Hypertension control and cardiometabolic risk: a regional perspective

Descriptive Cross-Sectional Study on Knowledge, Awareness, and Adherence to Medication among Hypertensive Patients at a Tertiary Care Centre in Colombo District, Sri Lanka

Objective

This study was aimed to assess the patient's knowledge and awareness about hypertension and adherence to antihypertensive medication among hypertensive patients.

Methods

The descriptive cross-sectional study was conducted in three medical clinics of Colombo South Teaching hospital, Kalubowila, Sri Lanka, from April 2019 to September 2019. Total of 384 hypertensive patients were recruited by systematic randomized controlled sampling and interviewed with validated questionnaires to assess their knowledge about hypertension and adherence to antihypertensive medication. Data were analyzed using SPSS (version 21) analytical package, and the chi-squared test was performed.

Results

The total sample consisted of 384 hypertensive patients with a mean age of 59.32 (±12.34SD). This included 180 (46.9%) males and 204 (53.1%) females. The male : female ratio was approximately 9 : 10. Most of patients were with primary and ordinary educational status (65.9%), normal body mass index (54.9%), mild elevation of LDL cholesterol (76.3%), and coexistent ischemic heart disease (39.6%). The knowledge about hypertension among majority of patients was reasonable. However, they were unaware about normal values of blood pressure (69%, 95% of CI 1.92–2.09) and diagnostic values of hypertension (90.1%, 95% of CI 2.26–2.40). Moreover, they were unaware of their blood pressure values at time of diagnosis (75.3%, 95% of CI 2.09–2.25), at recent clinic visit (71.3%, 95% of CI 2.0-2.17), and target level (81.8%, 95% of CI 2.25-2.41). Most patients had adequate knowledge about the risk factors and complications of hypertension and were aware of their target organ damage (70.3%). Most patients believed that medication alone is not sufficient to control blood pressure (41.7%, 95% of CI 1.40-1.51) and adequate control of their blood pressure reduces complications (68.2%, 95% of CI 1.37-1.51). Most of the patients (71.8%) had reasonable good drug compliance. The forgetfulness was commonly attributed for nonadherence (69%, 95% of CI 1.26-1.36).

Conclusions

The knowledge about hypertension among majority of patients was reasonable. But, they were unaware about their disease status and their diagnosis, target, and recent blood pressure values. Most of patients had adequate knowledge about the risk factors and complications of hypertension. However, they were unaware about their target organ damage due to hypertension. The drug compliance was reasonable among them. The forgetfulness was common reason for nonadherence. Therefore, healthcare professionals should implement individualized educational programmes to increase the awareness of disease status, appropriate blood pressure levels, and adherence of treatment to improve the outcome of patients.

Prevalence of cardiometabolic risk factors and selected cardiovascular diseases in hypertensive and normotensive participants in the adult Polish population: The WOBASZ II study

Hypertension is one of the most important causes of cardiovascular disease (CVD) incidence and mortality. The aim of the study was to assess the prevalence of metabolic syndrome and its individual components i.e., diabetes, obesity, elevated triglycerides (TG), low HDL (high-density lipoprotein) cholesterol, as well as selected manifestations of CVD i.e., atrial fibrillation (AF), peripheral artery disease (PAD), coronary artery disease (CAD), myocardial infarction (MI), and stroke in persons with and without hypertension in the Polish population.The analysis included participants of Polish multicentre WOBASZ II Study i.e., 6163 persons aged 19 and above. The Mantel Haenszel anlysis and multidimensional logistic regression model were used to assess the relations between the prevalence of metabolic syndrome and its individual components as well as selected manifestations of CVD with hypertension.Compared to normotensives, metabolic syndrome was over 5 times more prevalent in participants with hypertension (OR = 5.35, 95% CI:4.71-6.09). Components of the metabolic syndrome and selected manifestations of CVD were more prevalent in participants with hypertension compared to normotensives. The Mantel-Haenszel odds ratios (95% confidence intervals) were as follows: obesity counted as BMI > 30 kg/m OR = 2.58 (2.26-2.96), raised triglycerides OR = 2.34 (2.07-2.64), reduced HDL-C OR = 1.81 (1.59-2.06), metabolic syndrome OR = 5.35 (4.71-6.09), diabetes OR = 2.54 (1.98-3.26), AF OR = 1.47 (1.09-2.00), PAD OR = 1.51 (1.14-1.99), CAD OR = 1.94 (1.52-2.49), MI OR = 1.89 (1.32-2.70), hospitalization due to HF OR = 2.02 (1.43-2.87), hospitalization due to exacerbation of CAD OR = 2.13 (1.58-2.86), hospitalization due to revascularization OR = 2.38 (1.49-3.80), hospitalization due to stroke OR = 1.72 (1.1-2.68).Compared to normotensive participants, persons with hypertension had higher prevalence of diabetes, obesity, MS, PAD, CAD, stroke, MI and AF, and more frequent need for hospitalization due to HF, exacerbation of CAD and for coronary revascularization.

