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Hypertension common as well as poorly controlled in patients with cardiovascular comorbidities

Monday, January 28 2008 | Comments

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What's This? Nearly three-quarters of U.S. adults with cardiovascular disease comorbidities (CVC) have hypertension, and though treatment rates exceed 75% in many patient populations, less than half of treated patients achieve blood pressure control, investigators reported.

The study included 4,646 adults who participated in the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey in 2003 and 2004. Results showed 1,671 survey respondents had hypertension (systolic blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm Hg [or 130 mm Hg systolic blood pressure or 80 mm Hg diastolic blood pressure in patients with diabetes or chronic kidney disease]) or self-reported use of medication for lowering blood pressure.

Overall, 68.5% of those with hypertension were receiving treatment for the condition, with 52.9% of treated patients achieving blood pressure control, which was defined as systolic blood pressure lower than 140 mm Hg and diastolic blood pressure lower than 90 mm Hg.

Among subjects who had no CVCs, 23.1% had hypertension, 66.5% received treatment and 64.6% achieved blood pressure control. More than half of patients with dyslipidemia had hypertension (51.8%; P<.01 as compared with subjects who had no CVCs). Treatment was given to 68% of those patients with dyslipidemia and 49.3% gained blood pressure control (P<.05). The prevalence of hypertension was 61.5% in patients with the metabolic syndrome (P<.01). Treatment was given to 70.9% of patients and 63.7% achieved control or 46.7% if based on blood pressure lower than 130/85 mm Hg.

Hypertension rates exceeded 69% in patients with diabetes, (76.8%), chronic kidney disease (81.8%), stroke (69.5%), congestive heart failure (71.4%), peripheral arterial disease (73.7%), and coronary artery disease (73%; P<.01 for all conditions). Treatment rates in patients with those conditions ranged from 65.9% of those with chronic kidney disease to 89% of those with stroke, while control rates ranged from 34.9% of stroke patients (P<.01) to 61.2% of diabetes patients.

Among patients with ≥2 CVCs, 76.9% had hypertension (P<.01), 82.5% received treatment (P<.01), and 51.8% had controlled blood pressure.

"These high-risk persons with low rates of [hypertension] control represent an urgent need for intensified efforts to achieve [blood pressure] control," the study authors concluded. "Despite receiving treatment, many have systolic [blood pressure] that is still 20 mm Hg or greater above goal, clearly justifying Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommendations for prescribing these patients dual therapy to start with." (Wong N, et al. Arch Intern Med 2007;167:2431-2436.)

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