Trends and determinant factors in hypertension control in a population study with 25 years of follow-up

The present study focused on trend in hypertension control and on determinant factors that may influence efficacy in antihypertensive therapy. Two measures of treatment efficacy were used: population blood pressure and the relative frequency of effectively treated patients (blood pressure <140/90 mmHg).

Copenhagen City Heart Study is a prospective longitudinal epidemiological study with 25 years of follow-up. The study population were treated hypertensive patients. The blood pressure measurement was fully standardized and measurement method was unchanged throughout the observation period. A questionnaire was completed by the participants and double-checked by the technicians.

The number of treated hypertensive patients increased considerably and hypertension control increased from 21 to 26%. Pretreatment SBP was stable in the observation period indicating that start-to-treat practice was stable. Treated SBP decreased from 157.9 to 148.7 mmHg. Four determinant factors were significant. Men presented a higher pretreatment SBP before starting antihypertensive medication. Elderly patients presented a higher pretreatment SBP and were poorly treated as compared with younger hypertensive patients. Obesity was associated with a high threshold SBP. The fourth factor was diagnosis. Patients with myocardial infarction were better treated in last surveys than patients from other diagnosis groups. Treated DBP was stable.

Hypertension treatment efficacy is improving but still far from acceptable. The evaluation of determinant factors identified four areas that need special attention: men, elderly and obese hypertensive patients. The fourth factor is diagnosis. The results may indicate a beneficial effect of systematic control of hypertensive patients during a limited time after a myocardial infarction.