Only two out of every five hypertensive patients are able to control the condition with medication – and people who are older, have black ethnicity or are on lower incomes are more likely to fare worse, researchers report today.
In what is one of the largest population based studies to look at high blood pressure control in middle-aged adults, the University of Oxford used data from the UK Biobank (UKB) to establish how well blood pressure is controlled among the age group.
Among all 459,484 Biobank participants, 56% (256,203) had high blood pressure and of those, 47% (120,211) were unaware of their condition. Of the latter group, 27% (36,524) were not taking any drugs to treat it.
The final analysis included 99,468 people, 46% (45,607) of whom were women. The average age of the participants was 62 and 93% (92,385) were white, while 25,606 had been educated only to primary school level.
Out of the total cohort, 19% (19,344) had been diagnosed with cardiovascular disease, while 40% (39,887) were obese. Current smokers accounted for 9% (9254). On average, they had been diagnosed with high blood pressure seven years earlier.
Writing in Open Heart, the research team found that of the 19,344 with cardiovascular disease, 19% (3740) took three or more high blood pressure drugs. Of the 79,022 without cardiovascular disease, 12.5% (9886) were neither smokers nor obese.
However, they established that only two in five middle-aged people taking medication for high blood pressure were able to control their condition – but when a higher cut-off blood pressure threshold of less than 160/100 mm Hg was applied, 21% (20,573) were not being treated properly for the condition.
Having coexisting conditions was most strongly associated with blood pressure control, including those not linked to a heightened risk of cardiovascular disease, while factors associated with poor blood pressure control included being over 60, male, drinking 30 or more units of alcohol a week, black ethnicity and obesity.
Low household income – calculated at £18,000 a year, low educational attainment, and manual labour jobs were also associated with poor blood pressure control.
However, the researchers say smoking was associated with higher odds (24%) of blood pressure control, likely due to more intensive treatment to cut the higher cardiovascular disease risk of smokers.
The authors say there are some caveats to their findings, despite it being one of the largest population based studies to look at high blood pressure control in middle aged adults.
These include reliance on self-reported coexisting conditions and drug treatments, and the fact that UK Biobank baseline data do not include information on influential factors such as sticking to drug treatment and use of healthcare services.
They write: “Having a comorbidity was associated with higher probability of control, possibly due to more frequent interaction with the healthcare system and/or appropriate management of those at greater cardiovascular risk.
“More research is needed to understand barriers to [high blood pressure] control, and the mechanisms underlying the association between [it] and comorbidities not linked with increased [cardiovascular disease] risk.”
Tapela N, Collister J, Clifton L et al. Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK. Open Heart 12 March 2021
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