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Original Research

Characteristics Associated With Antihypertensive Treatment and Blood Pressure Control: A Population-Based Follow-Up Study in Peru

Authors:

J. Alfredo Zavala-Loayza,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Catherine Pastorius Benziger,

University of Washington, Seattle, WA, US
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María Kathia Cárdenas,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Rodrigo M. Carrillo-Larco,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Antonio Bernabé-Ortiz,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Robert H. Gilman,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, US; Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, PE
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William Checkley,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, MD, US
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J. Jaime Miranda ,

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima; Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, PE
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Antonio Bernabé-Ortiz,

About Antonio
CRONICAS Cohort Study Group
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Juan P. Casas,

About Juan P.
CRONICAS Cohort Study Group
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George Davey Smith,

About George Davey
CRONICAS Cohort Study Group
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Shah Ebrahim,

About Shah
CRONICAS Cohort Study Group
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Héctor H. García,

About Héctor H.
CRONICAS Cohort Study Group
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Robert H. Gilman,

About Robert H.
CRONICAS Cohort Study Group
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Luis Huicho,

About Luis
CRONICAS Cohort Study Group
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Germán Málaga,

About Germán
CRONICAS Cohort Study Group
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J. Jaime Miranda,

About J. Jaime
CRONICAS Cohort Study Group
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Víctor M. Montori,

About Víctor M.
CRONICAS Cohort Study Group
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Liam Smeeth,

About Liam
CRONICAS Cohort Study Group
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William Checkley,

About William
CRONICAS Cohort Study Group
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Gregory B. Diette,

About Gregory B.
CRONICAS Cohort Study Group
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Robert H. Gilman,

About Robert H.
CRONICAS Cohort Study Group
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Luis Huicho,

About Luis
CRONICAS Cohort Study Group
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Fabiola León-Velarde,

About Fabiola
CRONICAS Cohort Study Group
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María Rivera,

About María
CRONICAS Cohort Study Group
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Robert A. Wise,

About Robert A.
CRONICAS Cohort Study Group
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William Checkley,

About William
CRONICAS Cohort Study Group
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Héctor H. García,

About Héctor H.
CRONICAS Cohort Study Group
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Robert H. Gilman,

About Robert H.
CRONICAS Cohort Study Group
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J. Jaime Miranda,

About J. Jaime
CRONICAS Cohort Study Group
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Katherine Sacksteder

About Katherine
CRONICAS Cohort Study Group
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Abstract

Background: Over one-quarter of the world’s adult population has hypertension, yet achieving adequate treatment or control targets remains a challenge.

Objective: This study sought to identify, longitudinally, characteristics associated with antihypertensive treatment and blood pressure (BP) control among individuals with hypertension.

Methods: Data from individuals enrolled in the population-based CRONICAS Cohort Study (adults ≥35 years, living in 4 different rural/urban and coastal/high-altitude Peruvian settings) with hypertension at baseline were used. Antihypertensive treatment and BP control were assessed at baseline and at 15 months. Multinomial logistic regressions were used to estimate relative risk ratios (RRR) and 95% confidence intervals (95% CI) of factors associated with antihypertensive treatment and BP control at follow-up.

Results: At baseline, among 717 individuals with hypertension (53% women, mean age 61.5 ± 12.4 years), 28% were unaware of their hypertension status, 30% were aware but untreated, 16% were treated but uncontrolled, and 26% were treated and controlled. At follow-up, 89% of unaware and 82% of untreated individuals persisted untreated, and only 58% of controlled individuals remained controlled. Positive predictors of receiving treatment and being controlled at follow-up included age (RRR: 0.81; 95% CI: 0.73 to 0.91 for every 5 years) and family history of a chronic disease (RRR: 0.53; 95% CI: 0.31 to 0.92 vs. no history); whereas Puno rural site (RRR: 16.51; 95% CI: 1.90 to 143.56 vs. Lima) and male sex (RRR: 2.59; 95% CI: 1.54 to 4.36) were risk factors. Systolic BP at baseline (RRR: 1.27; 95% CI: 1.16 to 1.39 for every 5 mm Hg) and male sex (RRR: 1.75, 95% CI: 1.02 to 2.98) were risk factors for being treated but uncontrolled at follow-up.

Conclusions: Large gaps in treatment of hypertension were observed. Targeting specific populations such as men, younger individuals, or those without family history of disease may increase coverage of antihypertensive treatment. Also, targeting male individuals or those with higher systolic BP could yield better rates of BP control in the short term.

Highlights

  • The majority of subjects with hypertension correspond to the unaware (28%) or aware but untreated (30%) categories.
  • Between of 80% and 90% of patients in these 2 groups remain untreated at 15 months.
  • Forty-two percent of individuals whose blood pressure was controlled at baseline no longer do so at follow-up.
  • Implementation designs tailored to groups according to their risk profile together with patients' challenges and needs are required.
How to Cite: Zavala-Loayza JA, Benziger CP, Cárdenas MK, Carrillo-Larco RM, Bernabé-Ortiz A, Gilman RH, et al.. Characteristics Associated With Antihypertensive Treatment and Blood Pressure Control: A Population-Based Follow-Up Study in Peru. Global Heart. 2016;11(1):109–19. DOI: http://doi.org/10.1016/j.gheart.2015.12.002
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Published on 01 Mar 2016.
Peer Reviewed

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