Hypertension awareness, treatment, and control in coronary heart disease patients: results of the EUROASPIRE V survey conducted in 27 countries

Abstract

AIMS: Hypertension is a highly common cardiovascular risk factor, and a large proportion of patients with coronary heart disease (CHD) have uncontrolled hypertension. We report on the distribution and determinants of hypertension awareness, treatment, and control in CHD hypertensive patients. METHODS: The EUROASPIRE V survey included 8261 CHD patients from 27 countries. Awareness was defined as patients reporting being told by a health professional to have raised blood pressure (BP), being aware of their BP target and latest measurement. Patients using antihypertensive medication to lower BP were considered treated. Controlled hypertension was defined as BP <140/90mmHg (<140/85mmHg in patients with diabetes). Factors associated with hypertension awareness, treatment and control were identified with logistic regression. RESULTS: A total of 6496 EUROASPIRE V patients were considered hypertensive, from which 60.4% were aware, 91.7% were on treatment, and 46.8% were controlled. Number of antihypertensive drugs and adherence were independently associated with awareness (OR 1.23, 95%CI 1.16-1.31, and 2.18, 1.74-2.74 respectively) and control (1.11, 1.05-1.17 and 1.93, 1.57-2.37 respectively). Secondary (1.32, 1.03-1.68) and tertiary (1.70, 1.32-2.17) education and undertaking lifestyle changes (1.60, 1.37-1.87) were associated with awareness. Controlled patients were more often aware (1.43, 1.23-1.65) and had a healthier risk factor profile (BMI >25kg/m2 0.73, 0.61-0.87, diabetes 0.67, 0.59-0.76, LDL ≥1.8mmol/L 0.75, 0.65-0.86) than uncontrolled patients. CONCLUSION: Hypertension control remains poor in hypertensive CHD patients, despite high treatment and reasonable awareness levels. Communication with CHD hypertensive patients, especially those from vulnerable groups, needs to improve to facilitate change of health behaviours.