Appearance and potential predictors of poorly controlled hypertension at the primary care level in an urban community

Purpose

Hypertension (HT) is the major risk factor for cardiovascular diseases because of its poor control. To control HT at the primary care level in urban communities, there is a demand for deeper comprehension of the manifestations of poorly controlled HT. This study aimed to examine appearance of HT, including the association between the appearance and home blood pressure (HBP) control at the primary care level in urban communities.

Patients and methods

A cross-sectional study was conducted in July-October 2017 in an urban community in Thailand. The total sample size from randomization was 125 poorly controlled HT patients who were diagnosed with an average clinic blood pressure ≥140/90 mmHg in their last three visits. Data were collected by face-to-face interviews, HBP monitoring (HBPM), and blood and urine testing. Data analysis was conducted via descriptive statistics and the chi-square tests, with a significance level of p<0.05.

Results

HBPM revealed that 58.4% of patients with poorly controlled blood pressure from clinic measurement had a systolic blood pressure and diastolic blood pressure that were below the HBP target. Most patients were overweight/obese, but they were nonsmokers and nondrinkers. As comorbidities, they had hyperlipidemia (64.0%) and diabetes mellitus (53.0%). One-quarter of them had good levels of knowledge and literacy. Nearly half had good health self-care literacy. Only 13% exhibited adequate self-management behaviors, but more than half had biochemistry results within normal limits. There were significant associations of smoking history and having hyperlipidemia as a comorbidity with HBP control (p =0.010 and 0.046, respectively).

Conclusion

The role of HBPM is important in practice when it comes to monitoring HT control at the primary care level in an urban context. Smoking cessation and control of the blood lipid levels should be highlighted not only at the practice, but also at the policy level.

Impact of Statin Therapy on the Blood Pressure-Lowering Efficacy of a Single-Pill Perindopril/Amlodipine Combination in Hypertensive Patients with Hypercholesterolemia

INTRODUCTION

Several lines of research indicate that statins can lower blood pressure (BP) independently of their lipid-lowering effects when used as monotherapy and in combination with antihypertensive agents.

AIM

This short-term, open-label study examined whether statin therapy had a synergistic effect on the BP-lowering efficacy of perindopril/amlodipine in a subgroup of patients in the PERSPECTIVA study with concomitant hypertension and hypercholesterolemia, with or without statin at baseline.

METHODS

The PERSPECTIVA study recruited 732 adults with untreated or uncontrolled hypertension. This subgroup analysis of PERSPECTIVA included 587 patients with concomitant hypertension and hypercholesterolemia (mean age 56.7 years) of whom 226 were receiving a statin at baseline (statin [+] group) and 361 were not (statin [-] group). All patients received treatment with single-pill combination perindopril/amlodipine at a dose of 5/5, 10/5 or 10/10 mg/day. The study duration was 60 days with follow-up visits for BP monitoring at 7, 15, 30 and 60 days.

RESULTS

At day 60, BP control (<140/90 mmHg) was significantly greater in the statin [+] vs statin [-] group: 73 vs 64% respectively (+14%, P < 0.05). In the statin [+] group, the single-pill perindopril/amlodipine combination significantly reduced BP in patients previously untreated (n = 18), or treated with monotherapy (n = 97), dual therapy (n = 93), or triple therapy (n = 18): -38.8/-20.0, -39.1/-20.1, -38.0/-19.4, -39.9/-18.3 mmHg respectively (P < 0.001 vs baseline BP). The greatest BP reductions were observed in the first 7 days. Treatment was well tolerated with a similar rate of adverse events in the statin [+] group (0.9%) vs the statin [-] group (2.5%).

CONCLUSION

BP control rates in patients with uncontrolled hypertension and concomitant hypercholesterolemia are significantly improved with a treatment regimen that combines perindopril/amlodipine with statin therapy, regardless of previous antihypertensive therapy. This subanalysis of the PERSPECTIVA study supports the synergistic BP-lowering effect of statins and perindopril/amlodipine.

