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Gender-specific, multi-level determinants of outcomes of antihypertensive treatment: a sub-analysis of the Belgian PREVIEW study

Journal of Human Hypertension volume 25, pages 372–382 (2011)Cite this article

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Abstract

Gender-specific determinants of blood pressure (BP) values and control have not been the focus of clinical hypertension research. The purpose of this analysis was to identify gender-specific and multi-level (physician and patient) determinants of BP values and predictors of uncontrolled BP. We completed a subgroup analysis comparing men and women who participated in the Belgian PREVIEW study of second-line treatment effectiveness of valsartan, applying two-level hierarchical modelling of 90-day BP values and guideline-defined BP control. In total, 1665 women and 1525 men were treated by 504 general practitioners. Fewer women than men reached systolic BP (SBP) (P=0.015) and combined BP targets at 90 days (P=0.007). More than 26% of the variance in 90-day SBP (intra-class correlation coefficient (ICC)=0.270) and diastolic BP (DBP) (ICC=0.262) was attributable to physician-level factors for men; the physician-level ICCs for SBP and DBP were 0.259 and 0.268, respectively, for women. Determinants of 90-day BP values and predictors of uncontrolled BP varied considerably by gender. Many of the multi-level determinants of BP by gender are amenable to intervention, and the remainder can serve as warning signs to clinicians that patients may remain vulnerable to poor outcomes associated with sub-optimal BP control.

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References

  1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365 (9455): 217–223.

    Article  Google Scholar 

  2. Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289 (18): 2363–2369.

    Article  Google Scholar 

  3. Kannel WB . Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol 2000; 85 (2): 251–255.

    Article  CAS  Google Scholar 

  4. Lawes CM, Vander Hoorn S, Law MR, Elliott P, MacMahon S, Rodgers A . Blood pressure and the global burden of disease 2000. Part II: estimates of attributable burden. J Hypertens 2006; 24 (3): 423–430.

    Article  CAS  Google Scholar 

  5. Lawes CM, Vander Hoorn S, Rodgers A . Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371 (9623): 1513–1518.

    Article  Google Scholar 

  6. Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345 (18): 1291–1297.

    Article  CAS  Google Scholar 

  7. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19): 2560–2572.

    Article  CAS  Google Scholar 

  8. Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21 (6): 1011–1053.

    Article  Google Scholar 

  9. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. ESH-ESC task force on the management of arterial hypertension. 2007 ESH-ESC practice guidelines for the management of arterial hypertension. J Hypertens 2007; 25 (9): 1751–1762.

    Article  CAS  Google Scholar 

  10. Whitworth JA . 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21 (11): 1983–1992.

    Article  Google Scholar 

  11. Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339 (27): 1957–1963.

    Article  CAS  Google Scholar 

  12. Fagard RH, Van Den Enden M, Leeman M, Warling X . Survey on treatment of hypertension and implementation of World Health Organization/International Society of Hypertension risk stratification in primary care in Belgium. J Hypertens 2002; 20 (7): 1297–1302.

    Article  CAS  Google Scholar 

  13. Hajjar I, Kotchen TA . Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290 (2): 199–206.

    Article  Google Scholar 

  14. Lloyd-Jones DM, Evans JC, Levy D . Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA 2005; 294 (4): 466–472.

    Article  CAS  Google Scholar 

  15. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS . Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 2007; 49 (1): 69–75.

    Article  CAS  Google Scholar 

  16. Van der Niepen P, Giot C, van de Borne P . Prevalence of isolated uncontrolled systolic blood pressure among treated hypertensive patients in primary care in Belgium: results of the I-inSYST survey. J Hypertens 2008; 26 (10): 2057–2063.

    Article  CAS  Google Scholar 

  17. Degli Esposti E, Di Martino M, Sturani A, Russo P, Dradi C, Falcinelli S et al. Risk factors for uncontrolled hypertension in Italy. J Hum Hypertens 2004; 18 (3): 207–213.

    Article  CAS  Google Scholar 

  18. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM . Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162 (4): 413–420.

    Article  Google Scholar 

  19. Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM . Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension 2006; 47 (3): 345–351.

    Article  CAS  Google Scholar 

  20. Gasse C, Hense HW, Stieber J, Doring A, Liese AD, Keil U . Assessing hypertension management in the community: trends of prevalence, detection, treatment, and control of hypertension in the MONICA Project, Augsburg 1984-1995. J Hum Hypertens 2001; 15 (1): 27–36.

    Article  CAS  Google Scholar 

  21. Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S . Trends in hypertension prevalence, awareness, treatment, and control in older US adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc 2007; 55 (7): 1056–1065.

    Article  Google Scholar 

  22. Jokisalo E, Kumpusalo E, Enlund H, Halonen P, Takala J . Factors related to non-compliance with antihypertensive drug therapy. J Hum Hypertens 2002; 16 (8): 577–583.

