Despite increased therapeutic efforts, a substantial number of hypertensives do not reach BP goal. The knowledge of the factors associated with uncontrolled BP might help to identify this cohort and perhaps differently approach their treatment.
Aim: To assess the prevalence of BP control (defined as BP <140/90 mmHg) and its associated factors, in patients treated with 2 or 3 antihypertensive drugs.
Methods: In this observational, cross-sectional study, 1337 consecutively attended hypertensives (59% males, aged 63) treated with 2 or 3 antihypertensive drugs were evaluated in 36 referral centers in Spain. Office BP was measured and clinical and laboratory data were recorded. Microalbuminuria was defined as urinary albumin/creatinine ratio ≥22 (men) or ≥31 (women) and <300 mg/g in all cases. Established CV or renal disease was defined by the diagnosis of heart disease, cerebrovascular disease, peripheral vascular disease, advanced retinopathy and/or nephropathy [if serum creatinine >1.5 mg/dl (men) or >1.4 (women) and/or estimated glomerular filtration rate < 60ml/min/1.73m2 and/or macroalbuminuria (≥ 300 mg/g)].
Results: Seven-hundred sixty-seven patients (57.4%) had BP at goal (<140/90 mmHg). The prevalence of controlled BP according to the presence (yes vs. not) of risk factors was: diabetes: 52% vs. 60% (p=0.005); microalbuminuria: 49% vs 61% (p<0.0001). P=NS for the remaining: male sex: 58% vs. 56%; age >65yr: 55% vs. 46%; smoker: 57% vs. 58%; family CVD history: 57% vs. 60%; dyslipidemia: 56% vs. 61%; duration of hypertension >10yr: 56% vs. 59%; abdominal obesity: 55% vs. 60%; established CV or renal disease: 57% vs. 58%.
A logistic regression analysis was performed, with controlled/uncontrolled BP as the dependent variable and the following independent variables (those with p<0.2 in bivariate analyses): age, diabetes, dyslipidemia, abdominal obesity, microalbuminuria and duration of hypertension >10yr. The microalbuminuria was the only variable that remained in the model: MOR (95%CI): 0.626 (0.483-0.810); p<0.05.
Conclusions: In hypertensives treated with 2 or 3 antihypertensive drugs, the microalbuminuria was the only factor independently associated to the lack of BP control. The prevalence of controlled BP in this cohort was 57.4%.