Triple Combination Therapy for Global Cardiovascular Risk: Atorvastatin, Perindopril, and Amlodipine

Statins, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs) have markedly changed the clinical progression of patients with coronary artery disease (CAD). The goal of this paper is to review the rationale and evidence for combining these three drug classes in hypertensive patients with hypercholesterolemia or CAD. Data sources include a literature search for publications on the use of a statin combined with various antihypertensive drugs in patients with hypertension and hypercholesterolemia or stable CAD. Hypercholesterolemia and hypertension constitute major physiological risk factors of ischemic heart disease. Current guidelines recommend a global approach to risk management, using agents that address as many risk factors as possible. Dual combination therapies are an important component of guideline-recommended therapy in hypertension. Our review of the literature indicates that triple therapy with a statin, ACE inhibitor, and CCB is associated with a significant reduction in major cardiovascular events. For example, a post hoc analysis in 1056 patients with stable CAD participating in the EUROPA trial indicated that the addition of perindopril to a CCB and a lipid-lowering agent was associated with a 46 % reduction in the composite of cardiovascular death, myocardial infarction, and resuscitated cardiac arrest (p = 0.023). In addition, single pill formulations are known to result in better adherence to the treatment. Single-pill formulations that combine a statin, an ACE inhibitor, and a CCB appear to offer an effective approach to the management of global cardiovascular risk.

On the transition from a nurse-led hypertension clinic to hypertension control in primary care: identifying barriers to and factors acting against continuous hypertension control

Many hypertensive patients are not treated to target and hence do not benefit fully from the blood pressure-related improvements in cardiovascular health. Hypertensive patients who had primarily been treated to a target goal in a nurse-led hypertension clinic were re-examined to evaluate whether their target goal blood pressure was maintained after their discharge from the hypertension clinic for further control in primary care, and to evaluate potential barriers to and factors acting against continuous hypertension control. The median observation time was 3.6 years (range 3 months to 7.9 years). Only 45.2% of the patients were well controlled at the time of re-examination. No patient-related factors (age, body mass index, gender, attitudes towards medication) predicted the outcome. Two factors were significant in the reduction in continuous hypertension control: the cooperation between the patient and health personnel and the shared commitment towards the target goal were discontinued; and many patients did not make control visits to the general practitioner's office. In conclusion, maintained strict control of hypertension requires both continued close collaboration between the patient and health personnel, with an emphasis on treatment goals, and systematic control visits.

Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in samarkand, uzbekistan

Hypertension is one of the most important preventable causes of premature morbidity and mortality in the world. Many people with hypertension both in developing and developed countries have no adequate control of their blood pressure (BP). Hypertension-related knowledge and practice of patients play an important role in controlling hypertension and in preventing its long-term complications. The objective here was to study hypertension-related knowledge, practice and drug adherence of inpatients, and to examine an association between the knowledge regarding hypertension with BP control status and drug adherence. We studied hypertension-related knowledge, practice and drug adherence of patients in a hospital setting. A cross-sectional study was conducted among 209 patients with the diagnosis of primary hypertension at the Samarkand State Medical Institute. The study was conducted from June to September 2012. Drug adherence was studied using the Morisky 4-item self-report measure of medication-taking behavior. The reasons for drug non-adherence were assessed using a self-administered questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by a logistic model. The BP control rate and drug adherence of the patients were suboptimal (24.4% and 36.8%, respectively). Overall, 64.6% of patients had good or adequate and 35.5% had inadequate knowledge about hypertension. Good knowledge of patients was significantly associated with controlled BP (OR=5.4, 95% CI, 1.7-16.2) and drug adherence (OR=3.8, 95% CI, 1.4-10.8). In conclusion, the inpatients of the secondary hospital had sufficient general knowledge about hypertension, but they had inadequate knowledge about specific issues such as treatment for and symptoms of hypertension. Both drug adherence and BP control rate were suboptimal and significantly associated with hypertension knowledge. This study specifies potential areas of hypertension education that could be improved by patients' knowledge of hypertension.

Blood pressure control in hypertensive patients in the "Hiperdia Program": a territory-based study

BACKGROUND

Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level.

OBJECTIVE

To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil).

METHODS

Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤ 140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ(2) test, and simple and multiple Poisson regression were used in the statistical analysis.

RESULTS

The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled.

CONCLUSION

Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

Prevalence and control of high blood pressure in primary care: results from the German Metabolic and Cardiovascular Risk Study (GEMCAS)

Contemporary epidemiological data on blood pressure readings, hypertension prevalence and control in unselected patient populations covering a broad age range are scarce. The aim here is to report the prevalence of high blood pressure and to identify factors associated with blood pressure control in a large German primary care sample. We used data from the German Metabolic and Cardiovascular Risk Study including 35 869 patients aged 18-99 years. High blood pressure was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or using antihypertensive therapy. Factors associated with blood pressure control among patients receiving antihypertensive therapy were examined using multiple logistic regressions to estimate odds ratios and 95% confidence intervals. The prevalence of high blood pressure, uncontrolled high blood pressure and untreated high blood pressure was 54.8%, 21.3% and 17.6%, respectively. Age >50 years (1.52; 1.40-1.65), male sex (1.30; 1.20-1.41), elevated waist circumference (1.55; 1.45-1.65), high cholesterol (1.24; 1.16-1.33), high triglycerides (1.11; 1.04-1.19) and concomitant diabetes (1.29; 1.20-1.40) were independently associated with uncontrolled high blood pressure. In a majority of patients we observed hypertension despite treatment for high blood pressures. Studies examining the reasons for treatment failure are highly warranted.

Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxembourg: findings from ORISCAV-LUX study

Background

In the absence of evidence-based information, assessment of population awareness and management of diabetes, hypertension and dyslipidemia (treatable and preventable cardiovascular risk factors) are important to halt coronary and cerebrovascular diseases and to improve public health.

Methods

The analysis was based on a nationally representative sample of 1432 adult subjects, recruited for the ORISCAV-LUX survey (2007–2008). Descriptive and multivariable logistic regression analyses were performed. The 10-year Framingham risk score was calculated for each participant who classified at low, intermediate and high risk.

Results

Among the diagnosed cases, 32%, 60%, and 85% were respectively unaware of their diabetes, hypertension and dyslipidemia. Increasing age and BMI were the strongest protective factors against unawareness of hypertension and dyslipidemia. Having a family history decreased the risk of unawareness of hypertension (OR = 0.57; 95% CI 0.36, 0.92; P = 0.021), whereas, not having a family doctor increased double-fold the odd of being unaware of hypertension (P = 0.048). Poor health perception reduced significantly the risk of unawareness of dyslipidemia (OR = 0.27; 95% CI 0.11, 0.68). Concerning the management, diabetes was markedly better treated than hypertension and dyslipidemia. Among diabetic subjects (constituting 4% of the population), 3% were treated vs. 1% not treated. In contrast, 22% of the hypertensive participants (35% of the population) were not treated vs. 13% treated. Concerning dyslipidemia, only 9% of those with lipid disorder (70% of the population) were under medication vs. 61% not treated. For the treated cases of these pathologies, almost only one-third was under control. Framingham risk of developing CHD within 10 years was moderate to high among 62%, 27%, and 17% of the unaware/untreated diabetic, hypertensive, and dyslipidemic participants, respectively.

Conclusion

The considerable lack of awareness and insufficient management underscore the urgent need for intensive efforts to reduce the gap in prevention strategies, and control of cases according to explicit clinical guidelines.

A survey on blood pressure levels and hypertension control in a sample of the Italian general population

BACKGROUND

Hypertension represents a major cardiovascular risk factor with relevant consequences on morbidity and mortality in the general population. An optimal control of blood pressure (BP) is far from being achieved.

AIM

The objective of this study was to explore awareness of BP levels, prevalence of risk factors and status of hypertension control in a sample of the Italian general population.

METHODS

Subjects aged 18 years or older were enrolled on a voluntary basis during the 7th and 8th World Hypertension Days at our hospital centre, S. Andrea Hospital in Rome, and at other hospitals throughout the Italian Lazio region. Along with BP measurement, a short questionnaire was completed at the time of the interview.

RESULTS

Of 1165 individuals enrolled into the analysis, 71.7% were aware of their BP levels (82.5% among hypertensive patients). Within the whole cohort, 31.9% of subjects were under antihypertensive treatment, while the overall rate of subjects found to be hypertensive patients at our visit was 52.9% (n = 616). Among hypertensive patients taking antihypertensive drugs, 47.1% had controlled BP values with the remaining 52.9% showing uncontrolled hypertension. Mean systolic blood pressure (SBP) was 138.2 ± 20.7 mmHg and mean diastolic blood pressure (DBP) was 80.4 ± 11.3 mmHg in subjects receiving antihypertensive treatment. Among older hypertensive patients (71-94 years of age), only 76.9% were under treatment. Hypertensive males were more frequently treated than females in all age groups (p = 0.001). Smoking habit negatively affected efficacy of antihypertensive therapy in the age groups of 48-53 and 54-62 years (p = 0.008 and p = 0.01, respectively). Diabetic patients had higher mean SBP values than non-diabetic subjects (137.3 ± 22.1 vs 129.3 ± 18.2 mmHg, p = 0.02).

CONCLUSION

The results of our survey strongly support the need for a continuing educational effort aimed at providing correct advertisement of healthy lifestyles and awareness of adequate BP control. Based on our observations, particular attention has to be paid to women, younger subjects, elderly subjects and diabetic patients in order to reach appropriate BP control and reduction of cardiovascular risk in these subject categories.