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Prevalence, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities
Alexander A Leung1,2, Jeanne V A Williams2, Raj S Padwal3
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Hypertension treatment and control are significantly better in Canadian adults with comorbidities like heart attack or stroke, dyslipidemia, and diabetes. However, control remains low for those without recognized conditions, highlighting a critical gap in cardiovascular disease prevention.
Area of Science:
- Cardiovascular Health
- Public Health Research
- Epidemiology
Background:
- The relationship between specific medical conditions and the effectiveness of blood pressure (BP) treatment and control in the general population remains incompletely understood.
- Understanding these associations is crucial for developing targeted public health strategies to improve hypertension management.
Purpose of the Study:
- To investigate the association between selected comorbidities and the treatment and control of hypertension among Canadian adults.
- To identify disparities in blood pressure management based on the presence or absence of comorbidities.
Main Methods:
- Analysis of data from the Canadian Health Measures Survey (2007-2019) involving 5,841,453 hypertensive Canadian adults.
- Blood pressure was assessed in relation to comorbidities: prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.
- Statistical analysis using adjusted odds ratios (aOR) to compare hypertension treatment and control rates.
Main Results:
- Hypertension treatment and control were significantly higher in individuals with comorbidities such as prior heart attack or stroke (aOR 3.15), dyslipidemia (aOR 2.51), and obstructive sleep apnea (aOR 1.95).
- Individuals without any of the studied comorbidities were less likely to have their hypertension treated and controlled (aOR 0.34).
- Blood pressure control was notably low even in individuals without prior heart attack or stroke but with moderate (aOR 0.25) or high (aOR 0.10) Framingham risk scores.
Conclusions:
- Significant disparities in blood pressure control exist across different comorbidity profiles in Canada.
- The most substantial gaps in care are observed in individuals without recognized comorbidities, including those at moderate-to-high cardiovascular risk.
- Targeted interventions are essential to optimize blood pressure control and reduce cardiovascular disease burden and premature mortality, particularly in underserved populations without apparent comorbidities.
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.
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