    Article  CAS  Google Scholar 

  23. Van Wijk BL, Klungel OH, Heerdink ER, de Boer A . Rate and determinants of 10-year persistence with antihypertensive drugs. J Hypertens 2005; 23 (11): 2101–2107.

    Article  CAS  Google Scholar 

  24. Bailey KR, Grossardt BR, Graves JW . Novel use of Kaplan-Meier methods to explain age and gender differences in hypertension control rates. Hypertension 2008; 51 (4): 841–847.

    Article  CAS  Google Scholar 

  25. Banegas JR, Segura J, de la Sierra A, Gorostidi M, Rodriguez-Artalejo F, Sobrino J et al. Gender differences in office and ambulatory control of hypertension. Am J Med 2008; 121 (12): 1078–1084.

    Article  Google Scholar 

  26. Thoenes M, Neuberger HR, Volpe M, Khan BV, Kirch W, Bohm M . Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2010; 24: 336–344.

    Article  CAS  Google Scholar 

  27. Lawes CM, Vander Hoorn S, Law MR, Elliott P, MacMahon S, Rodgers A . Blood pressure and the global burden of disease 2000. Part 1: estimates of blood pressure levels. J Hypertens 2006; 24 (3): 413–422.

    Article  CAS  Google Scholar 

  28. Reckelhoff JF . Gender differences in the regulation of blood pressure. Hypertension 2001; 37 (5): 1199–1208.

    Article  CAS  Google Scholar 

  29. Van der Niepen P, Woestenburg A, Brie H, Vancayzeele S, MacDonald K, Denhaerynck K et al. Effectiveness of valsartan for treatment of hypertension: patient profiling and hierarchical modeling of determinants and outcomes (the PREVIEW study). Ann Pharmacother 2009; 43 (5): 849–861.

    Article  CAS  Google Scholar 

  30. Abraham I, Lee CS, Song M, Vancayzeele S, Brie H, Hermans C et al. ‘Later, lazier, and unluckier’: a heuristic profile of high vulnerability is an independent predictor of uncontrolled blood pressure (the PREVIEW study). Int J Gen Med 2010; 3: 163–166.

  31. Verbeke G, Molenberghs G . Linear Mixed Models for Longitudinal Data. Springer-Verlag: New York, NY, 2000.

    Google Scholar 

  32. Choudhry NK, Fletcher RH, Soumerai SB . Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 2005; 142 (4): 260–273.

    Article  Google Scholar 

  33. McLean DL, Simpson SH, McAlister FA, Tsuyuki RT . Treatment and blood pressure control in 47,964 people with diabetes and hypertension: a systematic review of observational studies. Can J Cardiol 2006; 22 (10): 855–860.

    Article  Google Scholar 

  34. Messerli FH, Williams B, Ritz E . Essential hypertension. Lancet 2007; 370 (9587): 591–603.

    Article  CAS  Google Scholar 

  35. Journath G, Hellenius ML, Petersson U, Theobald H, Nilsson PM . Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden. Eur J Cardiovasc Prev Rehabil 2008; 15 (3): 258–262.

    Article  Google Scholar 

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Acknowledgements

The PREVIEW study was supported by grants from Novartis Pharma.

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Authors and Affiliations

  1. Matrix45, Earlysville, VA, USA

    K MacDonald, C S Lee & I Abraham

  2. Center for Health Outcomes and PharmacoEconomic Research, University of Arizona College of Pharmacy, Tucson, AZ, USA

    C S Lee & I Abraham

  3. College of Nursing, University of Arizona, Tucson, AZ, USA

    H-C Chen, M L Ko, G E Fidel & S Reel

  4. Chi Mei Medical Center, Tainan, Taiwan

    H-C Chen

  5. Novartis Pharma, Vilvoorde, Belgium

    H Brié, C Hermans & S Vancayzeele

  6. Department of Nephrology and Hypertension, Universitair Ziekenhuis, Brussels, Belgium

    P Van der Niepen

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  1. K MacDonald
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  8. S Vancayzeele
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  9. S Reel
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  10. P Van der Niepen
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Correspondence to K MacDonald.

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Competing interests

Drs MacDonald, Lee and Abraham are employees of Matrix45 and by company policy are prohibited from owning equity in client organizations. Matrix45 provides similar services for other biopharmaceutical companies. Drs Brié and Vancayzeele and Ms Hermans are employees of Novartis Pharma. Dr Van der Niepen has consulted with and received research grants and contracts from Novartis Pharma. Ms Chen, Ms Ko, Ms Fidel and Dr Reel declare no potential conflicts of interest.

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MacDonald, K., Lee, C., Chen, HC. et al. Gender-specific, multi-level determinants of outcomes of antihypertensive treatment: a sub-analysis of the Belgian PREVIEW study. J Hum Hypertens 25, 372–382 (2011). https://doi.org/10.1038/jhh.2010.71

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