Aperçu

Résumé (français)

Veuillez noter que les résumés n'apparaissent que dans la langue de la publication et peuvent ne pas avoir de traduction.

Résumé (anglais)

Background
Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.
Methods
Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.
Results
A total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk.
Conclusions
Large differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.
Hypertension is of major clinical and public health importance because of its high prevalence and strong link with numerous adverse health outcomes.1-3 Controlling blood pressure (BP) has been proven to be highly effective in preventing stroke, heart attack, heart failure, and premature death in both the young and old.4,5 Even so, disturbing data from numerous sources indicate a general decline in both patient awareness and control of hypertension in Canada and the US in recent years, leading to concerns that this could lead to a rise in preventable disability and death.6-8
Consequently, in the past few years, urgent calls have been made for renewed national interest in improving BP control, government reinvestment in hypertension care, and re-engagement among the clinical and scientific communities to enhance the monitoring and evaluation of key hypertension indicators.9-11 Crucial to this effort is ongoing surveillance of hypertension detection, treatment, and control, along with accurate identification of vulnerable groups who are most susceptible to clinical care gaps. Identification of the major risk factors associated with uncontrolled BP is necessary to inform effective health policy and targeted interventions.
Older age, a sedentary lifestyle, a low level of intake of fruits and vegetables, and a high level of sodium consumption are associated with a higher prevalence of hypertension, but none of these factors has been shown to independently predict worse BP control among Canadian adults.12 Despite the importance of high BP, little work has been done in identifying the major predictors of uncontrolled BP.13 To address this issue, we designed this study to assess whether medical conditions that commonly coexist with hypertension (including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity) may be associated with differences in BP treatment and control rates.