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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The management of hypertension in Canada: a review of current guidelines, their shortcomings, and implications for the future.CMAJ. 2001; 164: 517-522
- Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.Lancet. 2004; 364: 937-952
- Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010; 376: 112-123
- Hypertension—time to move on.Lancet. 2005; 365: 1108-1109
- Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.JAMA. 2012; 307: 1273-1283
- The impact of prevention on reducing the burden of cardiovascular disease.Circulation. 2008; 118: 576-585
- The American Heart Association and the Million Hearts Initiative: a presidential advisory from the American Heart Association.Circulation. 2011; 124: 1795-1799
- Effect of unrelated comorbid conditions on hypertension management.Ann Intern Med. 2008; 148: 578-586
- Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients?.Circulation. 2009; 119: 2978-2985
- Blood pressure in Canadian adults.Health Reports. 2010; 21: 37-46
Centers for Disease Control and Prevension. National Health and Nutrition Examination survey data. Hyattsville, MD: US Department of Health and Human Services, CDC; 2010. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed December 2, 2011.
- Changes in hypertension awareness, treatment, and control rates in Canada over the past two decades.CMAJ. 2011; 183: 1007-1013
- Comparison between an automated and manual sphygmomanometer in a population survey.Am J Hypertens. 2008; 21: 280-283
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470
- Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of the WHO/IDF Consultation.WHO Press, Geneva, Switzerland2006 (1-46)
- General cardiovascular risk profile for use in primary care: the Framingham Heart Study.Circulation. 2008; 117: 743-753
- International prevalence, recognition, and treatment for cardiovascular risk factor in outpatients with atherothrombosis.JAMA. 2006; 295: 180-189
- Multiple cardiovascular disease risk factors in Canadian adults.CMAJ. 1992; 146: 2021-2029
- Contemporary practice patterns in the management of newly diagnosed hypertension.Can Med Assoc J. 1997; 157: 23-30
- Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: Findings for 5 large cohorts of young adult and middle-aged men and women.JAMA. 1999; 282: 2012-2018
- A retrospective analysis of the prevalence and treatment of hypertension and dyslipidemia in Southwestern Ontario, Canada.Clin Ther. 2008; 30: 1145-1154
- Antihypertensive drug therapy and blood pressure control in men and women: an international perspective.J Hum Hypertens. 2010; 24: 336-344
- Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States.Cardiovasc Diabetology. 2010; 9: 7-11
- US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008.JAMA. 2010; 303: 2043-2050
- High risk of cerebro-cardiovascular morbidity in well treated male hypertensives: a retrospective study of 40-59 year old hypertensives in a Swedish primary care district.Acta Med Scand. 1984; 216: 251-259
- Survival in treated hypertension: follow up study after two decades.BMJ. 1998; 317: 167-171
- Risk profiles and prognosis of treated and untreated hypertensive men and women in a population-based longitudinal study: the Reykavik Study.J Hum Hypertension. 2004; 18: 615-622
- High blood pressure and cardiovascular disease mortality risk among US adults: The Third National Health and Nutrition Examination Survey mortality follow-up study.Ann Epidemiol. 2008; 18: 302-309
- Why cardiovascular mortality is higher in treated hypertensives versus subjects of the same age, in the general population.J Hypertens. 2003; 21: 1635-1640
- Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors.CMAJ. 2009; 181: e55-e66
- Management of hypertension in elderly long-term-care residents.Can J Cardiol. 2008; 24: 912-915
- Screening for cardiovascular risk in asymptomatic patients.J Am Coll Cardiol. 2010; 55: 1169-1177
- Status of cardiovascular health in US adults: Prevalence estimates from the National Health and Nutrition Examination Survey (NHANES) 2003-2008.Circulation. 2012; 125: 45-56
- Low prevalence of “ideal cardiovascular health” in a community-based population: the Heart Strategies Concentrating on Risk Evaluation (Heart Score) study.Circulation. 2011; 123: 850-857
- The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy.Can J Cardiol. 2012; 28: 270-287
Article info
Publication history
Published online: March 04, 2013
Accepted:
December 5,
2012
Received:
November 1,
2012
Footnotes
See editorial by Tobe and Liu, pages 526-527 of this issue.
See page 604 for disclosure information.
Identification
Copyright
© 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
