113 Hypertension awareness, treatment, and control in hypertensive CHD patients 5 ranging from 12.6% in Ireland to 87.5% in Bulgaria. Use of treatment to lower blood pressure were high across countries, from 66.9% in Ireland to 95.0% in Lithuania, with a mean of 90.9% in HICs and 92.0% in MICs. The proportion of controlled patients was 45.2% in HICs and 50.3% in MICs, ranging from 20.8% in Ireland to 66.1% in Serbia (Supplementary Figures 1-3). Supplementary Tables 2 and 3 present the distribution of demographic, risk factor and medical variables by country. DISCUSSION The prevalence of hypertension among patients following hospitalization for CHD in the EUROASPIRE V study is 79.7%. Among the 6547 patients fulfilling the definition of hypertension, 46.6% had controlled hypertension, 91.1% were on antihypertensive medication, and 59.9% had been told they were hypertensive and were aware of their BP and target and level. Aware patients were more often female, highly educated, they used a higher number of medications, adhered to treatment, were less likely to smoke, and undertook lifestyle changes. Patients with controlled hypertension were younger, aware of hypertension and had a generally healthier risk factor profile. Hypertension awareness The levels of hypertension awareness found in our study (59.95%) are higher than estimates reported in previous studies conducted in the general population, ranging from 47.0% to 53.0% (7,17,18). This analysis focused on hypertensive patients with CHD, and it is expected that they present higher levels of awareness given that they have a higher cardiovascular risk and they are likely to have more contact with healthcare professionals as compared to the general population. In addition, most studies defined hypertension as the prior diagnosis by a health professional, while we assessed awareness of BP target and level as well. Finally, our patient selection might have led to overestimation of the levels of awareness, since one of the criteria to define patients as hypertensive in our study was having been informed by a health professional that they had raised blood pressure. Our results show that there is room for improvement in hypertension awareness in secondary prevention. Despite comparatively high levels, 10.6% of hypertensive patients had not been informed that they had raised blood pressure, 12.6% were not aware of their latest BP measurement results, and almost one third were not aware of their target. Being informed about one’s diagnosis is an important step in risk factor management (19–22), and awareness of hypertension is particularly important in our study population of hypertensive CHD patients given their high cardiovascular risk. Previous research shows that hypertensive patients aware of their condition have a higher risk perception (23), which may increase health-seeking behaviour and motivation to change lifestyles (22,24). In concordance, we observe that aware patients used a higher number of antihypertensive medications, were less likely to smoke, and they more often reported to adhere to treatment and undertake lifestyle changes. However, we also find that awareness levels were lower among patients with primary educational level compared to higher educated patients. Improvements in hypertension awareness, especially among patients with low educational attainment, can therefore be a helpful strategy to promote health behaviors.
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