The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population

Abstract

The objective of this prospective follow-up study (median follow-up time 20 years) was to investigate whether there are differences in cardiovascular disease (CVD) and all-cause mortality among hypertensive men and women by awareness, treatment and blood pressure (BP) control status. The study was carried out among 20 358 men and 21 537 women aged 25-64 years living in Eastern and south-western Finland within the framework of the North Karelia Project and the Finrisk studies. Risk factors of CVD and life-style habits were assessed by a self-administered questionnaire, BP and laboratory measurements. The participants were classified into five groups according to their BP status: (i) normotensive, (ii) patients treated with antihypertensive drugs and controlled for HT, (iii) patients treated with antihypertensive drugs but uncontrolled for HT, (iv) hypertensive people aware of their HT but untreated, (v) hypertensive people unaware of their hypertension (HT). In men, all-cause and CVD mortality was significantly higher in all HT subgroups compared with the normotensive group. The risk increase for CVD mortality was 49-125% and 27-79% for all-cause mortality, respectively. Treated and controlled hypertensive women at baseline did not have any increase in CVD (hazard ratio (HR) 1.14; 95% CI 0.89-1.46) or all-cause mortality (HR 1.09; 95% CI 0.72-1.67) compared with normotensive women. In men, however, the corresponding HR were 1.58 (95% CI 1.28-1.96) for CVD and 2.25 (95% CI 1.70-2.99) for all-cause mortality. Treated hypertensive women seem to benefit from achieving normal BP.

Trends in cardiovascular mortality and hospitalisations, and potential contribution of inhospital case-fatality rates to changes in national mortality in the Czech Republic 1994–2009

“…In the Czech population, stroke mortality fell significantly in all age groups, while hospitalisations for stroke declined more rapidly in young and middle-aged individuals. Despite a lower occurrence of stroke in women, the course of illness in women is more severe than in men,32 most likely due to increased age and a higher prevalence of comorbidity and other risk factors, such as hypertension 33. The admission data also suggest a rapid decline in inhospital CFR, which, according to our calculations, could have made a major impact on the national mortality from stroke.…”

Factors Associated with Prevalence, Awareness, Treatment and Control of Hypertension among Adults in Southern China: A Community-Based, Cross-Sectional Survey

“…Increasing the awareness, treatment and control of hypertension will reduce morbidity and mortality of cardiovascular diseases [19]. Compared with the survey in 2002, the awareness treatment and control of hypertension among adults in Zhejiang province increased from 37.13% to 54.33%, from 29.61% to 46.34%, from 10.15% to 18.26%, respectively.…”

The dynamics of hypertension prevalence, awareness, treatment, control and associated factors in Chinese adults

“…Increased proportion of awareness, treatment and control of hypertension was related to declined morbidity and mortality of cardiovascular diseases [25]. Some findings from CHNS 1991-2011 were encouraging.…”