title: Long term trends in control of hypertension in the Northern Sweden MONICA study 1986-2009.
abstract: BACKGROUND
  A large proportion of treated hypertensive subjects do not achieve target blood pressure (BP) levels. We investigated trends in treatment and BP levels in the population, and among treated hypertensive subjects in northern Sweden.
  
  
  METHODS
  The six Northern Sweden MONICA population surveys 1986 to 2009, included 6342 subjects aged 45 to 74 years of age, participation rate 79.3%. Factors associated with lack of BP control are presented for 1106 participants in 2009. BP control was defined as a systolic BP <140 and a diastolic BP <90 mm Hg among treated hypertensive patients.
  
  
  RESULTS
  Between 1986 and 2009, the proportion of the population that received antihypertensive treatment increased. The proportion of the whole population having BP <140/90 mm Hg increased for all (p < 0.001 for each subgroup), except for men 45-55 years old. In 2009, 62.4% of the population had BP <140/90 mm Hg, 67.2% in women and 58.1% in men (p = 0.002). In the group of treated hypertensive patients, the proportion having BP control increased (p < 0.001) with no difference between sex or age groups. In 2009 52.1% of treated hypertensives had BP control. In 2009, adequate BP control among treated hypertensive patients was 63.9% for those with BMI <25, but only 48.8% for those with BMI > 25 (p = 0.015). Abdominal obesity was associated with less BP control (48.1%) than without abdominal obesity (66.2%, p = 0.007). Women who were physically inactive had better BP control than those who were active (p = 0.03). Men treated with two or more antihypertensive drugs were 50% more likely to reach target BP than men with monotherapy (60.4% vs. 40.0 %, p = 0.035). Rural or urban living, level of education, diabetes mellitus or having a high cardiovascular risk were not associated with better BP control.
  
  
  CONCLUSIONS
  Antihypertensive treatment and BP control have increased in northern Sweden since 1986, although in 2009 still barely half of the treated patients achieved adequate BP levels. Intensified treatment and weight reduction may help to further improve BP control.
authors.affiliation: Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. ellinor.torma@nll.se.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Törmä
authors.affiliation: Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden. bo.carlberg@umu.se.
authors.forename: Bo
authors.initials: B
authors.lastname: Carlberg
authors.affiliation: Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden. Marie.eriksson@umu.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden. janhakan.jansson@vll.se.
authors.forename: Jan-Håkan
authors.initials: JH
authors.lastname: Jansson
authors.affiliation: Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. mats.eliasson@nll.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Eliasson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications; D012307:Risk Factors; D013548:Sweden
chemical_list: D000959:Antihypertensive Agents