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Relation between blood pressure control, body mass index, and intensity of medical treatment
Ikuo Saito1, Kazuko Murata, Hiroshi Hirose
1Health Center, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. saito@hc.cc.keio.ac.jp
Insights
Blood pressure control was satisfactory in 53.5% of treated hypertensive patients. Obese patients required more intensive treatment, showing higher insulin resistance, indicating a need for intensified medical management in this group.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Hypertension management remains a significant public health challenge.
- Achieving optimal blood pressure control is crucial for preventing cardiovascular complications.
- Obesity is a known risk factor for hypertension and may impact treatment efficacy.
Purpose of the Study:
- To assess blood pressure control rates in treated hypertensive patients.
- To investigate the association between obesity, treatment intensity, and blood pressure control.
- To explore the role of insulin resistance in obese hypertensive patients.
Main Methods:
- A cross-sectional study of 226 treated hypertensive patients.
- Blood pressure control assessed against systolic (< 140 mmHg) and diastolic (< 90 mmHg) goals.
- Patients categorized by Body Mass Index (BMI); treatment intensity quantified by dose score and drug count.
Main Results:
- Overall, 53.5% of patients achieved control for both systolic and diastolic blood pressure goals.
- No significant differences in blood pressure control rates were observed across BMI groups.
- Higher treatment intensity (dose score, number of drugs) and positive correlation with BMI were noted in obese patients (BMI ≥ 27).
- Obese patients exhibited higher serum insulin and insulin resistance (HOMA-IR) values.
Conclusions:
- Hypertension management in a specialized clinic achieved satisfactory blood pressure control in just over half of treated patients.
- Obesity is associated with increased treatment intensity and insulin resistance, suggesting a need for more aggressive therapeutic strategies in this population.
- Intensified medical treatment is warranted for obese hypertensive patients with insulin resistance to improve blood pressure control.
Abstract:
A cross-sectional study was performed to assess the rates of blood pressure (BP) control to a systolic goal (< 140 mmHg), to a diastolic goal (< 90 mmHg), and to both in a sample of 226 treated hypertensive patients. We also examined the association between obesity, BP control, intensity of treatment defined as dose score (summed ranks of doses of all antihypertensive drugs taken), and number of drugs. Of the 226 treated patients (mean age, 60 years; 20.4% women), 67.7% were controlled to the systolic goal, 72.1% were controlled to the diastolic goal, and 53.5% were controlled to both. Patients were divided into four groups according to body mass index (BMI): less than 23, A; 23-24.9, B; 25-26.9, C; and 27 or more, D. There were no differences in the rates of BP control to the systolic goal, to the diastolic goal, or to both among the four groups; however, the dose score and number of drugs administered were higher in patients of group D than in those of the other groups. There was a tendency toward a higher intensity of drug treatment in obese patients with either controlled or uncontrolled BP. The dose score and number of drugs correlated positively with BMI. In representative subgroups (n = 62), serum insulin and the homeostasis model assessment value of insulin resistance were higher in the patients in group D than in the other groups. These findings indicate that hypertensive patients managed in a hypertension clinic had satisfactory BP control in 53.5% of cases. A higher intensity of medical treatment is needed to achieve BP control in obese hypertensive patients characterized by insulin resistance.
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