103 Hypertension awareness, treatment, and control in hypertensive CHD patients 5 INTRODUCTION Hypertension is the most common cardiovascular risk factor for coronary heart disease (CHD) and it is associated with a high risk of cardiovascular mortality and morbidity (1). Patients with established CHD are considered to have a very high cardiovascular risk and need close control of cardiovascular risk factors (1). Clinical guidelines recommend lifestyle changes and use of antihypertensive medications to control hypertension (2). Despite these recommendations, previous research indicates that levels of hypertension control are low, with differences by age, sex, educational level, and country (3,4). More than one third of CHD patients in the EUROASPIRE IV survey (5) conducted in 20122013 had blood pressure levels above the recommended target level. It is suggested that risk factor awareness can influence risk factor levels (5) through better medication adherence and lifestyle changes (10), and research in the general population shows low levels of hypertension awareness (3,6), especially among women and those with a low educational level (6–8). However, awareness and its role on health behaviors among hypertensive patients with CHD has not been studied. Time trends show that the levels of hypertension awareness, treatment, and control are increasing, and that these trends are highly variable per country (1,9). Therefore, it is relevant to update the knowledge we have on blood pressure (BP) awareness, treatment, and control of hypertension, and to investigate factors that may improve them among hypertensive patients with established CHD. In this study, we report the prevalence of hypertension among CHD patients from the EUROASPIRE V survey in 27 countries, and we assess the distribution and determinants of hypertension awareness, treatment and control among CHD patients with hypertension. METHODS Study design and population EUROASPIRE V is a cross-sectional survey conducted in 2016-2017 (10). The survey included 8261 participants aged 18-80 years from 27 high (HICs) and middle-income countries (MICs), as grouped in the World Bank Country classification 2023, within the European Society of Cardiology (ESC): Belgium, Bosnia & Herzegovina, Bulgaria, Croatia, Czech Republic, Egypt, Finland, Germany, Greece, Ireland, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, The Netherlands, Poland, Portugal, Romania, Russia, Serbia, Slovenia, Spain, Sweden, Turkey, Ukraine, and the UK (11). Participants were enrolled consecutively with a previous diagnosis of CHD, consisting of myocardial infarction, myocardial ischemia, or coronary procedures including acute or emergency coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) as previously described in detail (10). For this analysis, we excluded participants without a diagnosis of hypertension, and with missing values in the variables sex, age, and blood pressure measurement during the interview. The study was approved by the research ethics committees in each participating center, and each participant provided informed consent.
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