title: Multimorbidity and blood pressure control in 37 651 hypertensive patients from Danish general practice.
abstract: BACKGROUND
  Patients with hypertension are primarily treated in general practice. However, major studies of patients with hypertension are rarely based on populations from primary care. Knowledge of blood pressure (BP) control rates in patients with diabetes and/or cardiovascular diseases (CVDs), who have additional comorbidities, is lacking. We aimed to investigate the association of comorbidities with BP control using a large cohort of hypertensive patients from primary care practices.
  
  
  RESULTS
  Using the Danish General Practice Database, we included 37 651 patients with hypertension from 231 general practices in Denmark. Recommended BP control was defined as BP <140/90 mm Hg in general and <130/80 mm Hg in patients with diabetes. The overall control rate was 33.2% (95% CI: 32.7 to 33.7). Only 16.5% (95% CI: 15.8 to 17.3) of patients with diabetes achieved BP control, whereas control rates ranged from 42.9% to 51.4% for patients with ischemic heart diseases or cerebrovascular or peripheral vascular diseases. A diagnosis of cardiac heart failure in addition to diabetes and/or CVD was associated with higher BP control rates, compared with men and women having only diabetes and/or CVD. A diagnosis of asthma in addition to diabetes and CVD was associated with higher BP control rates in men.
  
  
  CONCLUSIONS
  In Danish general practice, only 1 of 3 patients diagnosed with hypertension had a BP below target. BP control rates differ substantially within comorbidities. Other serious comorbidities in addition to diabetes and/or CVD were not associated with lower BP control rates; on the contrary, in some cases the BP control rates were higher when the patient was diagnosed with other serious comorbidities in addition to diabetes and/or CVD.
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark. mspaulsen@health.sdu.dk
authors.forename: Maja S
authors.initials: MS
authors.lastname: Paulsen
authors.forename: Morten
authors.initials: M
authors.lastname: Andersen
authors.forename: Janus L
authors.initials: JL
authors.lastname: Thomsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Schroll
authors.forename: Pia V
authors.initials: PV
authors.lastname: Larsen
authors.forename: Jesper
authors.initials: J
authors.lastname: Lykkegaard
authors.forename: Ib A
authors.initials: IA
authors.lastname: Jacobsen
authors.forename: Mogens L
authors.initials: ML
authors.lastname: Larsen
authors.forename: Bo
authors.initials: B
authors.lastname: Christensen
authors.forename: Jens
authors.initials: J
authors.lastname: Sondergaard
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001249:Asthma / Q000453:epidemiology; D001794:Blood Pressure / Q000187:drug effects*; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011320:Primary Health Care; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents