‐Specific Differences in Cardiovascular Risk Factors and Blood Pressure Control in Hypertensive Patients

“…To the best of our knowledge, only one study compared the estimated cardiovascular risk between hypertensive men and women and reported similar findings . Despite the higher estimated risk in women, the prevalence of established CVD did not differ between sexes, in contrast with previous reports, which reported higher rates in men . A possible explanation for this finding is that the Framingham equation underestimates the cardiovascular risk in women .…”

Use of Antibiotics in Children

“…Such a database is under development and implementation thus allowing for a reasonable level of qualification of such prescriptions on a nationwide basis in the future. 19,20 in the European Surveillance of antimicrobial Consumption study, the total (including adults) use of outpatient antibiotics in Denmark was low (about 14 DDD per 1000 inhabitants daily) compared with most other countries, 3 and the described utilization may be viewed as an example of a relatively low prescription rate pattern.…”

Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: A cross-sectional study

“…On the other hand, the finding that morbidity count was associated with poorer BP control was consistent with a previous study. [24] However, the same study also postulated that multimorbidity could result in more frequent contacts with medical practitioners, and thus facilitated their BP control. [24] Having diabetes mellitus as a comorbidity should be regarded as an exceptional case since the threshold of optimal control is different and harder to achieve (<130/90 mmHg).…”

“…A previous study, however, indicated that some comorbidity might improve BP control while some might hinder it. [24] Each comorbidity as a separate covariate could be investigated in future research to explore this relationship in greater depths. In addition, the variables studied were mostly socioeconomic factors, patient-related factors and therapy-related factors.…”