Factors associated with blood pressure control in hypertensive patients with coronary heart disease: evidence from the Chinese Cholesterol Education Program

PLoS One. 2013 May 15;8(5):e63135. doi: 10.1371/journal.pone.0063135. Print 2013.

Abstract

Blood pressure (BP) remains poorly controlled among hypertensive patients with coronary heart disease (CHD) in China. Improvement of its management will require an understanding of the patient characteristics and treatment factors associated with uncontrolled hypertension. A cross-sectional survey of 3,279 patients from 52 centers in China was performed to examine potential barriers to adequate blood pressure control of hypertensive patients with CHD. Uncontrolled hypertension was defined as blood pressure ≥130/or 80 mmHg. Multivariable logistic regression was used to identify factors associated with poor blood pressure control. Mean age of the patients was 65 years, 40% were women, and mean BMI was 25 kg/m(2). Mean systolic blood pressure was 136±18 mmHg and mean diastolic blood pressure was 80±11 mmHg. Only 18% of patients had a mean blood pressure <130/80 mmHg during the study period. Multivariate analysis revealed several independent factors of poor blood pressure control: body mass index ≥23 kg/m(2), the presence of stable angina pectoris (SAP), family history of diabetes, and use of calcium channel blockers (CCB). Further analysis showed that non-dihydropyridine calcium antagonist was significantly correlated with low BP control rate. Some of these may be amenable to modification. The results of our study suggest that overweight, the presence of SAP and family history of diabetes are important factors for tight BP control in primary care. In addition, non-dihydropyridine calcium channel blockers appear less effective than other therapies in control of blood pressure and should not be the first choice among hypertensive patients with CHD. Further identification of patients at risk of poor BP control can lead to targeted interventions to improve management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure*
  • China
  • Cholesterol / blood*
  • Coronary Disease / blood
  • Coronary Disease / complications
  • Coronary Disease / physiopathology*
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / complications
  • Hypertension / physiopathology*
  • Male
  • Middle Aged
  • Patient Education as Topic*

Substances

  • Cholesterol

Grants and funding

This work was supported by the National Natural Science Foundation of China (81270194 to Dr. Dachun Xu, 81270193 to Dr. Yidong Wei). It was also supported in part by the National Key Basic Research Program of China grant No. 2013CB531100 to Dr. Yi-Han Chen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.