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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Article info
Publication history
Published online: March 14, 2015
Accepted:
March 10,
2015
Received:
February 24,
2015
Footnotes
See editorial by Spence, pages 593-595 of this issue.
See page 669 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
