Elsevier

International Journal of Cardiology

Volume 218, 1 September 2016, Pages 83-88
International Journal of Cardiology

Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study

https://doi.org/10.1016/j.ijcard.2016.05.044Get rights and content

Highlights

  • EURIKA was a cross-sectional observational study in 12 European countries.

  • Uncontrolled hypertension was assessed among patients treated for hypertension.

  • More than half of all treated patients continued to have uncontrolled hypertension.

  • Approximately 14% had apparent resistant hypertension.

  • Associations were seen between hypertension and other cardiovascular risk factors.

Abstract

Background

The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336).

Methods

EURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N = 5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis.

Results

In the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93–2.73), body mass index (BMI; OR per kg/m2: 1.03; 95% CI: 1.01–1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m2: 1.06; 95% CI: 1.04–1.08), diabetes (OR: 1.28; 95% CI: 1.06–1.53), use of statins (OR: 1.36; 95% CI: 1.15–1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09–1.23), and geographic location. Similar results were seen in sensitivity analyses.

Conclusions

Over 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors.

Introduction

Despite recent reductions in rates of mortality from cardiovascular disease (CVD) throughout Europe, CVD remains responsible for approximately 47% of all deaths across the continent each year [1]. Primary and secondary prevention of CVD, therefore, remains of great importance. Principal risk factors for having a first cardiovascular event include age, sex, smoking, arterial hypertension, dyslipidaemia, diabetes, obesity, and physical inactivity [2]. Control of modifiable risk factors remains poor: the most recent European CVD statistics report that the prevalence of elevated blood pressure in adults aged 25 years or over ranges between 33.6% (Israel) and 48.3% (Ukraine), whereas the prevalence of dyslipidaemia in the same population ranges between 24.0% (Tajikistan) and 69.8% (Iceland) [1].

Recently, we conducted the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; ClinicalTrials.gov identifier: NCT00882336), a study of the management of cardiovascular risk factors in primary care in 12 European countries [3]. Included patients were aged 50 years or over and had at least one risk factor for CVD but no history of cardiovascular events. As part of this study, we have previously reported that control of blood pressure among patients with hypertension in Europe is approximately 38.8%, whereas control of blood serum cholesterol levels among patients with dyslipidaemia is approximately 43.3% [4]. In the present paper, we describe in detail the prevalence of uncontrolled hypertension and of apparent resistant hypertension among patients being treated for hypertension in the EURIKA population. Factors associated with uncontrolled hypertension and with apparent resistant hypertension were also assessed.

Section snippets

Study design and participants

EURIKA was carried out in 12 European countries (Austria, Belgium, France, Germany, Greece, Norway, Russia, Spain, Sweden, Switzerland, Turkey, and the UK) [4]. Data collection started in May 2009 and ended in January 2010, with a 3-month data collection period for each country. The study protocol was approved by the appropriate clinical research ethics committees in each participating country, and all patients provided signed informed consent.

The methods for the study have been reported in

Patient characteristics and factors associated with uncontrolled hypertension

Of the 7641 patients included in EURIKA, 5220 were treated for hypertension and had blood pressure measurements available in the database, and were therefore included in the analysis. The mean age was 64.5 years, and 47.9% were men (Table 1). A total of 29.3% had diabetes, and the mean BMI was 29.6 kg/m2.

In the primary analysis, 2691 patients (51.6%) had uncontrolled hypertension (Fig. 1). In the sensitivity analysis, using different definitions of blood pressure control according to patients'

Discussion

Here, we have analysed factors associated with uncontrolled hypertension and with apparent resistant hypertension in a European population of patients being treated for hypertension, using data from the large, international EURIKA study. Two definitions of control of blood pressure were used: in the primary analysis, SBP < 140 mm Hg and DBP < 90 mm Hg for all patients according to the 2007 ESH/ESC guidelines in place at the time the study was carried out [10], and in the sensitivity analysis an

Disclosures

Claudio Borghi has received speaker and consulting fees from Menarini, Servier, Takeda, and MSD; Florence Tubach and Eliseo Guallar have received research funding from AstraZeneca; Jean Dallongeville and Julian P. Halcox have received speaker and consulting fees from AstraZeneca; Jesús Medina is an employee of AstraZeneca. The other authors declare that they have no competing interests.

Acknowledgements

EURIKA was funded by AstraZeneca. The study was run by an independent academic steering committee. The authors had full access to all data and had final responsibility for the contents of the manuscript and the decision to submit it for publication. Writing support was provided by Stephen Sweet of Oxford PharmaGenesis, UK, and was funded by AstraZeneca.

References (25)

  • M. Nichols et al.

    European cardiovascular disease statistics

  • J. Perk et al.

    European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

    Eur. Heart J.

    (2012)
  • F. Rodriguez-Artalejo et al.

    Rationale and methods of the European study on cardiovascular risk prevention and management in daily practice (EURIKA)

    BMC Public Health

    (2010)
  • J.R. Banegas et al.

    Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study

    Eur. Heart J.

    (2011)
  • J. Dallongeville et al.

    Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study

    Eur. J. Cardiovasc. Prev. Rehabil.

    (2011)
  • IMS Health

    OneKey

  • G. Mancia et al.

    2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

    Eur. Heart J.

    (2013)
  • W.T. Friedewald et al.

    Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge

    Clin. Chem.

    (1972)
  • R.M. Conroy et al.

    Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project

    Eur. Heart J.

    (2003)
  • G. Mancia et al.

    Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

    Eur. Heart J.

    (2007)
  • SPRINT Research Group et al.

    A randomized trial of intensive versus standard blood-pressure control

    N. Engl. J. Med.

    (2015)
  • K.H. Bonaa et al.

    Association between blood pressure and serum lipids in a population. The Tromsø study

    Circulation

    (1991)
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