Association between blood pressure, the treatment of hypertension, and cardiovascular risk factors in women.
OBJECTIVE
To examine relationships of normal blood pressure (BP), hypertension and degree of BP control with cardiovascular disease (CVD) risk factors and predicted 10-year risks for coronary heart disease (CHD) and stroke.


METHODS
Cross-sectional survey.


METHODS
107 Marks and Spencer retail stores in the UK.


METHODS
14,077 women, aged 30-64 years, screened for CVD risk factors between 1988 and 1991.


METHODS
Systolic (SBP) and diastolic (DBP) BP; total, high-(HDL) and low-density lipoprotein (LDL) cholesterol, ratio of total to HDL cholesterol (TC/HDL-C); triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein (a), glucose, body mass index, antihypertensive medication and predicted risks for CHD and stroke. Hypertension was defined as SBP > or = 140 mmHg and/or DBP > or = 90 mmHg and/or taking anti-hypertensive medication. Subjects were divided into normotensives with optimal (n = 6,599), normal (n = 3,170) and high normal (n = 2,184) BP levels, and hypertensives with adequate BP control (n = 228), untreated (n = 1,729) and inadequate BP control (n = 291).


RESULTS
BP level was associated with other CVD risk factors among both normotensives and hypertensives. Women with inadequately controlled BP had the worst risk profile, followed by untreated hypertensives, those with adequately controlled BP and normotensives. Odds ratios for being in the top quintile of predicted 10-year CHD and stroke risks were 1, 2.7, 4.2, 8.5, 13.0, 18.9 for CHD; 1, 1.1, 5.8, 18.7, 20.6, 756 for stroke, for optimal, normal, high normal, adequate BP control, untreated and inadequate BP control groups respectively.


CONCLUSIONS
Untreated hypertensives and women taking anti-hypertensive medication but with BP > or = 140/90 mmHg have the most atherogenic risk factor profiles. Effective management of BP and the associated CVD risk requires a multi-factorial approach, rather than addressing BP control in isolation.
Nanchahal
K
K
Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, UK. kiran.nanchahal@lshtm.ac.uk
Ashton
W D
WD
Wood
D A
DA
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001053:Apolipoproteins / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D014280:Triglycerides / Q000097:blood; D014852:Wales / Q000453:epidemiology
D000959:Antihypertensive Agents; D001053:Apolipoproteins; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides