Determinants of Poor Hypertension Management in Patients with Ischaemic Heart Disease

Unlabelled: Not much is known about factors influencing hypertension management in patients with ischaemic heart disease (IHD). Therefore, the aim of the study was to assess factors influencing hypertension management in patients hospitalized due to IHD. We reviewed hospital records of 1051 consecutive patients with a discharge diagnosis of myocardial infarction (MI; n = 290), unstable angina (n = 247), percutaneous coronary intervention (PCI; n = 259) or coronary artery bypass grafting (CABG; n = 255) who were hospitalized at three university (n = 533) or three community (n = 518) cardiac departments. During the follow-up interview (6-18 months after discharge) 70.2% of study participants fulfilled the criteria for a diagnosis of hypertension. Hypertension had not been diagnosed during index hospitalization in 17.5% of hypertensive participants. Overall, 7.1% of hypertensives were not treated with any blood pressure lowering agent. Irregular health checks (odds ratio, OR, 16.3, 95% confidence interval, CI, 4.1-64.0), alcohol drinking (OR 3.3, 95% CI 1.5-7.0), unstable angina (OR 2.7, 95% CI 1.3-5.8), hypertension awareness (OR 0.2, 95% CI 0.1-0.5) and blood pressure lowering drugs prescribed at discharge (OR 0.08, 95% CI 0.03-0.19) were significantly related to the probability of not being on antihypertensive medication. High blood pressure (>or=140/90 mmHg) was found in 68.9% of hypertensives; older age (OR 1.3, 95% CI 1.0-1.6) and hypertension awareness (OR 0.6, 95% 0.3-1.0) were the only significant predictors of uncontrolled hypertension. Among treated participants with uncontrolled hypertension, 33.4% were on monotherapy, 66.6% were on combination therapy, 25.5% were on three or more drugs and 14.7% were on combination of three or more drugs with diuretic.

Conclusions: Hypertension management in the secondary prevention of IHD is not satisfactory. Age and hypertension awareness are the main factors related to the quality of blood pressure control in the post-discharge period.