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

OBJECTIVE: 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). DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.