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Canadian Journal of Cardiology

Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study

Published:March 14, 2015DOI:https://doi.org/10.1016/j.cjca.2015.03.012

      Abstract

      Background

      Although clinical practice guidelines for the management of hypertension exist in Canada, the rate of contemporary blood pressure (BP) control remains unclear.

      Methods

      In the Primary Care Audit of Global Risk Management (PARADIGM) study, 3015 healthy, middle-aged Canadians, free of cardiovascular disease (CVD) or diabetes were evaluated. In this analysis, we characterized the CVD risk factors, treatment patterns, and BP control rates in subjects with uncomplicated hypertension.

      Results

      A total of 917 subjects (30.4%) had a diagnosis of hypertension. The median age was 59 ± 8 years. The mean treated systolic/diastolic BP were 134 ± 14 mm Hg/82 ± 9 mm Hg, respectively. CVD risk factors included past/current smoking (35.9%), abdominal obesity (62.5%), and dyslipidemia (59.4%). Using the Framingham Risk Score, 20.4%, 41.0%, and 38.5% of the subjects were at low, intermediate, and high risk, respectively. Of the 88% with treated hypertension, 46.9%, 38.7%, and 14.3% received 1, 2, or ≥3 drugs, respectively. The rate of BP control was 57.4% (systolic BP < 140 and diastolic BP < 90 mm Hg). The rate of BP control was lower in patients prescribed diuretic monotherapy (53.2%) vs those who received angiotensin converting enzyme inhibitor/angiotensin receptor blocker monotherapy (66.5%; P < 0.01).
      Importantly, BP control deteriorated with increasing Framingham Risk Score, and was lower in patients with metabolic syndrome vs those without (P < 0.00001 for both).

      Conclusions

      PARADIGM demonstrated that CVD risk factors are prevalent in Canadians with uncomplicated hypertension. BP control was modest (57.4%) and was lowest in patients prescribed diuretic monotherapy and in those at highest CVD risk. Despite the success of national hypertension strategies, enhanced efforts are warranted to improve BP control in Canada.

      Résumé

      Introduction

      Bien qu’il existe au Canada des directives de pratique clinique pour le traitement de l'hypertension, le degré de contrôle actuel de la pression artérielle (PA) reste incertain.

      Méthodes

      L'étude PARADIGM (Primary Care Adult of Global Risk Management) a évalué 3015 Canadiens d’âge moyen, sains, sans maladie cardiovasculaire (MCV) ni diabète. Dans cette analyse, nous avons caractérisé les facteurs de risque des maladies cardiovasculaires, les modes de traitement, et les degrés de contrôle de la PA chez les sujets atteints d'hypertension sans complication.

      Résultats

      Un total de 917 sujets (30,4 %) avaient un diagnostic d'hypertension. L'âge médian était de 59 ± 8 ans. Les valeurs moyennes de pression artérielle systolique (PAS)/diastolique (PAD) des sujets traités étaient de 134 ± 14 mmHg / 82 ± 9 mmHg, respectivement. Les facteurs de risque de MCV incluent un tabagisme passé/actuel (35,9 %), une obésité abdominale (62,5 %) et une dyslipidémie (59,4 %). En utilisant le score de risque de Framingham, 20,4 %, 41,0 % et 38,5 % des sujets étaient respectivement à risque faible, intermédiaire et élevé. Parmi les 88 % traités pour hypertension, 46,9 %, 38,7 % et 14,3 % ont reçu respectivement 1, 2 ou ≥3 médicaments. Le pourcentage des patients dont la PA a été contrôlée était de 57,4 % (PAS <140 et PAD < 90 mmHg). Le contrôle de la PA était inférieur pour les patients sous prescription d’une monothérapie diurétique (53,2 %) par rapport à ceux recevant une monothérapie IECA/ARA (66,5 %, P < 0,01).
      Fait important, le contrôle de la PA s’est détérioré pour les score de risque de Framingham croissants, et était plus faible chez les patients présentant un syndrome métabolique par rapport à ceux sans (P < 0,00001 pour les deux).

      Conclusion

      PARADIGM démontre que les facteurs de risque de MCV sont répandus chez les Canadiens souffrant d'hypertension sans complication. Le contrôle de la PA était modeste (57,4 %) et était le plus faible chez les patients sous prescription d’une monothérapie diurétique et chez les personnes à risque plus élevé de maladie cardiovasculaire. Malgré le succès des stratégies nationales pour le traitement de l'hypertension, des efforts supplémentaires sont nécessaires pour améliorer le contrôle de la pression artérielle au Canada.
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