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Optimal blood pressure control after coronary events: the challenge remains
Elise Sverre1, Kari Peersen2, Jan Erik Otterstad2
1Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway; Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Insights
Poor blood pressure control is common after heart events, linked to diabetes and obesity. Medication use decreased post-discharge, indicating suboptimal treatment for hypertension.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Suboptimal blood pressure (BP) control remains a significant challenge in patients post-myocardial infarction (MI) or coronary revascularization.
- Identifying factors associated with unfavorable BP control is crucial for improving patient outcomes and reducing cardiovascular event recurrence.
Purpose of the Study:
- To identify sociodemographic, medical, and psychosocial factors associated with unfavorable BP control in patients hospitalized with MI and/or coronary revascularization.
- To assess the trends in BP-lowering medication prescription from hospital discharge to follow-up.
Main Methods:
- Cross-sectional study of 1012 patients with data collected from hospital records, questionnaires, clinical exams, and blood samples.
- Follow-up duration ranged from 2-36 months (mean 17 months).
- Statistical analyses included adjusted and linear regression models to identify predictors of unfavorable BP control.
Main Results:
- Forty-six percent of patients exhibited unfavorable BP control (≥140/90 mm Hg, or ≥80 mm Hg for diabetics) at follow-up.
- Diabetes (OR 2.4), higher body mass index (OR 1.05 per 1.0 kg/m²), and older age (OR 1.04 per year) were significantly associated with unfavorable BP control.
- A significant decrease in the proportion of patients treated with angiotensin inhibitors and beta-blockers was observed from discharge to follow-up (P < .001).
Conclusions:
- Blood pressure control is insufficient following coronary events, with obesity and diabetes being key associated factors.
- The prescription of BP-lowering drugs appears suboptimal, with a notable decrease in the use of essential antihypertensive medications.
- Targeting overweight and intensifying pharmacologic treatment are critical strategies to enhance BP control in this patient population.
Abstract:
We identified sociodemographic, medical, and psychosocial factors associated with unfavorable blood pressure (BP) control in 1012 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. This cross-sectional study collected data from hospital records, a comprehensive self-report questionnaire, clinical examination, and blood samples after 2-36 (mean 17) months follow-up. Forty-six percent had unfavorable BP control (≥140/90 [80 in diabetics] mm Hg) at follow-up. Low socioeconomic status and psychosocial factors did not predict unfavorable BP control. Patients with unfavorable BP used on average 1.9 (standard deviation 1.1) BP-lowering drugs at hospital discharge, and the proportion of patients treated with angiotensin inhibitors and beta-blockers decreased significantly (P < .001) from discharge to follow-up. Diabetes (odds ratio [OR] 2.4), higher body mass index (OR 1.05 per 1.0 kg/m2), and older age (OR 1.04 per year) were significantly associated with unfavorable BP control in adjusted analyses. Only age (standardized beta [β] 0.24) and body mass index (β 0.07) were associated with systolic BP in linear analyses. We conclude that BP control was insufficient after coronary events and associated with obesity and diabetes. Prescription of BP-lowering drugs in hypertensive patients seems suboptimal. Overweight and intensified drug treatment thus emerge as the major factors to target to improve BP control.