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Hypertension: a cross-sectional study of the role of multimorbidity in blood pressure control.

Sarkar C, Dodhia H, Crompton J, Schofield P, White P, Millett C, Ashworth M - BMC Fam Pract (2015)

Bottom Line: We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP.Hypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP.We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity.

View Article: PubMed Central - PubMed

Affiliation: King's College London, Department of Primary Care and Public Health Sciences, Capital House, 42 Weston Street, London, SE1 3QD, UK. chandra.sarkar@kcl.ac.uk.

ABSTRACT

Background: Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investigate the relationship between multimorbidity and systolic blood pressure (SBP) in patients with hypertension.

Methods: A cross-sectional analysis of anonymised primary care data was performed for a total of 299,180 adult patients of whom 31,676 (10.6 %) had a diagnosis of hypertension. We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP. We constructed a regression model to identify the determinants of SBP control.

Results: The strongest predictor of mean SBP was the number of comorbidities, β -0.13 (p < 0.05). Other predictors included Afro-Caribbean ethnicity, β 0.05 (p < 0.05), South Asian ethnicity, β -0.03 (p < 0.05), age, β 0.05 (p < 0.05), male gender, β 0.05 (p < 0.05) and number of hypotensive drugs β 0.06 (p < 0.05). SBP was lower by a mean of 2.03 mmHg (-2.22, -1.85) for each additional comorbidity and was lower in MM regardless of the type of morbidity.

Conclusion: Hypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP. We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity. Further research is needed to determine whether consultation rate, "white-coat hypertension" or medication adherence influence BP control in MM.

No MeSH data available.


Related in: MedlinePlus

The relationship between number of comorbidities and mean systolic blood pressure in patients with hypertension. Error bars show the 95 % confidence interval of the mean
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Fig1: The relationship between number of comorbidities and mean systolic blood pressure in patients with hypertension. Error bars show the 95 % confidence interval of the mean

Mentions: Patients with MM were further categorised by the number of comorbidities in addition to hypertension. The mean SBP of those with one comorbidity (n = 9626) was 137.1 mmHg (95 % CI 136.7, 137.4), for those with two comorbidities (n = 4028) was 136.0 mmHg (95 % CI 135.5, 136.5) and for those with three comorbidities was 134.3 mmHg (95 % CI 133.5, 135.2). Full results for patients with up to 5 or more comorbidities are displayed in Fig. 1.Fig. 1


Hypertension: a cross-sectional study of the role of multimorbidity in blood pressure control.

Sarkar C, Dodhia H, Crompton J, Schofield P, White P, Millett C, Ashworth M - BMC Fam Pract (2015)

The relationship between number of comorbidities and mean systolic blood pressure in patients with hypertension. Error bars show the 95 % confidence interval of the mean
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4528716&req=5

Fig1: The relationship between number of comorbidities and mean systolic blood pressure in patients with hypertension. Error bars show the 95 % confidence interval of the mean
Mentions: Patients with MM were further categorised by the number of comorbidities in addition to hypertension. The mean SBP of those with one comorbidity (n = 9626) was 137.1 mmHg (95 % CI 136.7, 137.4), for those with two comorbidities (n = 4028) was 136.0 mmHg (95 % CI 135.5, 136.5) and for those with three comorbidities was 134.3 mmHg (95 % CI 133.5, 135.2). Full results for patients with up to 5 or more comorbidities are displayed in Fig. 1.Fig. 1

Bottom Line: We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP.Hypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP.We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity.

View Article: PubMed Central - PubMed

Affiliation: King's College London, Department of Primary Care and Public Health Sciences, Capital House, 42 Weston Street, London, SE1 3QD, UK. chandra.sarkar@kcl.ac.uk.

ABSTRACT

Background: Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investigate the relationship between multimorbidity and systolic blood pressure (SBP) in patients with hypertension.

Methods: A cross-sectional analysis of anonymised primary care data was performed for a total of 299,180 adult patients of whom 31,676 (10.6 %) had a diagnosis of hypertension. We compared mean SBP in patients with hypertension alone and those with one or more co-morbidities and analysed the effect of type of comorbidity on SBP. We constructed a regression model to identify the determinants of SBP control.

Results: The strongest predictor of mean SBP was the number of comorbidities, β -0.13 (p < 0.05). Other predictors included Afro-Caribbean ethnicity, β 0.05 (p < 0.05), South Asian ethnicity, β -0.03 (p < 0.05), age, β 0.05 (p < 0.05), male gender, β 0.05 (p < 0.05) and number of hypotensive drugs β 0.06 (p < 0.05). SBP was lower by a mean of 2.03 mmHg (-2.22, -1.85) for each additional comorbidity and was lower in MM regardless of the type of morbidity.

Conclusion: Hypertensive patients with MM had lower SBP than those with hypertension alone; the greater the number of MM, the lower the SBP. We found no evidence that BP control was related to BP targets, medication category or specific co-morbidity. Further research is needed to determine whether consultation rate, "white-coat hypertension" or medication adherence influence BP control in MM.

No MeSH data available.


Related in: MedlinePlus