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

Title: Hypertension: a cross-sectional study of the role of multimorbidity in blood pressure control
Authors: Sarkar, C
Dodhia, H
Crompton, J
Schofield, P
White, P
Millett, C
Ashworth, M
Item Type: Journal Article
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.
Issue Date: 7-Aug-2015
Date of Acceptance: 28-Jul-2015
URI: http://hdl.handle.net/10044/1/41797
DOI: http://dx.doi.org/10.1186/s12875-015-0313-y
ISSN: 1471-2296
Publisher: BioMed Central
Journal / Book Title: BMC Family Practice
Volume: 16
Copyright Statement: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
RETROSPECTIVE COHORT
CARE
ADHERENCE
IMPACT
EPIDEMIOLOGY
MANAGEMENT
SEVERITY
DISEASE
Adult
Aged
Antihypertensive Agents
Blood Pressure Determination
Comorbidity
Cross-Sectional Studies
Female
Humans
Hypertension
Linear Models
London
Male
Middle Aged
Treatment Outcome
Public Health
1117 Public Health And Health Services
Publication Status: Published
Article Number: 98
Appears in Collections:School of Public Health