114 Chapter 5 Treatment Almost all hypertensive participants in the EUROASPIRE V study were on at least one antihypertensive drug prescribed to lower blood pressure. This finding suggests higher treatment levels compared to other studies in secondary prevention (25–27), as well as the previous EUROASPIRE surveys (9). This difference might be induced by exclusion of true normotensive patients from the present analysis. In line with previous literature, we observe that hypertension control remains suboptimal despite high levels of medication use (9,27). In this study, more than 80% of patients reported to take medications all or nearly all the time, and medication adherence was higher among patients with controlled hypertension. More than one medication is usually needed to control hypertension (2), and we observe that the mean number of antihypertensive drugs used was higher among patients with controlled hypertension. The use of multiple drugs and combinations of medication should be studied to further investigate the role of medication in hypertension control in secondary prevention of CHD. Control Hypertension control as defined by ESC guidelines was achieved by 46.4% of the hypertensive CHD patients participating in the study. Other studies in secondary prevention of CHD generally find higher control estimates, from 59.0% in the CLARIFY registry to 77.0% in the REACH registry (26,28). Previous reports of the EUROASPIRE survey show an increase in BP target attainment from 44.7% in EUROASPIRE II to 58.0% in EUROASPIRE V. These estimates refer to all study participants, whereas this analysis focuses on the subgroup of CHD patients with hypertension. Therefore, our results showing lower levels of patients meeting the BP target at interview are expected (7,10). The poor level of control that we observe in this population of hypertensive patients is concerning, as raised blood pressure is a prominent risk factor for cardiovascular morbidity and mortality. Barriers to hypertension control relate to patient, physician, and healthcare system factors (29). At patient level, our results indicate high levels of most patients in this study were using at least one antihypertensive drug, reported to adhere to medication, and that patients’ awareness and health behaviors can be improved. Multivariable analysis showed that controlled patients had a healthier risk factor profile, in line with previous studies (17,30). Many of the patients’ characteristics associated with better hypertension control are modifiable, such as physical activity, BMI or lipid levels, and our results emphasize the role of healthy lifestyles in hypertension control. In this study, 17.7% were current smokers the time of the interview and about two thirds performed less physical activity than recommended. The positive association between current smoking and hypertension control can appear counterintuitive as smoking is an important risk factor for hypertension and cardiovascular disease (2). This positive association has been reported previously (17) and may result of the cross-sectional study design, as less severe patients could be less motivated to change their smoking habits (17). Use of recommended antihypertensive medication has been proven a useful strategy in reducing BP levels (31,32). In our analysis of the EUROASPIRE V survey, the number of antihypertensive medications
RkJQdWJsaXNoZXIy MTk4NDMw