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Canadian Journal of Cardiology

The Impact of Cardiovascular Risk-Factor Profiles on Blood Pressure Control Rates in Adults From Canada and the United States

Published:March 04, 2013DOI:https://doi.org/10.1016/j.cjca.2012.12.004

      Abstract

      Background

      It is unclear whether blood pressure control varies across the spectrum of atherosclerotic risk.

      Methods

      We used data from nonpregnant adults who had fasted laboratory samples drawn for the 2007-2009 cycle of the Canadian Health Measures Survey (CHMS) or the 2005-2008 US National Health and Nutrition Examination Survey (NHANES).

      Results

      The 1692 CHMS subjects and 3541 NHANES participants were demographically similar (aged a mean of 45 years), although NHANES participants exhibited higher obesity rates (33.8% vs 22.2%, P < 0.001). Over 80% of CHMS and NHANES subjects with hypertension had at least 1 other cardiovascular risk factor. As the number of atherosclerotic risk factors increased, hypertension prevalence increased, but blood pressure control rates improved (from 48% among hypertensives with no other risk factors in CHMS to 77% among those with 3 or more risk factors, and from 35% to 53% in NHANES). However, the converse was not true: The distribution of Framingham risk scores for those subjects with “controlled hypertension” was nearly identical to the distribution among those adults with uncontrolled hypertension in both CHMS and NHANES and substantially higher than scores in normotensive subjects.

      Conclusions

      Although control of blood pressure was better in patients with multiple atherosclerotic risk factors, hypertensives with controlled blood pressures exhibited risk-factor profiles similar to those of participants with uncontrolled blood pressures. This suggests the need, in educational messaging and therapy decision making, for an increased focus on total atherosclerotic risk rather than just blood pressure control.

      Résumé

      Introduction

      On ignore si la maîtrise de la pression artérielle varie selon le spectre du risque athérosclérotique.

      Méthodes

      Nous avons utilisé les données d’adultes non enceintes qui avaient des échantillons pour laboratoire à jeun prélevés durant le cycle 2007-2009 de l’Enquête canadienne sur les mesures de la santé (ECMS) ou l’enquête NHANES (National Health and Nutrition Examination Survey), États-Unis, 2005-2008.

      Résultats

      Les 1692 sujettes de l’ECMS et les 3541 participantes de la NHANES avaient des caractéristiques démographiques semblables (âge moyen de 45 ans), quoique les participantes de la NHANES montraient des taux plus élevés d’obésité (33,8 % vs 22,2 %, P < 0,001). Plus de 80 % des sujettes de l’ECMS et de la NHANES souffrant d’hypertension avaient au moins 1 autre facteur de risque cardiovasculaire. Comme le nombre de facteurs de risque athérosclérostique augmentait, la prévalence de l’hypertension augmentait, mais les taux de maîtrise de la pression artérielle s’amélioraient (de 48 % chez les hypertendues de l’ECMS n’ayant aucun autre facteur de risque à 77 % chez celles ayant 3 facteurs de risque ou plus, et de 35 % à 53 % chez celles de la NHANES). Cependant, l’inverse n’était pas vrai : la distribution des scores de risque de Framingham des sujettes de l’ECMS et de la NHANES ayant une « hypertension maîtrisée » était presque identique à la distribution des adultes ayant une hypertension non maîtrisée et substantiellement plus élevée que les scores des sujettes normotendues.

      Conclusions

      Bien que la maîtrise de la pression artérielle ait été meilleure chez les patientes ayant de multiples facteurs de risque athérosclérotique, les hypertendus ayant des pressions artérielles maîtrisées ont montré des profils de facteur de risque similaires à ceux des participantes ayant des pressions artérielles non maîtrisées. Ceci indique la nécessité, dans le message éducatif et la prise de décision thérapeutique, de se concentrer de plus en plus sur le risque athérosclérotique global plutôt que sur la maîtrise de la pression artérielle seule.
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